Today we’ve got one of my favourite types of startups - a niche product that could have a wide impact.

MyOpNotes is well worth a look, and you can read about them below (premium subscribers get the full story, as ever). But first….

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MyOpNotes could get hospitals paid fairly, faster… which is better for everyone

It’s no secret that the UK healthcare system is struggling. People living longer, combined with years of funding cuts, have left the NHS with an uncertain future.

But part of the problem for individual healthcare trusts, as Grant Nolan, co-founder and CEO of MyOpNotes sees it, is that they’re not being paid properly for the work they do.

When a surgeon does some work for a patient, they write up notes about what they’ve done. These are then read by specialists whose job it is to ‘code’ the work, to make sure the trust is paid the right amount. 

Each part of a procedure will have a different code, which has a different tariff assigned to it. Submitting the right codes is essential for getting paid the right amount.

And this isn’t just a process unique to the NHS. It happens around the world. In countries such as the US, for example, the codes will be sent to a patient’s health insurance provider instead.

But backlogs of the admin to collect codes from medical notes are common.

“It's just like a pile of invoices which you haven't sent. One hospital we spoke to had a backlog of 40,000 cases,” says Nolan.

And because the system relies on humans doing boring, repetitive work, errors are common… and can be costly. 

Back in 2010, the British Medical Journal published research that found primary care trusts had made about £1 billion worth of mistaken payments over the previous three years. This included overpayments and well as underpayments, but there’s no doubt that an NHS built on inaccurate payments to hospitals is a problem for everyone.

Although it’s difficult to get a handle on the true cost of the problem, Nolan says one hospital he spoke to estimated the problem as being worth between £2 million and £4 million per year, just for that hospital.

Nolan explains that the core of the problem is that surgeons write notes that are useful to themselves, which then have to be parsed by medical billers, and the two parties are looking for completely different things from the notes.

“No-one's really looking at how we can match up and marry up that gap and align the two, build a bridge. And really that's where MyOpNotes comes in.”

How it works

MyOpNotes is a web-based application that surgeons use after completing a procedure. The interface takes them through a flow that allows them to select the work they’ve done and add all the details, down to things like the type of anaesthetic used.

As they do this, the relevant billing codes pop up on screen, ready to be submitted so the trust can get paid. And the trust doesn’t have to pay someone else to code it up because it all happens instantly.  

Nolan says that in the future, the software will even handle submitting the right codes for payment, as soon as the surgeon has filled in the details.

The software is designed specifically for surgery use cases right now, but could be expanded to other forms of healthcare in the future.

The story so far

Before he became a tech entrepreneur, Nolan was a doctor working in plastic surgery for the NHS, so he has seen the problems with clinical coding up close.

He started on the path to MyOpNotes when he was doing some research that involved reading text-based notes and manually extracting the data to put into a spreadsheet.

“It was madness. If we just recorded the data in the right way, I could press a button and get all the data I want,” Nolan explains.

So, as a side gig to his dayjob, he started working on a startup idea with a focus on the research use case. 

Then he realised the far more potent commercial case for software like this was clinical coding.

A Topol Digital Fellowship allowed him to transition to become a full-time startup founder, which is what he’s been doing for the past two months.

Nolan has co-founded MyOpNotes with Martin Woolley, Kieran Lee, and Rajen Nagar. Another key member of the team is, he says, is a medical coder with 30 years’ experience, who deeply understands the problem the startup is solving from the other side of the workflow to surgeons.

The startup was recently announced as a participant in the second run of the Baltic Ventures accelerator in Liverpool.

Next steps

Nolan says the first stage of bringing MyOpNotes to market is to hone the offering through proof-of-concept work with between five and seven hospitals. The first NHS trust to work with them has recently begun using the software in a live test.

One reason for these tests is to get quantifiable data to prove the software makes financial sense for healthcare providers. 

From there, they’re looking into channel partnerships that would allow them to sell the tech alongside other software that hospitals need to buy anyway. This, Nolan says, will be far more efficient than going through the long sales cycles of selling into individual trusts themselves.

Beyond that, the startup plans to expand beyond surgery into other medical procedures, and to serve markets beyond the UK.

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