As doctors at Boston-based Massachusetts General Hospital meet with patients during their rounds, a physician listens in real-time from Mumbai or Hyderabad and transcribes relevant details directly into the patient’s electronic medical record (EMR).
The India-based ‘virtual scribe’, typically a doctor who is either fresh out of medical college or has a few years of work experience, is taking over from assistants who used to accompany the doctor physically on rounds in the what is broadly defined as the medical-scribe business — one of the fastest-growing occupations in the US healthcare sector.
IKS Health, a $6 billion US-based company that provides the documentation service based on digitally-recorded patient visits, has about 450 doctors on staff across Mumbai and Hyderabad extending support to patient visits in hospitals such as Massachusetts General — the largest teaching and research hospital of Harvard Medical School — and other clinics and hospitals across the US. The number of doctors is slated to go up to over a 1,000 this year, according to IKS, which counts Mumbai-based Rakesh Jhunjhunwala among its investors.
The number of medical scribes in the US has grown from about 7,000 in 2014, according to the American College of Medical Scribe Specialists, to nearly 25,000 currently. Apart from IKS, other scribe technology vendors in the US market such as iScribeMD, Physicians Angels, Scribe Technology Solutions and Skywriter MD are also betting on the virtual scribe business, with Indian doctors on the radar. Paresh K. Shah, president of MindLeaf Technologies based in Bedford, Massachusetts, which started out by handling outsourced functions including payroll and IT, is now working on “virtual scribe solutions that integrate seamlessly into their workflow and that reduce documentation time”, thereby reduce physician burnout. Shah, in response to specific queries on its outsourcing mandate to India and how it deals with the patient privacy concerns, said the company would not comment “due to other commitments”. Augmedix, a San Francisco startup has partnered with search-engine major Google to use the Google Glass technology for scribing, with back-end support from Indian physicans. Doctors wear these devices through the day, live-streaming their office visits to the virtual scribes in Bangalore, who look on and take detailed notes. Augmedix has raised over $35 million from venture capitalists and health systems.
Ventures such as Augmedix charge US-based doctors between $1,500 and $4,000 per month. Payouts to the Indian doctors is either in the form of a contracted salary amount or monthly retainership, alongside payments based on actual billing hours. Founded in 2007, the 4,500-member strong workforce at IKS manages more than $6 billion in revenue for more than 14,000 physicians throughout the US and has offices in Los Angeles, Chicago, Denver, Montgomery, apart from Mumbai and Hyderabad.
A doctor in India who is involved in the process, but did not wish to be identified, said junior doctors who sign up for this get to interact closely with physicians in the US, get acquainted with the best patient management practices, and learn how to create an accurate and complete electronic health record of a patient while getting to use sophisticated electronic health record systems.
The use of virtual scribes is being seen as a significant upgrade over live scribes, and therefore the growing demand for the service. While medical scribes are trained assistants who work alongside physicians to handle computer-related tasks, virtual scribes are qualified medical doctors who are better qualified to handle the task as compared to interns or temp staff who generally double up as medical scribes.
Generally, the patient is aware of the scribe, but virtual scribing ensures that there isn’t another person physically in the room, thereby turning the interaction more “non-intrusive”, unlike in case of live scribing. A live scribe can also impact the relationship and conversation captured between a patient and a physician because the patient is conscious about a third party in the room that they do not know.
In case of virtual scribing, the privacy aspect can be addressed as the microphone can be muted, as and when the physician in the US chooses to. Also, the scribes can ping the doctors to ask questions or seek further clarification, while the doctors can request that the scribes look things up, or set up prescription orders.
An IKS spokesperson said the doctors working for it from India are selected based on a series of tests, evaluations and interviews to assess their aptitude. “We typically hire younger doctors who are either fresh out of Medical College or have a few years of work experience.
On the incentive for them, the spokesperson said: “They join us for an opportunity to interact closely with senior physicians, learn their best practices in managing patients, learn how to create accurate, complete and compliant electronic health records while getting hands-on experience of using sophisticated electronic health record systems. They see this as an excellent opportunity to continue to learn, enhance their clinical skills while getting insights for managing an efficient practice. Some opt to use this experience to set up their individual practices while others use it as an opportunity to keep themselves clinically engaged as they prepare for their next level courses”.