Podiatrist Dr. Mark Lewis greets his first patient of the morning in his suburban Seattle exam room and points to a small video camera mounted on the right edge of his glasses. “This is my scribe, Jacqueline,” he says. “She can see us and hear us.”
Jacqueline is viewing the appointment on her computer screen after sunset, 13,000 kilometers away in Mysore, a southern Indian city known for its palaces and jasmine flowers. She copiously documents the details of each visit and enters them into the patient’s electronic health record, or EHR.
Jacqueline (her real name, according to her employer), works for San Francisco-based Augmedix, a startup with 1,000 medical scribes in South Asia and the US The company is part of a growing industry that benefits from a confluence of healthcare trends, now including the pandemic, that is dispersing patient care around the world.
Medical scribes first appeared in the 1970s as note-takers for emergency room physicians. But the practice took off after 2009, when federal HITECH law incentivized healthcare providers to adopt EHR. They were supposed to simplify patient record keeping, but instead created the need for scribes. Doctors find entering notes and data into poorly designed EHR software cumbersome and time-consuming. Thus, writing is a rapidly growing field in the US, with a workforce that expanded from 15,000 in 2015 to roughly 100,000 this year.
A 2016 study found that physicians spent 37% of a patient’s visit on a computer and an average of two additional hours after work on EHR tasks. EHR use contributes to physician burnout, increasingly seen as a public health crisis in itself.
Before COVID-19, most scribes, usually young aspiring healthcare professionals, worked in the exam room within steps of the doctor and patient. This year, when the pandemic led patients to avoid clinics and hospitals, many scribes were fired or suspended. Many have returned, but scribes increasingly work online, even from the other side of the world.
Remote scribes connect to the sound in the exam room through a tablet or speaker, or through a video connection. Some create medical notes in real time; others take notes after visits. And some have the help of speech recognition software programs that get more accurate with use.
While many remote scribes are based in the United States, others are abroad, primarily in India. Chanchal Toor graduated from dental school and faced limited job opportunities in India when she was hired by an Augmedix subcontractor in 2015. Some of her fellow scribes also trained or aspired to become dentists or other healthcare professionals, she said . Toor, now a manager at Augmedix in San Francisco, said that writing, even remotely, made her feel like part of a healthcare team.
Augmedix recruits people who have a bachelor’s degree or its equivalent and assess proficiency in English reading, listening and writing, the company said. Once on board, the scribes undergo about three months of training. The curriculum includes medical terminology, anatomy, physiology, and mock visits.
Revenue has increased this year and its sales team has grown from four to 14 members, Augmedix CEO Manny Krakaris said. Sachin Gupta, CEO of IKS Health, which employs Indian doctors as remote scribes for their American counterparts, projects revenue growth of 50% this year for his writing business. He said the company employs 4,000 people, but declined to share how many are scribes.
Remote scribe “Edwin” gives internist Dr. Susan Fesmire more time, freeing her from having to finish 20 charts at the end of each day. “It was like having constant homework you don’t finish,” he said. With the help of “Edwin” —Fesmire said he refuses to use his real name — she had the time and energy to become COO of her small practice in Dallas. Edwin works for Physicians Angels, which employs 500 remote scribes in India. Fesmire pays $ 14 an hour for his services.
Doctors with foreign scribes say that the notes may need some correction for dialect differences and that the scribes may not be familiar with the local vocabulary. “I had a patient from Louisiana,” said Fesmire, “and Edwin later said, ‘What is chicory, doctor?’ But he also praised his notes for being more accurate and complete than his.
Kevin Brady, president of Physicians Angels, said his scribes start at $ 500 to $ 600 per month, plus health care and retirement benefits, while older scribes earn between $ 1,000 and $ 1,500, middle-class family income in India. . . . . Employers must provide employees with health insurance, although many scribes are contractors, and the Indeed.com job site says the average salary for a scribe in India is $ 500 a month. Scribes in the United States earn about $ 2,500.
Remote monitoring is still a small part of the market. Craig Newman, chief strategy officer at HealthChannels, parent of ScribeAmerica, the largest remote writing company in the US, said the company’s remote writing business has tripled since the start of the pandemic, but that “a The vast majority “of the company’s 26,000 American scribes still work in person.
Artificial intelligence and scribes won’t eliminate the physician burnout that stems from the nature of the health care system, said Dr. Rebekah Gardner, an associate professor of medicine at Brown University who researches the topic. Neither can take on arduous HCE tasks like submitting requests for approval of procedures, drugs and tests by the insurance company, he said.
