Clinical workflow has been a problem for many many years. (That is surely one reason it persists – numbed acceptance).   A 2013 study showed that physicians spend only 25% of their working time on direct patient care.

On top of slowing down patient care, it also drains healthcare workers of their spirit and enthusiasm for work.

Another 2013 study determined that ER physicians are spending 44% of their working time on data entry work.

Many studies (aggregated here) have since shown that EMRs have remained a steady source of frustrating documentation burden and burnout for clinicians.

A 2012 study showed that medical scribes significantly improve emergency department throughput. Our partner Scribe America has since built a giant business supplying scribes to the healthcare industry for well over a decade now.

Yet another article from 2019 articulates the burden that EMRs STILL place on clinicians, and shows how scribes continue to be the primary solution to the persistent problem.

Despite the consistent approval scribes meet from clinicians, with hospital budgets undergoing severe compressive effects, it’s increasingly difficult for administrators to shoulder the cost of paying for scribes.

Workflow performance suffers. Budgets choke off traditional proven solutions. It really is time for something new.


Almost every ER in the world now regularly runs well over capacity. It is often referred to as a “staffing challenge,” but that implies incredibly expensive solutions. We’re not ready to say that the solution is to produce more physicians and nurses. While that may help, it does swap one crisis for another one: who’s going to pay for all that expansion??

We’re better to call it what it REALLY is – a large shortfall of capacity.


For many years, the EMR giants (eg. Epic, Cerner, Meditech, Allscripts) have been directly aware of the workflow challenges facing their clinician users. They have made modest attempts at relieving the problem, but their responses have continued to fall further and further behind common usability standards in other verticals.  They have countless audiences and functions to serve, making it difficult to do any one thing really well. In fact, the primary function of an EMR is to ensure proper billing for healthcare services. Clinical workflow is secondary at best.

Consequently, clinical users must commit significant time and energy to navigation and data entry. Given that they are spending more time with the EMR than with patients, it’s no surprise that many acute care healthcare workers possess hostile feelings toward their EMR platforms.


Point solutions for documentation have provided some relief. Companies like Nuance (Microsoft), MModal (3M), DeepScribe, Robin, and Suki are developing very helpful dictation and charting tools, but they are limited in scope. Most of them are designed for outpatient scenarios, and don’t help much in the hospital.

And we get it!  Acute care is an unpredictable non-linear dynamic system. From that standpoint, the ER is horribly difficult for solution developers. Combined with the general resistance from incumbents and hospital IT to a complex of vendors, it’s no small wonder that innovators stay away.


Further to the above, the emergency department is a particularly difficult environment for these outpatient workflow tools:

  • the abundance of background noise,
  • the unpredictability and breadth of clinical use cases, and
  • the time & complexity of the typical patient journey

These factors make for a steep challenge in the pursuit of a clear narrative about that patient. It simply requires time and effort for a person to compose and complete one.


Many clinicians are skeptical about software solutions and find it difficult to envision how they would use software until they actually see it in action.

Plus, for the balance of their careers, they’ve had little/no agency in selecting the productivity tools available to them.

Sadly, they are often forced to use software that was not designed with them in mind. In turn, this can create a hostile situation for any new vendor proposing yet another tool for clinicians to use. It’s rather likely that resistance and doubt is the first response by any clinician to new apps or software.