Why starting in Sweden forced us to develop superpowers

Sweden has both among the highest quality bar and the highest complexity in the world when it comes to medical notes. This is due to:

1. Patients are able to read their own medical notes in a national platform
2. No standardized templates for medical notes, rather being unique to every clinic
3. Highly structured input formats in medical notes for quality register reporting

The result has been that we’ve been forced to develop an ambient scribe that can satisfy these incredibly high quality requirements of our users here in Sweden.

Patients are able to read their own medical notes
‍Sweden is an outlier in the world in that there is a national platform called 1177, which all EHRs connect to. Directly after a medical note is saved in the EHR, it becomes available to the patient. It is not only common that patients read their medical notes, but also that they complain to the care provider if something is missing or feels incorrect. According to the Swedish National Board of Health and Welfare, a key purpose of the medical note is to be a source of information for the patient. Altogether, this means that the quality bar of medical notes is incredibly high, especially in contrast to other countries where the medical note rather acts as a reminder note for the clinician the next time the patient visits.

No standardized templates for medical notes
‍Just in the Stockholm region in Sweden, there are over 10 000 different medical note templates used. We have yet to come across two different clinics in Sweden that have identical medical note templates. There are also not just a lot of templates (a typical primary clinic often has ~10 different templates for various types of visits), but they are also highly complex (a typical primary care new visit template has ~50 headings in it). This can be compared to many other countries, where the SOAP (Subjective, Objective, Assessment, Plan) note template with four headings is often used as a golden standard across clinics. As a result, we’ve been forced to develop Tandem to be extremely modular and flexible to be able to quickly adapt to new templates. Because if the template doesn’t match exactly 1:1 in Tandem with the EHR, the note cannot be automatically transferred to the EHR.

Highly structured input formats in medical notes
‍In addition to the large volumes of complex templates - they are often also highly structured in terms of the accepted inputs. This is partly due to the many quality registers that we have in Sweden, which metrics are reported to on specific formats. For example, we have the National Diabetes Registry where over 300 different variables are logged related to diabetic patients. This means that the inputs rather than being text fields, instead are multiple choice, dropdown menus, numeric fields, etc. Again, this requires Tandem to be highly flexible to be able to output medical notes that matches these desired formats. Otherwise, the transfer to the EHR and the quality register reporting doesn’t work.

As we are expanding internationally, we are now recognizing how valuable this trial through fire in Sweden has been. It has forced us to develop Tandem to be extremely adaptable and scalable - which is paying dividends also when onboarding entirely new medical specialties, new care settings, and even new countries. We are committed to continue developing solutions that not only saves clinicians time, but also contributes to improving the quality of care provided.

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‍Lukas Saari
‍CEO & Co-Founder, Tandem Health