The Guide to Medical Scribe Services [Updated for 2024]
How to choose a scribe that meets your needs
There are lots of medical scribe companies out there. This guide will help you decide which one is best for you. Get the cheat sheet to help evaluate your options.
As a Medical Provider Going into 2024, your question is not, “Do I need a scribe?”
That's a no-brainer. You already know most EMR’s are a nightmare. Doctors and nurses are already overworked. What's more, providers are not compensated for clinical notes. When doctors earn hundreds of dollars per hour caring for patients, why on earth would a physician do clerical work for free?
The correct question is, "What kind of scribe should I get?"
This guide will help you choose.
How to use this guide
We evaluate each type of medical scribe system based on 6 factors:
Companies that provide this type of scribe service
Work required (for you, not the scribe)
Keys to success with this type of scribe system
Cost (relative to other options)
Our recommendation
Anything else you should know
Ready? Let's get started.
Option 1: Hire and train your own scribes
Providers: You and your staff
Work required: All the usual HR tasks: hiring, firing, payroll, training, covering sick days, turnover
Keys to success: When hiring, look for pre-med undergraduates or nursing students; Consider advertising at local universities
Cost: Probably the most expensive, due to payroll & overhead costs
Recommendation: Only worth it if you strongly prefer in-person scribes
What you should know: You’ll have to do everything involved in hiring an employee: advertise the position, interview applicants, make offers, run payroll, pay benefits & workers comp, train new hires (including HIPAA compliance), and deal with ordinary HR issues such as turnover, sick days, and office dynamics in general.
In this model, the scribe joins the physician in the examination room. Be aware that some patients may perceive the presence of a scribe as intrusive, and there is some indication that male patients may have a less favorable view of scribes. However, other studies have found that patients have no negative views of the presence of a scribe during consultations, and that the majority of patients report scribes had a positive bearing on their visit.
Option 2: Use a medical scribe contracting company
Providers: A medical scribe outsourcing company such as: ScribeAmerica, PhysAssist, ProScribeMD, ScribeMD, ScribeKick
Work required: Moderate
Keys to success: Adapt your workflow to incorporate scribes; While you may develop routines & rapport with a specific scribe, expect to deal with some turnover
Cost: Generally less expensive than in-house scribes, but more expensive than virtual scribes or voice-recognition technology
Verdict: Viable but still expensive
What you should know: This is similar to option #1, but without the HR responsibilities. Scribe service providers will hire, train, and manage scribes for you on a contract basis. Rather than managing payroll, you receive an invoice.
Most commonly, the scribe will join you in the exam room. Some companies also offer systems that place the scribe in a different room, listening in to the appointment via a microphone. Naturally, you must still accommodate additional the additional workers within your office space.
Option 3: Use remote or "virtual" scribes
Providers: ProMedica Partners (that’s us), NextGen, AugMedix, SharpScribe, Chase Clinical Documentation, HelloRache, and others
Amount of work required: Moderate to set up, then easy
Keys to success: Provider must be diligent & attentive to detail, especially during setup phase
Cost: Often the least expensive option
Verdict: The cleanest and easiest option when managed well
What you should know: In the virtual scribe model, your scribe assistant works in an off-site HIPAA-compliant facility which is maintained by the scribe company. Your assistant takes instructions via voice messages, and completes your notes accordingly. You receive notes via secure online transmission, usually overnight, and then review each note before signing off.
Remote scribes can be significantly less expensive than in-house or contracted scribes, due to lower labor and overhead costs. You'll also never have to worry about hiring or interpersonal issues. The levels of quality and professionalism of remote scribes can be quite high, because the remote scribe company creates a dedicated work environment with no distractions.
Option 4: Voice recognition software linked to EHR
Providers: Robin, Nuance Dragon, suki.ai, talkEHR, MModal
Work required: Similar to virtual scribes, though setup may take longer
Keys to success: For standalone software, create your own clinical notes process to use the software efficiently; services that use human scribes to review computer-generated notes are more reliable. Make sure you don't spend lots of time troubleshooting
Cost: One-time software purchase with no labor costs; Expect to pay a recurring charge for this service on top of software and hardware purchases
Verdict: User interfaces and AI are improving. Will not be as easy or accurate as human scribes for most users
What you should know: Despite marketing claims, none of these companies offer robust AI-based scribe systems yet. Instead, most provide a hybrid solution that pairs speech recognition software with a human virtual scribe.
If you opt to use software by itself, plan to invest significant time to set it up properly. A pure software-based scribe system works only if you do exactly what the software is designed & configured to do. If you don’t follow correct procedures, or if your use case is non-standard, scribe software will be a recipe for frustration.
AI-based scribe services are likely to advance rapidly in the near future as companies like Amazon, Google, and Microsoft, which recently acquired Nuance after a partnership of several years, develop new solutions such as Amazon Transcribe Medical and Nuance DAX (Dragon Ambient Experience). While not perfect, these services are improving all the time, with some estimating that within 2-3 years they will be the dominant solution throughout the industry.
Option 5: Dictation or transcription services
Providers: Numerous local providers
Amount of work required: A lot
Keys to success: Speaking like a robot
Cost: Varies by provider; Often charged by minute or by line of text
Verdict: The worst of both worlds
What you should know: If you are nostalgic for med school, or if you enjoy speaking like a robot, this is the scribe system for you. You were probably forced to use transcription services while in residency. If so, you know the drill. This option offers both the frustration of communicating with machines AND the drudgery of data entry. Stay away if you can.
(Not an) Option 6: Do your own notes
Providers: You
Amount of work required: A lot
Keys to success: Work nights and weekends
Cost: Your personal time; Opportunity costs
Verdict: Just say no.
What you should know: How much is your time worth? We've been over this. You’re a doctor, not a stenographer. Why would you sacrifice money, family time, and sleep to work for free?
When considering scribe services, it’s important to take into account the opportunity costs for physicians. Of course, physicians make hundreds of dollars per hour seeing patients, and all practice revenue is ultimately derived from the physician-patient interaction. But even beyond that, a physician’s time and energy becomes much more valuable when invested in improving a practice. The last thing doctors should do is unpaid data entry.
As we said at the beginning of this article, getting a scribe is a no-brainer. Focus on caring for your patients, and get help with the busywork, and save hours of your time every week (or even every day).
Next steps
Our own remote scribe service, ProMedica Smart Scribe™, is an excellent solution for many providers. Our scribes provide overnight service and impeccable accuracy. While we don’t provide real-time notes, our clients find that the next-day service is equally efficient, sometimes more so. Our system is also less intrusive, and generally less expensive than real-time virtual scribes.
We also offer a new telemedicine Smart Scribe™ service, which ideal for many providers doing mostly telehealth visits, and completely unintrusive.
Still trying to figure out which type of scribe to use? Our medical scribe cheat sheet will help you assess your options: