Podiatrist Dr. Mark Lewis greets his first patient of the morning in his suburban Seattle exam room and points to a tiny video camera mounted on the right rim of his glasses. “This is my scribe, Jacqueline,” he says. “She can see us and hear us.”
Jacqueline is watching the appointment on her computer screen after the sun has set, 8,000 miles away in Mysore, India. She copiously documents the details of each visit and enters them into the patient’s electronic health record.
Jacqueline (her real first name, according to her employer), works for San Francisco-based Augmedix, a startup with 1,000 medical scribes in South Asia and the U.S. The company is part of a growing industry that profits from a confluence of healthcare trends—including, now, the pandemic—that are dispersing patient care around the globe.
The scribe workforce is expected to reach 100,000 this year, up from 15,000 in 2015, according to the American College of Medical Scribe Specialists.
Before COVID-19, most scribes—typically young, aspiring health professionals—worked in the exam room a few paces away from the doctor and patient. This year, as the pandemic led patients to shun clinics and hospitals, many scribes were laid off or furloughed. Many have returned, but scribes are increasingly working online—even from the other side of the world.
Remote scribes are patched into an exam room’s sound via a tablet or speaker, or through a video connection. Some create doctors’ notes in real time; others annotate after visits. And some have help from speech-recognition software programs that grow more accurate with use.
While many remote scribes are based in the U.S., others are abroad, primarily in India. Augmedix in San Francisco recruits people who have a bachelor’s degree or the equivalent, and screens for proficiency in reading, listening comprehension and writing in English, the company said. Once on board, scribes are trained for about three months. The curriculum includes medical terminology, anatomy, physiology and mock visits.
Revenue has grown this year, and the sales team went 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 U.S. counterparts, projects 50% revenue growth this year for its scribing business. He said the company employs 4,000 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 every day. “It was like constantly having homework that you don’t finish,” she said. With the help of “Edwin”—Fesmire said he declines to use his real name—she had the time and energy to become chief operating officer of her small Dallas practice. 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 notes may need minor editing for dialectal differences, and scribes may be unfamiliar with local vocabulary.
Remote scribing is still a small part of the market. ScribeAmerica’s remote business has increased threefold since the pandemic’s outset, said Craig Newman, chief strategy officer of parent company HealthChannels, but “a large majority” of the company’s 26,000 U.S. scribes still work in person.
It’s a highly unregulated industry for which training and certification aren’t required. The service typically costs physicians $12 to $25 an hour, and studies show scribe use is linked to less time spent on patient documentation, higher job satisfaction and more time to see patients—which can mean more revenue.
Remote scribing also raises cybersecurity concerns. Reported data breaches are rare, but some scribe companies have lax security, said Cliff Baker, CEO of the healthcare cybersecurity firm Corl Technologies.
The next step in the trend could be no human scribes at all. Tech giants like Google, EHR companies and venture-backed startups are developing or already marketing artificial intelligence tools aimed at reducing or eliminating the need for humans to document visits.
AI and scribes won’t eliminate physician burnout that stems from the nature of the healthcare system, said Dr. Rebekah Gardner, an associate professor of medicine at Brown University who researches the issue. Neither can take on burnout-driving EHR tasks like submitting requests for insurance approval of procedures, drugs and tests, she said.
Kaiser Health News is a not-for-profit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.