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Service DesignMar 5, 2024

Niku Sondagar, Note Dr's founder and chief executive, explains how the AI tool can help busy physios

In an exclusive Q&A with PhysioUpdate editor Ian A McMillan, Niku Sondagar explains how Note Dr can help to alleviate some of the admin pressures facing physiotherapists, freeing them to focus on the parts of their work that provide the most fulfilment – improving patients' lives

Tell us about your professional background and do you still practise clinically?

I started studying dentistry in university in Hungary, however I couldn't get tuition fee support, had bills of tens of thousands of pounds to pay, and to stay in school. I was petrified over whether I would be able to make enough to pay these bills and also stay on top of my university work. At the time, I didn’t have many friends or family and felt I couldn't ask for their help.

I saw a clinic that had a bad website, and asked if they wanted me to re-make it for them, for a fee. They kindly trusted me and I went on to build a website for them. They were so happy with my work, they gave me more work and recommended me to their friends.

At that time, I had a student mentor who just had a new-born baby, while also, like me, studying as an international student. She inspired me to think that if she can do it while raising her new-born child, I should be able to also achieve my goals of running a business while in university. I went on to build a technology agency, working for some of the world's biggest companies developing apps and websites, leading a team of more than 40 people in three cities.

I’ve used the resources from my business to invest into my own healthcare projects, which included starting my own luxury private clinic, selling medical supplies and building my own health-tech start-up, which was acquired by a US firm.

Currently, my full-time job is dedicated to working on Note Dr, an AI tool, which automatically generates clinical notes and letters by securely listening and understanding the conversation between patients and physiotherapists. 

Niku enjoys getting to know Note Dr customers and hearing their heart-warming stories

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How did you get into AI and are people right to be suspicious of its potential?

Before I went to university, I wanted to read research papers but found them difficult to follow. As a result, I built an app, which collated journal articles and used AI to summarise them into short, easy-to-read pieces. The app went on to win an App of the Year award at a prestigious healthcare awards show.

Since that time, AI has skyrocketed to being much more powerful and accessible. However, I feel it's entirely reasonable for people to be cautious about its potential.

Within physiotherapy, I empathise with concerns such as whether AI will understand the nuances of patients' feelings, or will it always make the right clinical choices. I also understand the worries over whether AI will be able to maintain that personal touch and trust that are so crucial in physiotherapy.

However, this cautious mindset also encourages awareness, education and policy to mitigate risk. Through this, it can create a culture allowing physiotherapists and AI partners to implement responsible AI into practice, with the utmost safety. 

I believe that by taking such an approach, physiotherapists can ensure that AI tools are used in ways that truly benefit patients and themselves, complementing the therapist's expertise, rather than attempting to replace it.

What inspired you to set up Note Dr?

I have seen many people suffer challenges with their mental health. This led me taking a sabbatical to take time for myself away from my work to focus on my own recovery. Around this time, I lost a friend, to suicide, who worked in healthcare and would often complain about the burden of their job. This deeply hurt me.

I feel this provided a strong impetus to using my skills in technology and healthcare to build something that could improve the wellness of clinicians by reducing the pressures they face in their roles. I researched this issue in-depth, reviewing the literature, getting feedback through surveys and interviewing clinicians. Here, I discovered that the time spent on admin was a significant contributing factor to the burdens experienced by many clinicians, especially physiotherapists.

Having gained data to prove there was a desperate need for an appropriate solution, I quickly started developing the AI that powers Note Dr today. I hoped to build a service that relieves admin pressures and enables clinicians to focus on the parts of their work that provide the most fulfilment – improving the lives of patients.

What reception have you had so far? Any awards?

It’s been very positive and I feel there’s a fundamental need, especially with those who aspire to provide the best level of care and communication for their patients. I like to speak with all our customers and get to know them well. It's great to hear their heart-warming stories.

One person using Note Dr explained to me that she used to stay-up until 10 pm after their kids went to bed writing up notes and letters. She explained that she found it difficult to switch-off after work, and even when she would spend time with their kids, she was thinking about her patients and what had to be done.

Since starting to use Note Dr, she is able to leave the clinic, with all the clinical admin done not worrying it needs to be done later and able to spend her evenings dedicated to her family.

We've been focusing most of our time on ensuring our time is spent with customers and providing the best service possible. Consequently, applying for awards hasn’t been on our radar. Positive impacts like this one I shared are the awards I strive for.

A friend's suicide ... deeply hurt me. I feel this provided a strong impetus to using my skills in technology and healthcare to build something that could improve the wellness of clinicians by reducing the pressures they face in their roles

How does it help busy physiotherapists?

Note Dr generates the clinical notes, letters and reports for an appointment, so physiotherapists do not need to write them from scratch.

This enables physiotherapists to focus their time better with patients. Once the appointment is completed, physiotherapists hit finish and within a few seconds the sessions' clinical notes will be produced, summarising all the key clinical details following a template of their choosing such as SOAP, SOTAP or a custom one provided by the clinician.

A 2023 study found that 13 per cent of physiotherapists are suffering from burnout with a further 16 per cent at risk. Worryingly, 78 per cent of physiotherapists are either exhausted or at risk of exhaustion.  

Burnout can be shown in many ways. The Maslach Burnout Inventory – which is used by the World Health Organization – explains that physiotherapists experiencing burnout may feel the following 

  • emotionally overextended and exhausted by one's work
  • depersonalisation, giving unfeeling and impersonal responses toward recipients of care
  • lacking feeling of personal accomplishment
  • cynicism
  • feelings of lack of competence

Further linkage between clinician burnout being associated with poor patient satisfaction and longer recoveries have been proven. Note Dr helps combat this, by significantly reducing the time spent on clinical admin.

In addition, by being able to automatically write summary letters, messages and reports to patients and other involved professionals, we’re finding physiotherapists are achieving greater adherence with rehabilitation guidance and motivation between patients. It’s fantastic to see how powerful this technology is. 

How can people find out more?

To learn more about Note Dr, click  

How do you relax away from work?

Relaxation is super important to me. Outside of work I love to stay active, so you can find me at the gym, swimming or kayaking. Alongside this, I enjoy making art, much of my muse being human emotions. Most importantly, the best way to relax is to spend time with my loved ones, my family.

Author: Niku Sondagar
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