Meet the Google Glass Co. Saving Doctors Hours Each Day

Augmedix uses Google Glass to eliminate manual data entry into electronic health records, saving precious time for doctors. We asked Ian Shakil, the company's cofounder and CEO, to tell us more. 

The idea behind Augmedix is surprisingly simple. The business uses Google Glass technology and medical scribes to automate data entry for electronic health records (EHRs). Augmedix cofounder and CEO Ian Shakil has admitted it's a straightforward formula, but it seems to be paying off.  

Shakil explained that just a few years after its inception, the company already has five large healthcare systems and hundreds of physicians using Augmedix. In 2016 alone, Augmedix has been named Fast Company's "Most Innovative Healthcare Company of 2016," closed a $17 million funding round supported by those five major health systems, and also received $16 million in Series A funding.

In a recent Q&A, Shakil told MD+DI about the eureka moment that led to Augmedix, how his background in the medtech industry prepared him to be a digital health entrepreneur, and what's next for the company. 

(Editor's note: This Q&A has been edited slightly for brevity and clarity.)

MD+DI: Tell me about how Augmedix works.

Ian Shakil: The pain point that we're addressing is this tragic fact that doctors spend two, three hours a day on the computer, typing and clicking, typically right in front of the patient with their back turned. Everybody dislikes this. The patients don't like it. Doctors hate it. It's not what they went to med school for. Doctor management doesn't like this either.

What we do is say--Doctors, hey, stop doing it this way. Simply wear Google Glass and go into the clinic. Go have a normal conversation with your patient, a human dialogue, like you always wish you could have had. In the background, from Google Glass, from the audiovisual stream, we will fill in the forms and fields and dropdowns and structured data of whatever EHR system you use, better and faster than you could, thereby saving you that time. Giving you a third of your day back.

We will also serve you information on demand . . . if you're a doctor you can say, "Show me the labs. Who is the next patient? What's the cholesterol?" You name it and it pops up. You don't have to go fetch this information or distract yourself and the patient.

The audiovisual is streamed to a human being elsewhere in the world. We call them an expert, a remote scribe. They see and hear what the doctor sees and hears, are sitting in a secure cockpit, and have all the tools to do all the documentation and serve the doctor right then and there. They have the electronic health record up--the Epic, the Cerner, the Practice Fusion, whatever the doctor uses--and they have all the tools to create cards, manipulate Google Glass from afar, see the schedule, etcetera.

MD+DI: Where did the idea for Augmedix come from?

IS: I've worked in various healthcare settings, mostly in the medical device industry, and I became very familiar with the trials and tribulations of being a doctor by working with doctors. I went to grad school at Stanford to get my MBA. My cofounder (Pelu Tran) went to med school at Stanford to get his MD. The two of us met in grad school and knew we wanted to do something big together, but just didn't know what, exactly.

We had a rare opportunity in 2012, right after I graduated, to try on a very early version of Google Glass. That was a eureka moment, really. We knew then and there that this device was ready for prime time and we could just see, "Oh my gosh, it belongs on doctors. And we know just what to do with it." We became obsessed quickly. I quit my job and Pelu, my cofounder, dropped out of medical school. Together, we formed the first Glass company, more or less to do then what we now do today without hardly any pivots or deviations.

We now have around 500 people around the world working for us, up from the two of us in 2012.

MD+DI: That's incredible. Tell me how you two got the company and product off the ground so rapidly?

IS: I wish I could say it was easy or something. One, hiring expert people. We brought in some of the foremost experts in scaling these technology-enabled body-heavy services and brought them into our company quickly. The folks who founded the world's first medical transcription companies in the 1990s, which are foundational in this space, and grew them to over 20,000 employees--early on, they came and started working for us. That was one of the ways we got into rapid-scale mode.

Two, it's just about keeping it simple. There are a lot of really exciting things you could do with Google Glass when they're sitting on the eyes and ears of doctors all day, everyday. We want to do those things too and it's an amazing platform opportunity, but right now, we're really just focused on knocking it out of the park with our core service.

Those are the two secrets to going quickly. Maybe number three is, just finding the right customer partners and figuring out the ones who will let you scale quickly and losing the people who are merely dabblers and piloteers . . .

MD+DI: How did you get your first physician users to adopt the product? Did it take much convincing?

IS: The service itself is pretty compelling. I meet very few doctors that, when they hear about it, don't say, "Hey, I want that." Demand is extraordinary and even to this day, demand is off the charts. We struggle to fulfill demand, which is a good problem to have.

In the early days, we engaged independent doctors. Doctors that are unaffiliated and told them about the service . . . "If you try it, you like it, you keep it." We got enough of those people, dozens, engaged and loving it and showing good data, that we had enough juice to go out and engage big, mega health systems. The first of those was Dignity Health. We now have five major health systems that are commercial and expanding with us.

It was just a slow progression: independents, then one health system, then everyone starts to pile in. Interestingly, today our five health systems have so many doctors that we really don't need to add any more health systems. We would be a billion-dollar company multiple times over just servicing the doctors in the health systems that we have. That's pretty astonishing. We are adding more health systems but it's not what we're all about as a company.

Also, our health systems have recently become our venture investors. A couple months ago they . . . joined a coalition to back us, partner with us, help us scale deep into their organizations and across the country.  

MD+DI: How many physicians are using Augmedix now?

IS: We're not yet in the thousands. We will be next year. We're still in the hundreds . . . That may not sound like a lot of doctors, but we charge each doctor user in the low-single-digit thousands of dollars per month. So even at that level it's a significant amount of revenue.

MD+DI: I know you worked at Edwards Lifesciences earlier in your career. How did your experience at a traditional medtech company inform your work at Augmedix?

IS: When I first joined Edwards, I joined their leadership rotational program, which is the best in the industry. It was awesome. I should have paid them for the experience, because they sort of force you to bounce all around the company and take on different roles. I was an R&D engineer. I was a manufacturing supervisor of 70 people in a cleanroom. I was in the IT Quality group and then I was in marketing and then I was in business development. So they literally just force you to see a company from every angle. It's really good training for being an entrepreneur in the healthcare space. I couldn't have asked for more, really.

It also exposed me to how doctors and health systems think and make decisions, as well as how to operate in a regulated environment. In that case it was FDA. In this case, we have other regulations involving HIPAA and CMS. We also have to be mindful of privacy regulations regarding camera usage as well as HITRUST and SOC 2. There were a lot of parallels between the two worlds.

MD+DI: What are future plans for the technology?

IS: What's amazing is we offer an incredible service that saves doctors a third of their day, improves the doctor-patient interaction, doctors are delighted, and documentation is better . . . But eventually we want to take advantage of the fact that we're sitting there on the eyes and ears of doctors all day, every day, and we have a pipe to the EHR. That allows us to, over time, do so much more. 

For example, we can start serving carefully timed and curated guidance and reminders to doctors to help them with chronic care condition-related matters. We can help doctors communicate with other doctors and provide team communication services. We can actually save the audio-visual and send it to the patient on the patient portal so that they can relive the moment with their family. We can ultimately service all types of different content to the doctor, even content outside of the EHR. Ultimately, we'd like to be able to get into the world of small data and big data and be able to perform helpful analytics to assist doctors and help them know how they fare relative to benchmarks or help Dignity Health know the variances and practice patterns with respect to this drug prescription or this productivity-related matter.

We will be in a position that will be perfect to provide these sorts of services. In many cases they will be human-powered, over time they will be powered by speech recognition and natural language processing. Ultimately we'll be able to say--"What are the three words uttered before the missed diagnosis of the flu in women over 40 on Tuesdays in northern Colorado?" . . . Nobody else has that platform to do that today.

MD+DI: What obstacles to expansion remain? Will the approach of remote scribes eventually become a bottleneck?

IS: We are a supply-constrained company, not a demand-constrained company. I know that sounds strange, but demand obviously outstrips our ability to supply, and it probably will for years to come. The constraint is not Google Glass units. The constraint is human beings, scribes, as well as their project managers, QA-ers, trainers, and implementers. In other words, the entire operations team, particularly the scribes.

As a capital-constrained startup, we can only take on so much risk at a time. Hiring in waves, implementing in waves, and doing so while obsessing over quality and staying within a defined cost envelope. So that will be the limiter for us for a while. We want to be in the 6000-10,000 doctor range by 2019-2020. We'll need a similar number of scribes. On any given day, there's a one-to-one relationship between a scribe and a doctor. So we're going to have to scale to a population, a workforce, that is that big.

There are companies that do coding and transcription that have employee bases that are that big or significantly bigger. It's achievable and we have many people working for us that have expertise in doing that. Nonetheless, that is the rate-limiting step for the company.

MD+DI: Augmedix strikes me as a connected health device company that has gotten a lot of things right. Do you have any advice or lessons learned to share?

IS: The first rule is, there's no rule. The second rule is, don't listen to me or any expert too much. I'm not a serial entrepreneur. I have an n-of-1 experience.

Keep it simple. We're using human beings in a business model that a kindergartner can understand . . . It's just simple. I think a lot of people would say, "Let's start doing these four things at a time and see if we can use speech recognition today." Then, I think you end up disappointed and trying to do more than is possible. I think you can only innovate on so many dimensions at a time. You can't innovate on every dimension all at once. I see a lot of inspired entrepreneurs that just lose sight of that.

The other things is, solve a really big pain point. We're saving doctors a third of their day and we charge a lot for it too. It's worth it. But I see a lot of people out there with healthcare innovations where you need a microscope to see the ROI (return on investment). It might show up after three years, through the noise. Those aren't the innovations that America needs right now. Those aren't the innovations that venture capitalists are excited to invest in right now, especially if you're a first-time entrepreneur.

I guess it's easy for me to say, "Go solve a big problem." I guess that sounds like an old, tired truism. But if you're not doing something disruptive, you're going to have a hard time in this market if you're a first-time entrepreneur.

MD+DI: What role do you think the emerging area of digital health, mobile health, and wearables will play in the mainstream medtech industry?

IS: I think they're on a collision course for each other. I constantly talk to medical device people who are asking, "What's our digital strategy? How are we engaging patients? How are we getting into the services area?" It makes sense. The lines are blurry. These medical device companies already have channels into these health systems and into doctors. They sell suites of services. Why limit that expertise and that channel to just devices? Why not offer expertise that provides a 360-degree experience for surgeons and doctors to offer things to their patients? I think it's just a natural extension. I think doctors want that too. I think patients want that too. Patients are increasingly engaged as well and they want to know about their devices and want to engage with their devices. Their devices are going to increasingly offer not just therapeutic benefits, but even lifestyle and health benefits. There are just so many areas where the two worlds are seeping into each other.

I think the smart medical device companies as well as the smart biopharma companies are just trying to figure out what their digital health strategy is.

MD+DI: Anything else you'd like to say?

IS: A lot of people have this perception that Google Glass and the smartglass space is dying or dead. That couldn't be further from the truth. It's just all about enterprise and the world of work these days . . . It's not just Google Glass. It's also other smartglass platforms from folks like Vuzix and Sony and other Asian manufacturers. The more the merrier, from my perspective. They're being adopted in all kinds of enterprise use cases, even outside of healthcare. For example, oil and gas, frontline manufacturing fields. There are a lot of similarities for how smartglass can make a dent in those sectors versus healthcare.

[Images courtesy of AUGMEDIX]