Electronic Record Keeping With Google Glass and Helpers

Ingrid Hein

January 09, 2017

LAS VEGAS — The combination of Google Glass technology and remote scribe services is helping doctors meet federal requirements to complete electronic health records (EHRs).

"Call me the world's most biased person, but I think Google Glass is the stethoscope of this century," said Ian Shakil, cofounder and chief executive officer of Augmedix, the company that developed the model.

Thousands of doctors will be using this service by the end of the year, he reported here at the Consumer Technology Association 2017 Digital Health Summit.

The medical scribe industry has taken off in the past few years. It is estimated that 100,000 scribes will be employed by doctors in 2020 (JAMA. 2015;313:1315-1316).

Human scribes working remotely with a doctor through Google Glass are more efficient than in-person scribes, Shakil asserted. And there are distinct advantages to the remote-scribe model, which saves doctors time and aggravation. "It's 25% to 50% cheaper than an in-person model," he reported. And on average, an Augmedix scribe saves a doctor from spending up to 3 hours a day on the computer completing EHRs, freeing up time for patients.

In the Augmedix model, a doctor wears Google Glass and a remote scribe can see and hear the doctor and patient. At the end of the day, the doctor goes into the file to verify and approve the notes that the scribe took during the visit; the notes do not become permanent until the doctor gives the okay.

In addition, the scribe can deliver information to the doctor in real-time during the patient visit. For example, information about medications prescribed to the patient in the past, blood test results, and other charted information can be quickly displayed in the Google Glass for the doctor to see. By eliminating the need to focus on a computer screen during the visit, the doctor can remain engaged with the patient.

The human-backed technology is gaining popularity. Among the health-network giants Augmedix has signed with are Dignity Health, Sutter Health, and TriHealth, Shakil reported.

An investment round secured $23 million just last month, with investors such as McKesson Ventures and OrbiMed joining the pack. That brings the company's total funding to more than $60 million.

There is a shortage of human scribes in the United States, Shakil explained. "Doctors can't find scribes who want to work long hours in the city." And in-person scribes are often doing the work for educational purposes, and that can be burdensome to the doctor, he added. "They take up physical space, can call in sick, and there's no way to check quality. Without a centralized software solution, trained people, and quality assurance, you don't get consistency in the service," he said.

Davin Lundquist, MD, chief medical information officer of Dignity Health, has been using the Google Glass scribe technology for about 3 years, since Augmedix launched the service. He said he doesn't even notice the glasses anymore. "I imagine it's like wearing regular glasses; after a while, you don't remember they're there."

It's like having a copilot with you. It's someone you can actually interact with.

The remote scribe has become an integral part of his day, he explained. "The scribe has a perspective of who I am and what I'm doing," Dr Lundquist said. "It's like having a copilot with you. It's someone you can actually interact with. They can grab information the moment you need it," he said.

Dr Lundquist has been working with his current Augmedix scribe for about 6 months. "Vivian's fabulous. We interact. I'll say, hey, it's Friday night, you need to get going, the clinic is running late — obviously you keep it professional," he said.

His previous remote scribes have gone on to management positions with the company.

The strength of the Augmedix model is how much time it saves. It's a perfect marriage between technology and humans, he pointed out. "Our physicians are saving more than 2 hours a day using Glass," he told Medscape Medical News.

One year-long study of physician productivity in a cardiology clinic showed that the 10 physicians with scribes saw 9.6% more patients per hour than the 15 without (Clinicoecon Outcomes Res. 2015;7:489-495). And the clinic saw an additional 84 new patients and 423 follow-up patients, which generated $1,372,694; the cost of the scribes was $98,588.

A systemic review has shown that medical scribes can improve clinician satisfaction, productivity, time-related efficiencies, revenue, and patient–clinician interactions (J Am Board Fam Med. 2015;28:371-381).

Augmedix claims that its model saves doctors 2 to 3 hours per day, but no direct comparison has yet been published.

The Patient Perspective

Although the technology is compliant with the Health Insurance Portability and Accountability Act (HIPAA), encrypting data at both the client end and the scribe end of the operation, it doesn't offer much in terms of technologic innovation for the patient, said Shawn Nason, chief executive officer of the Nason Group and chief transformation officer at Healthways.

If we're going to use technology, can't we do better for the patient?

"Google Glass is a one-way mirror — it might save time for the doctor, but it only reflects back to the doctor," he said. "If we're going to use technology, can't we do better for the patient?"

He suggested that the patient should have access to Google Glass to access health records. "We all know that when you empower the patient with their health information, that's when the quality of care really changes," he explained.

"The consumer really needs to understand and have access to the technology, as well as the provider," he said. It could go a long way in helping patients better understand their condition.

Nason described his brother, who was diagnosed with diabetes a year ago. He never really understood the ramifications and stayed in denial. "If someone had put some glasses on him and shown him he would need surgery a few months later if he didn't take better care of himself, that might have helped," he said.

Mr Shakil is cofounder and chief executive officer of Augmedix. Dr Lundquist is chief medical information officer of Dignity Health, which is an investor in Augmedix. Mr Nason is chief executive officer of the Nason Group and chief transformation officer at Healthways.

Consumer Technology Association (CES) 2017 Digital Health Summit. Presented January 6, 2017.


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