Division of Labor—Ian Shakil’s Digital Pin Factory

Industrial Revolution-era economists identified the division of labor as a tremendous contributor to efficiency, economy and prosperity. Adam Smith described a pin factory assembly line — specialized workers performing separate tasks. David Ricardo refined the logic of specialization, articulating his principle of comparative advantage.

Two centuries later, digital technologies let healthcare providers divvy up tasks in ways never before possible. Ian Shakil’s Augmedix documentation service allows physicians to transfer recordkeeping tasks to specialized colleagues. This, he says, means greater productivity, happier doctors and patients, and, ultimately, better care coordination and outcomes.

Electronic health records (EHRs) will contribute vitally to healthcare in the not-too-distant future. They should enable patients to interact more efficiently with their own physicians, move from one physician to another, and deal with emergencies while traveling. Presently, however, EHRs are an agonizing distraction for physicians. They are designed more for reimbursement accounting than for therapeutics.

Mandated by Washington, today’s EHRs force doctors to focus on computers during examinations, diverting attention from patients. They demand heavy follow-up work by doctors after patients leave. And their usefulness to medicine is severely limited by their design.

In 2012, Ian Shakil, a then-recent Stanford business school graduate, started working in early-stage healthcare startups. Friends afforded him the rare opportunity to try on a primitive version of Google Glass (a small computer imbedded in eyeglass-like headgear). This was Shakil’s eureka moment. He became obsessed (his word) with building the first Google Glass startup to tackle high-value medical applications. He quit his job and persuaded his friend Pelu Tran to drop out of Stanford’s medical school. In late 2012, they co-founded Augmedix — before either possessed a Google Glass device.

Most physicians today have a dual role. They are diagnosticians — interacting with and serving patients — and they are scribes, recording and editing the information acquired during physical examinations.

Augmedix divides these roles — diagnostician and scribe — between two groups of people. Thus, the system captures the efficiencies of specialization and focus just as Adam Smith’s pin factory did.

Here’s how it works: In the examination room, the doctor wears Google Glass, which live-streams audio and video of the exam to a medical scribe employed by Augmedix. As doctor and patient converse, the scribe compiles the EHR in real-time. By the time the examination ends, the scribe completes the EHR, including complex forms, fields and dropdowns, and makes it available to both doctor and patient. Generally, the doctor has no need to edit the EHR and is free to do other productive work.

The doctor never has to fiddle with a laptop or tablet. Augmedix also offers a Siri- or OnStar-like feature allowing the doctor to retrieve information from the patient’s previous EHR data. Ask out loud, “What were the patient’s last three blood pressure readings?” and the numbers appear on the Glass screen. Results are mediated through the scribe-expert, helping from afar.

Augmedix obviates the need for physicians to enter data into EHRs or to manipulate a keyboard to retrieve data. The transmission from the examination room to scribe occurs over end-to-end encrypted channels, preserving patient privacy and complying with HIPAA regulations.

According to Shakil, physicians using Augmedix save 25 percent to 35 percent of their workweek. That enables them to see more patients, spend more time with current patients, or enjoy more leisure time.

But, Shakil notes, there’s a more fundamental impact of separating the physician and scribe functions. With no computer duties in the examination room, the doctor can focus on the patient. Some say this feels more like the medical practice of a half-century ago — intimate, personal, human. For the same reason, he said, patients are more satisfied with the encounters.

A greater division of labor into specialized tasks also has indirect effects on healthcare. Present-day EHRs’ exhausting recordkeeping drives some people out of medicine and, no doubt, discourages others from entering the field. Technologies like Augmedix may help medicine attract and retain physicians. The existence of professionals devoted to EHRs may accelerate the day that EHRs become the therapeutic tools some visionaries hope they will be.

Shakil intends to expand Augmedix beyond EHR scribing to offer a series of Google Glass-facilitated medical services — all helping medicine to take advantage of centuries-old economic logic.