A Labor History of Health Records: On Medical Scribes and the Ethics of Automation

Abstract

This paper explores the human labor demands that underpin the utility of patient health records. I examine where these labor demands originated historically, and I consider how they might evolve, given the recent rise of artificial intelligence (AI) being developed to automate the collection and categorization of patient health information. Using a sociotechnical framework, the paper identifies a complicated paradox: the labor of medical scribes has become crucial for the benefits of electronic health records (EHR) to be realized; simultaneously, scribe work has been regarded in medical literature as inconspicuous and transitory, a stopgap measure wholly replaceable by a more efficient solution. The paper thus critically interrogates the premise that automation can replicate and replace scribe labor, and it examines the ethics of moving toward a fuller reliance on AI.