Could a Virtual Scribe Solve EHR Usability Problems?

Posted on October 26, 2015 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Jibo: A Home Robot Promises a New Level of AI Use

I ran across a new, five pound, home robot called Jibo in an IEEE publication my wife gets. Jibo, whose first planned product run has sold out at $750 each, promises to ship this Spring. It bills itself as the first social robot.

Started as an INDIEGOGO project that banked close to $4 million, Jibo recently added $36 million from investors.  Its technology smarts come from its founder, chief scientist and MIT Associate Professor, Dr. Cynthia Breazeal.
Jibo’s driven by an ambition to bring artificial intelligence capabilities to the home market. Though it’s not mobile, it’s touch sensitive, gesture sensing and can dip and swivel 360 degrees to capture events. Jibo’s natural language processing uses two high res cameras to recognize faces, do your selfies and run video calls.

Dr. Cynthia Breazeal and Friend

Dr. Cynthia Breazeal and Friend

With these capabilities, Jibo is far smarter than smart thermometers, vacuum cleaners or security systems. It’ll use these to learn your phrases and gestures, so it can act as your calendar, inbox, media organizer and general personal assistant. Importantly, Jibo has a significant, developer program. That’s what gave me the idea for a virtual scribe.

An EHR Virtual Scribe?

High end EHRs have been using natural language processing for years. You dictate and the system figures out what and where to put the text. These pricey add-ons aren’t widely used.

Less versatile, but far more used is Dragon Voice. Other smart assists are various macro systems and front ends. These improve an often frustrating, mind numbing EHR interface, but are only a partial solution. Their major disadvantage is that the user is tethered to a machine. Ideally, a doctor should be able to talk with their patient, and seamlessly use the record as needed.

If new, smart devices such as Jibo really can aid around the house, it should be possible in another generation or so, to free practioners from their tablets or keyboards. An EHR virtual scribe with cameras and projector could do these tasks:

  • Workflow. Set up workflow based on patient history and appointment type.
  • Encounter Record. Record doctor-patient audio and video unobtrusively.
  • History. Project the patient’s history and labs, etc., as requested.
  • Updates. As the user dictates, the scribe could show the entries to both.
  • Assessment. As the user builds the note, the scribe could show how it compares to similar cases or when asked do searches.
  • Plan. The scribe could produce potential plans and let the user modify them.
  • Orders. Based on the plan, past orders, etc., it could propose new orders.
  • Education. Provide tailored materials, references, etc.
  • Appointment. Set up appropriate follow on appointments.
  • Claims. Interface with claiming and reporting systems as needed.

Products such a Jibo hold the potential for a technical fix for EHRs seemingly intractable usability problems and do it at reasonable cost. Their combination of adaptable hardware, AI abilities and unobtrusive size may just be the ticket.