Trading Epistaxis and Airway Obstruction for Treating Syntax Errors and Procedure Notes Culminates in an EMR System Built for Otolaryngologists

“Cut! Too short! Too long!” Those words still elicit some anxiety, reminding me of my days as a medical student and a surgical intern. Nonetheless, after residency and a career performing major head and neck and endoscopic operations, I never would have guessed that “cut,” “too short” and “too long” would apply to sitting at a desk writing and editing computer code. More than one million lines of it. When I first started at Modernizing Medicine as Medical Director of EMA Otolaryngology, I didn’t know how to write code, but I quickly came to realize that my training as a surgeon – find a problem, diagnose it and fix it, safely and efficiently – would serve me as well in an office as it did in the OR.

I started working at Modernizing Medicine because I was disappointed with my prior two electronic medical record (EMR) systems. I could think and practice with a surgical mindset in the OR, but was flummoxed in the office. My prior systems slowed me down, didn’t follow a logical flow and didn’t document in a detailed and accurate way. In other words, the antithesis of surgical style.

While sitting down in front of a blank computer screen and tasked with coding the software for the ENT EMR system that I had envisioned, my surgical mindset turned on. I saw a problem and wanted to fix it – cut, cure and reconstruct. Learning to code initially harkened back to my first days in the OR. “There’s a plane when doing a tonsillectomy?” “I know the jugular is somewhere around here…” “The eye and brain are how close to the ethmoids?” Feeling once again like a new resident full of anticipation (although better rested and groomed), I used that all too familiar feeling to learn software coding to build a system designed specifically for otolaryngologists.

Early in residency, for better or worse, I earned the epithet of “the Ant.” Initially, the term came from a joke that despite my slight frame, I am a competitive athlete (an ant can lift several times its weight…). Soon the nickname was applied to my work ethic. By taking the clinical workload on my back, I do whatever it takes – no matter how difficult or tedious – to take care of patients and be the best surgeon I can. As my excitement grew for creating EMA, the “Ant” mentality was resurrected. Several months of coding resulted in an evolution of programming complexity: tubes to tympanoplasties, maxillaries to frontals, lymph node biopsies to neck dissections. The result is an elegant ENT-specific workflow that defines the system. As I started to use EMA in my busy surgical practice, I devised ways to make this specialty-specific EMR system more intuitive, faster and more detailed.

EMA Otolaryngology was successfully unveiled to fellow surgeons at the Vancouver AAO-HNS Annual Meeting in 2013, where we signed our first beta users. The beta process involved working with other ENTs who had various practice patterns and styles, and EMA now addresses and automatically adapts to these unique practice characteristics. As a software developer, “cut,” “too short,” and “too long” crept back into my daily lexicon, and I traded epistaxis and airway obstruction for treating syntax errors, procedure notes, exam descriptors and CPT coding. Tenets of a good surgical practice have been applied to software development: timely response, thoughtful analysis to diagnose problems or consider requests for changes and additions, plus implementation of rapid, detailed and accurate fixes.

I feel as if the health IT needs of ENTs have previously been neglected while health tech in general has advanced, but Modernizing Medicine’s radical model of the “physician-coder” working side-by-side with a team of seasoned software developers is a unique differentiator from all other EMR systems. The result is specialty-specific software that helps make workdays easier for practicing otolaryngologists.

If I “cut” time from the bureaucratic side of medicine and reduce the frustration of it taking “too long” to complete notes at the end of the day, I will no longer jump when hearing those words, and I’ll appreciate making days “too short” for fellow surgeons.

David Lehman, MD
David Lehman, MD

Pin It on Pinterest