Productivity Tip: How I Use Evernote to Be a Better Physician

Disclosures: I have none. I am not receiving any kind of endorsement from Evernote for this. This is merely a system that works well for me. I decided to share my experiences to potentially help others utilize this tool.

Also, please note that I have pretty much average computer skills. Whenever I have any computer issues I always have to ask my wife to fix it. I was still able to figure out a system that worked for me. If I can do it, so can you.

In this post we will discuss how I have been using Evernote to improve my efficiency and effectiveness as a sports medicine physician. Three months ago I committed to putting in the work necessary to maximize this tool after listening to this  podcast with Phil Libin, the co-founder and executive chairman of Evernote, on the Tim Ferriss Show. Prior to that time, I had been using it on and off for about a year, but I never fully got it off the ground. I have to admit that it requires some work up front, but I believe that the return on investment is well worth the effort.

This is just one example of the many ways that a physician could use Evernote. You can absolutely tweak it and find a way that makes sense to you, your thought process, and your work flow. I believe that all types of clinicians, including nurses, physician assistants, physical therapists, nutritionists, researchers, chiropractors, strength and conditioning coaches, etc. can find this post useful. Other groups that I see HUGE potential for here are medical students and residents, given that they are in the middle of trying to absorb an almost impossible and ever increasing amount of information. Honestly, anyone who endeavors to process and learn a large amount of detailed information could benefit from reading this post.

Trying to cover all of the features and possible applications of Evernote is WAY beyond the goals of this post and discussed all over the place already. I am zeroing in on my use as it relates to musculoskeletal and sports medicine. I must also admit, that I am still learning about ways to best utilize this tool, not just in medicine, but also in my everyday life (journaling, blogging, vacation ideas, etc.)

Evernote:
Evenote is a freemium application used for note taking, information organization and archiving. It basically allows you to store all kinds of information, whether it is from the web, photos from your phone, physical documents that have been scanned, voice memo’s, typed notes, etc. It also syncs up with all of your devices so that you can easily access it on the go. There are multiple layers of organization methods built into the program to make access to your stored info clean and streamlined.

There is a TON of information available on the web about utilizing Evernote. A few good places to start include…

The Evernote website blog can be found here.

A Wikipedia page can be found here.

A blog post on Lifehacker can be found here.

And here is a book,”Evernote Essentials: The Definitive Guide for New Evernote Users” by Brett Kelly.

I will first discuss what kinds of information I store in my Evernote system related to my work. I will then discuss how I am organizing this information.

My Evernote content:

Textbook Notes (handwritten)
Like most physicians I read a lot of textbooks. My reading process typically involves highlighting text that I want to review, followed by going back and reviewing my highlights. These are further distilled into analog, handwritten notes. I prefer hand written notes because I can reproduce the information in more of a diagrammatic or illustrative way that makes the most sense to me. I write all of these notes in a Moleskin Evernote notebook . Once I have completed a chapter’s worth of notes, I scan each page into a note in Evernote using the app’s Page Camera. I also scan related images that are present in the chapter (radiology pics, anatomy illustrations, etc), crop them, and send to Evernote to be incorporated into my handwritten notes.

book notes 2

Once it is scanned in, all of the handwritten text is actually searchable in Evernote. And yes, it is pretty accurate, despite the fact that as you can see I certainly do not have perfect penmanship. You can also annotate everything that is scanned in, including images and your handwritten text. You certainly do NOT need to use a Moleskin notebook, however. Any writing on any piece of paper can be scanned and searched on Evernote. I use this notebook because Evernote says that the pages are specially ruled and squared for optimum scannability. And because I just like the look and feel of the notebooks.

Electronic Textbooks
When using a electronic textbook, you can use CTRL + PRTSC keys to obtain a screenshot of the image that you want to save. You can then paste the image into an Evernote note. The image can then be cropped and annotated however you would like.

kindle copy paste

Conferences
I attend a lot of PM&R and sports medicine conferences which typically involves attending a large volume of lectures. I often experience information overload, especially after sitting through hours of Powerpoint presentations. I now bring my Moleskin notebook with me and take notes at each lecture. Taking notes helps to keep me engaged in the lecture, and using a notebook instead of my computer helps prevent me from getting distracted by email or sports scores. These notes are immediately scanned with my phone into Evernote to be easily and quickly accessed later. If notes are provided at the conference, you can scan those in too. One of the other benefits of immediate scanning is that the note will automatically be tagged with its date and location. That way it is much easier to look up “that conference I went to in San Diego” or “the annual meeting last February.”

Business Meetings
Most medical practices involve a lot of meetings. I again take handwritten notes and immediately scan them in so that I can access them later. You can also tag the notes with the names of meeting attendees or other relevant information that will help you organize this information.

Staying Up to Date on the Literature
Staying on top of the most recent scientific research papers is challenging, but critically important to being a good clinician. When I come across an abstract of a research article that I would like to read, I use the Evernote Webclipper to store it so that I can easily access it when I plan to do some more in depth reading.

Image Bank
In sports medicine, I see a lot of X-Rays, CT scans, MRI’s, and ultrasounds. I have generated a radiology image-bank of compiled images from my textbooks and from the web. I can use these images as instantaneous references if something comes up that I want to quickly review. This image bank also provides you with quick access to radiology images for preparing lectures, teaching medical students/residents, and even patient education. Remember that you can crop, add text, use arrows, circles, etc. through the annotation feature. The possibilities are endless here, as anything that requires visual interpretation could be stored for a quick reference (histology, gross pathology, anatomy illustrations, dermatology, all forms of radiology, so on and so forth).

 

image bank

 

Templates
One of the keys to efficiency in a clinical setting is the utilization of templates through your Electronic Medical Record system. Templates can include different types of progress notes, physical exams, procedure notes, radiology interpretation, therapy protocols, letters, emails etc. They maintain the redundant text allowing you to add in just the specifics for each individual patient, keeping you from typing everything from scratch every time you see a new patient. I have many templates that can be quickly filled out and stored in Evernote where they are accessible within a couple of clicks.  I can use the copy / paste function to incorporate the text into the EMR as well. I DO save the templates (i.e. smart texts or dot-phrases) in the EMR system itself as well, but if the EMR system ever changes for your practice, or you are a resident who has to work in a multitude of settings involving several different EMR systems, it is nice to have all of your templates saved and available at a single accessible location (in Evernote), regardless of where you are physically or which EMR system is being used.

templates

Procedure references
In sports medicine we often perform ultrasound guided procedures. From my residency and fellowship training, textbooks, videos, conferences, and clinical experience, I have picked up on a lot of tips and pearls for each procedure. It is nice to have instant access to a repository of my own customized protocols to review prior to each procedure. It provides you with the opportunity for a quick review, and you can quickly provide this info to medical students, residents, and colleagues.

Home therapy protocols or educational information for patients
I keep home therapy protocols (i.e. anterior knee pain, or grade 1-2 ankle sprain) that I can give to people in clinic. You can also keep documents that are intended to educate patients on things like weight loss, exercise, sleep, concussions, etc. These instructions can be quickly printed up and handed to the patient. You should also cut and paste the information from Evernote and into your EMR progress note (or after visit summary) so that there is a better record of the information that you provided the patient during the encounter.

Other work related documents
You can keep copies of diplomas, your Curriculum vitae, immunization records, ACLS certifications, CME courses, etc. If your employer requests any of this information, you’ve got it ready to go lickety-split.

Organization (separating the signal from the noise):

One of the main reasons that I find Evernote so useful is the multiple layers of organization that are used.  Maximizing all organization tactics including notebooks, tags, and links, allows you to optimize your overall organizational strategy to improve efficiency, searchability and overall functionality of your Evernote system.

Notebooks

notebooks
My first layer of organization involves the use of Notebooks. I use a rather minimalist approach.  It is important to remember, that you can only stack a single level of notebooks. This makes them more useful as broad categories, as opposed to having high specificity.

To start, I have a notebook titled “.inbox” which is where everything that I scan with my phone, or clip from the web is initially sent. Notes stay in this notebook only temporarily (usually just a few days) because I organize these notes into more specific categories (other notebooks) at a later time.

Second, I have a notebook titled “.jamescrownover” which is my main repository for information that isn’t directly work related. There are a lot of notes in this notebook by design. To further organize these notes so that they are quickly accessible, I use ‘tags’ (discussed below).

I also have a notebook titled “.ToRead” which is where I will send journal articles or blog posts that I look interesting and that I plan to read in the near future. Once I have read the article, I generally send it to the “.jamescrownover” notebook with the appropriate tags.

I have a notebook-stack titled “Work”.  Within the “Work” notebook there are other notebooks containing my image bank, templates, textbook notes, home therapy protocols, and a management notebook (containing a quick reference to management protocols for various sports injuries).

Given the limited stacking capacity of notebooks, their organization needs to remain fairly broad. If you rely solely on notebooks to organize your notes, you would end up with way too many notebooks to maintain functionality and efficiency. For example, my notebook titled ‘image bank’ contains nearly 300 notes/images. If I want to quickly view elbow Xrays, I would have to click on the ‘image bank’ notebook and scroll all the way down to the elbow images. More layers of organization are necessary streamline this process…

Links
Another layer of organization applied to your note books is through creating a note titled ‘.table-of-contents’ consisting of links. The title of your note should start with some kind of punctuation (like ‘.’) so that it shows up as the first note in your notebook. In your table-of-contents note, you can create links to every other note in that note book. You do this by right-clicking on the note that you want to create a link for, and clicking ‘copy note link’. Then go into your .table-of-contents note, hit right-click, and then paste. You can organize the table of contents however you like. For my example, if I want to pull up my elbow images, I just open the table of contents note and click on the desired links (as opposed to scrolling through a hundred or so notes).

table of contents

You can use links in many other ways to improve how all of your notes are networked together. For example, at the bottom of my textbook notes, I put links to all of the relevant images stored in my Evernote. So for a book chapter on elbow injuries, I have links to all of the elbow images, elbow templates, elbow management protocols, etc. at the bottom of that note. Basically you can link all notes that are somehow related to improve click- efficiency.

You can also create links to outside websites with related information. If you find a nice blog post or video on shoulder mobility, for example, you can place a link to it in your ‘shoulder textbook’ note. This can be done by copy-and-pasting the URL, or you can create a hyperlink.

Tags
Not only can you organize notes into a system of notebooks, you can also create ‘tags’. Using tags is where you can really boost the efficiency, searchability and overall functionality of your Evernote system. First, you can create as many tags as you want, which allows you to add a lot of specificity. Second, you can stack your tags into multiple layers, allowing you categorize notes much more specifically. For example, in my ‘concussion template’ note, I have a tag named ‘.template’ to place it in my stack of templates. I also have a tag called ‘.concussion template’ to be more specific.

Tags 2

To create your stacks of tags you just need to go to ‘view’ on the upper tool bar and click on ‘tags’ in the drop-down menu. You can use a drag-and-drop method to create your stacks of tags. It is pretty intuitive. My set-up has a ‘.work’ tag as the first layer. The next layer of the stack has the tags ‘.templates’, ‘.booknotes’, ‘.images’, etc. The third layer of the stack has more specific tags to the note, such as ‘.concussion template’, or ‘.tibia fracture image’, or ‘.anterior knee pain home therapy protocol’. Using a lot of tags for your notes allows you to easily search through all of the info you have stored, and allows you to keep your number of notebooks down to a reasonable level.

Tags

As mentioned earlier, I have a notebook titled .jamescrownover, that contains most of the notes that are not directly related to my work. Many of these are journal articles, or blog posts that I found interesting and wanted to save. As of now I have 168 notes in this notebook. The only practical way to quickly access notes in this notebook is via a thorough tagging system and using the search function.

I hope that some of you found reading this helpful. I am sure that there are many ways to set-up Evernote to get it working for you, and I am certain that my own system will continue to evolve and change over time. If anyone has additional thoughts or ideas on better utilizing Evernote, I’d love to hear from you.

Thanks for reading!

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