Telecharting, the New Telemedicine Frontier

Most people tend to think of telemedicine as remote or virtual care for patients, such as:

  • One-on-one video services and consultations by AmericanWell and Teledoc between doctor and patient
  • Video services where remote specialists consult, including teleICU
  • Telephone-based consultation for follow-up between providers and patients.

Some people lump in virtual medical education as well, with examples like Project ECHO. I also think of services like Zipnosis and GoDerma, which offer virtual care asynchronously.

According to the American Telemedicine Association, "Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status." That broadens what is considered telemedicine to almost any service that collects patient -eported data, including apps and the growing number of follow-up and two-way messaging services. Almost anything that we write about on HIStalk Connect would fall into this bucket.

A new area of telemedicine that is showing positive results, at least in small pilots and in funding news, is telecharting. Telecharting is using technology to remotely enter information into an EHR. You could call it “teledocumenting,” but I prefer “telecharting.”

Stepping back for a second, why would a clinician or a health system need a service to enter information into a software tool that costs tens of millions of dollars? The generally accepted answer is that EHRs are clunky and hard to use, especially given the time constraints of physicians and the shrinking amount of time for each patient encounter.

Providers are forced to chart in EHRs while they are with patients, which detracts from the encounter and makes physicians less efficient. Physicians are highly trained and expensive, so documenting encounters into an EHR is not the best use of their time. It’s also not a good path to win their hearts and minds because charting, at least for every doctor I know, frustrates them to no end.

The other reason telecharting is needed is that we’re implementing software that doesn’t fit the way medicine is practiced. We’re modifying the practice of medicine to meet software and charting needs. I would be curious to see the total cost of an EHR once you add in the cost of a scribe or telecharting service. Paying to chart may be a rounding error given how much EHRs cost, but it is another ongoing expense.

Regardless, hospitals are trying to find ways to optimize physician time while using EHRs. I know physicians who use scribes who follow them around and enter information into EHRs. The scribe usually seems to be a tech or MA who the physician has trained. Some doctors  double dip and use a scribe who also functions as a translator.

Most of the docs I know who use scribes are specialty physicians with high patient volumes and short visit times. We did research on this for my wife as she was setting up her derm practice.

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Hiring and training a scribe is expensive. It’s also strange to have a scribe tagging along to appointments. 

Now there is a remote or tele option for charting and scribing that uses Google Glass, no less. Augmedix, a Rock Health company, made a couple of big announcements this week. The first is that the company has now raised $7.3 million from a solid list of investors. The second is that the pilot results at Dignity were overwhelmingly positive.

I’ve familiar with Augmedix, having met its founder Ian a year and a half ago at HIMSS is New Orleans. Until this week, I wasn’t sure what Augmedix was doing. They’ve been intentionally vague in describing the service. But, if you read the Dignity story and pay attention to the video, you can clearly tell that Google Glass is capturing video and dialogue from patient encounters and that information is then being remotely entered into the EHR by Augmedix. Lt. Dan describes it that way as well in his post.

Once in the info is in the EHR, the physician can check it and accept it. Augmedix also enables querying of data in the EHR to Glass, and I assume it’s a subset of data with specific commands.

My main questions about telecharting is how it scales. In researching the use of scribes for my wife, the consensus was that scribes need to be specifically trained for a particular physician. Physicians explain the encounter in a certain way and scribes train themselves on how the physician works and how that fits into the specific EHR.

This may not be as much of a challenge with telecharting if it is not done in real time. Scribes entering the data would have additional time to chop up and/or format the data to fit into the EHR. But I’m curious how long it takes physicians to get used to verbally talking through their thought process so that information can be entered into an EHR.

Calling Augmedix and telecharting “telemedicine” stretches the definition, but the ATA’s is vague enough that telecharting fits. More hospitals are considering using scribes, so it will be interesting to see how they look at telecharting. Having the CMIO of Dignity making videos about how much he likes Augmedix certainly won’t hurt the sales process for the company.

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Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

  • Mobile Man

    Wow. What does this say about the current usability of EMRs? Imagine everyone (not just the rich and famous) having to employ a driver for the car they just bought… What happened to tech increasing productivity? The “business of healthcare” – always the opposite eh?

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