Our entrepreneurs: Grant Nolan

In our latest #OurEntrepreneurs profile we meet cohort 7 Clinical Entrepreneur Grant Nolan, Plastic Surgery ST4 trainee.

Tell us a bit about yourself 

I am a Plastic Surgery ST4 trainee, based in Manchester and co-founder of MyOpNotes which is a digital operation note platform.

Why did you apply to the programme and what are you looking forward to?

I found out about the CEP through LinkedIn – a number of very inspiring people seemed to have passed through it and their outputs have been impressive. I applied to seek guidance and mentoring through the innovation landscape. I think it can be challenging to address the many different aspects of trying to run a business while being a clinician and having a support structure for this was really appealing.

I am hoping for support through mentoring from other surgeon-entrepreneurs. I also hope that the CEP can support me with deploying MyOpNotes more widely, so it can have a greater effect throughout the NHS.

Tell us about your innovation  

MyOpNotes is a digital operation note platform that streamlines writing high-quality operation notes, captures all data and enables hospitals to be accurately paid.

The idea for MyOpNotes came following a national audit on skin cancer which I led (NMSC: PlastUK). Over 6-months, data on 2,200 patients from 34 hospitals were manually extracted from operation notes into a REDCAP database. This took ~300 clinician hours to achieve (150 surgeons, 20 hours/surgeon). It was a laborious task, with zero educational value and sometimes data was not available as it hadn’t been recorded. This was the first national audit on skin cancer excisions by plastic surgery and all the surgeons were recognised for their work through authorship*.

While the audit was a success, the grossly inefficient data capture sparked an idea. If a tool could be built which automatically captured all data from skin cancer excisions directly from operation notes, then the audit could be completed in minutes. Also, greater numbers of patients could be included more cost-effectively. Finally, if a template was used then data would likely be more complete/accurate.

We discussed this idea with another surgical start-up, and they advised that Trusts are not interested in a single solution for one condition. Consequently, we performed a ‘zoom-out’ pivot, and evolved to cover all surgical procedures using the same approach: procedure specific templates which help surgeons ensure all data is recorded and enables export of data.

I believe the root of issues in operation notes is data completeness, accuracy, and availability. If high-accuracy, structured, standardised data that was assessable could be recorded by the surgeon, this would have widespread applications to multiple stakeholders. The data could be used for:

• Improving patient care through improved communication with other healthcare professionals (e.g. physiotherapists, nurses, other doctors).
• Improving Operating Procedure Codes Supplement (OPCS) accuracy which is the mechanism that NHS hospitals are funded for surgery.
• Undertaking rapid/regular audit and quality improvement projects. This could enable ‘data driven decision making’ with ‘real-time’ data. A ‘rouge’ surgeon could be identified more readily, reducing patient harm.
• Reduced litigation risk due to poor documentation. Lowered costs when things do go wrong, as facts are more easily established, and cases defended or paid-out.
• ‘Big data’ repositories for undertaking ground-breaking surgical research, potentially leveraging AI or machine learning to identify patterns from real world data at a fraction of the cost compared to trials.

The main benefits I hope MyOpNotes will have are:

• Cost savings for NHS Trusts: MyOpNotes should improve the accuracy of OPCS coding and initial feasibility work suggests MyOpNotes could improve this by ~10%. An NHS Trust performing 50K operations/year could save ~£660K/year. Other cost-savings could be generated through improved workflow efficiency (reduced illegibility and improved operation note accuracy).
• Doctors/researchers/QI departments could save time through data exports, freeing up resources. Currently 32% of doctors spend >50 hours/year manually extracting data prior to analysis. Reduced litigation through gold-standard documentation could further enhances savings.
• Improvements in clinical care for patients undergoing 11.5M NHS operations/year. MyOpNotes creates gold-standard documentation using evidence-based peer-reviewed operation note templates. This approach has been shown by three systematic reviews to improve the quality of operation notes. The high-quality data generated by MyOpNotes could enable more quality improvement/audit projects. The use of this data in research will build knowledge and improve long-term patient outcomes.

What motivates you? 

I have been motivated by the current situation within the NHS. I feel like we must improve efficiencies to keep going. I enjoy problem solving which was one of the reasons I went into plastic surgery.

The main drive to build MyOpNotes was that it seems like an obvious idea to me, and something like this should already exist.

What are your ambitions for the next year?

In the next year, I hope to dedicate more time to MyOpNote to maximise the opportunity. I hope to run pilots in 5 hospitals and for those to then go on to use MyOpNotes on a long-term basis. We are also aiming to get grant/external funding to enable us to grow more rapidly.

Why do you think innovation is important in healthcare?

I think innovation in healthcare is really exciting. From working in the NHS, it’s clear that we have to innovate in order to continue to deliver high quality care. I don’t think without innovation the NHS will realistically be able to continue in its current format.

How can we find out more?

Please visit www.myopnotes.co.uk for more information.

*References

• https://doi.org/10.1093/bjs/znac232