The Bangladeshi scribes who keep the US healthcare system running

In 2009, the adoption of the digital medical documentation act in the US was intended to revolutionise the healthcare industry. However, it instead created a significant burden for doctors. 

After each patient visit, doctors now spent an excessive amount of time typing down details, a time that could be better spent in directly helping patients. 

This interruption to the flow of work also impacted the doctors' efficiency and the patients' overall satisfaction. 

The problem grabbed the attention of Ian Shakil, a Stanford graduate of Bangladeshi origin. He started looking for a way to help doctors. 

In 2012, when Google came out with their wearable smart glasses dubbed the Google Glass, Ian had his Eureka moment. If the doctors wore this glass during patient visits, it could automatically hear everything and record them. And this is how the idea of Augmedix was born. 

The Bangladesh connection

Google Glass took care of one part of the problem, but what about jotting everything down? Ian needed software to document everything word for word and without any mistakes. He also needed people to transcribe them (known as scribes). 

This time, inspiration came from somewhere else. Although Ian grew up in the US, he spent a handful of his summers in his father's homeland, Bangladesh. 

"And one thing he learned from his visits is that he wanted to leverage the power of Bangladeshi youth," said Rashed Mujib Noman, the country director of Augmedix. 

"Ian called up his cousin in Bangladesh to help him with his venture. His cousin got in touch with several software engineers and Augmedix started its journey in Bangladesh ," explained Rashed, a Buet graduate, who completed his MSc in Engineering from the University of South Carolina and an MBA from the New York Institute of Technology.

"We connect US doctors with remote scribes in Bangladesh who listen in, capture, and process doctor-patient conversations in real time. This information is then uploaded as a medical note to the provider's electronic health record (EHR) system, " Rashed said on Augmedix's service, adding "It can then be accessed and used to manage patient care".

"Once you're in the production room, it feels like you're zoomed into a new reality, one where you're just focused on the clinician, the patient, and the documentation," said Fayequa, Shams who was a scribe at Augmedix before becoming a global senior training specialist there. 

Augmedix Bangladesh is a subsidiary of Augmedix, which was listed on Nasdaq (an American stock exchange based in New York City) in December 2021. At the moment Augmedix operates out of five countries: the US, Bangladesh, India, Sri Lanka, and the Dominican Republic. 

In the early days of Augmedix, doctors mostly used Google Glass for communication. Now, around 80% of doctors have switched to smartphones.

Photo: Courtesy

Opportunities and challenges

Augmedix started scribing operations in 2017. Currently Augmedix Bangladesh employs more than 800 people, out of which more than 500 are scribes who support US doctors. 

But they still need more people. In fact, Augmedix Bangladesh plans to move to a brand new 67,500 sq feet location later this year to accommodate more growth, as they expect to employ more than 1,200 people by the end of this year. 

The company is committed to growing their footprint in Bangladesh. However, although they're generating jobs, they're still facing issues on the supply side. 

"We need to onboard roughly 50 new scribes every month, but are realistically hiring around 30," said Rashed, who worked for General Motors for more than six years and then another 11 years at Boeing before returning home to join Augmedix. 

According to him, the reason behind this struggle is Bangladeshi youths' subpar grasp of English grammar. In medical science, grammar is essential. A simple mistake can be disastrous.  

"Grammar has a tremendous impact; the whole course of treatment can be altered by one tiny mistake. Unfortunately, our local youths are lacking in this aspect," he explained.

Focus is the key, as the conversations these scribes note can potentially be life altering.  "This job requires an individual to be efficient and work flawlessly. A doctor in the US is putting her/his faith in you as a companion," explained Mohammad Saadat Saleheen, senior medical documentation specialist at Augmedix.

Augmedix has designed a three-month long training programme to combat this issue. The first one and half months of this training are spent on strengthening English language skills and learning medical terminologies. 

"We have designed an IELTS -like test for testing English proficiency. If someone scores 50% on this test, we select them for training. Our goal is to train them to score 80% in three months. As per our data, if someone scores less than 80% in our test, they cannot do this job properly," said Rashed.

Augmedix management realises the night shift is a dealbreaker for some, but they are finding the lack of English language skill to be a bigger issue. All applicants go through a rigorous hiring process. Out of every 18 trainees who start the paid mandatory training, around 11 or 12 successfully complete the training phase.

Rashed sounded slightly disappointed as we delved deeper into the lack of skilled manpower issue.  "We offer one of the best starting salaries for our scribes. We naturally offer pick-up and drop-off service for our night staff. All meals are complementary, not subsidised, with unlimited snacks. We offer class-leading medical insurance, life insurance, and not to mention, gratuity. Yet, we are struggling to find enough skilled recruits," he lamented.

The other issue that came up while discussing Augmedix's challenges was the internet. Augmedix currently utilises several separate ISPs so that their network never goes down. 

"We find latency to be a big issue here. If the latency gets too high, we start to experience packet loss, which means our audio and video feed starts getting choppy," said Rashed. In their future premises, they are even planning to use satellite-based internet. 

Plans for the future

Augmedix is one of the fastest growing players in the $70.8 billion global medical transcription market. Their year-end revenue stood north of $30 million at the end of 2022 and, moving forward, they expect to continue to grow year over year. They have so far not felt the impact of the global economic slowdown and have not had to make any cutbacks.

"We can explore markets in different countries, but the US market is so big we will keep focusing on it for the next few years," revealed Rashed.

Augmedix also has been operating a small data analytics operation for the last three years. This unit, which also operates out of Bangladesh, is a profitable venture and growing. 

There is another wing of their business, which could take advantage of Bangladesh's abundance of manpower and go big, called data structuring. 

"We do data structuring for our own needs, but we can offer this service to the world. This is a very tedious task, but I think with our massive human resources, we can even run data structuring operations comparable in scale to factories," hoped Rashed.