Scribe: Improving Older Adults' Access to Medical Instructions from Patient-Physician Conversations
Hilda Karimi, Jasprabhjit Bora, Martin Hammond · 2021 · Proceedings of the 18th International Web for All Conference (W4A '21) · doi:10.1145/3430263.3452420
Summary
This paper presents Scribe, a mobile prototype designed to help older adults access, organize, and recall medical information shared during doctor's visits. The research addresses a significant accessibility challenge: older patients, particularly those managing multiple chronic conditions across several healthcare providers, struggle to gather, organize, and recall the information communicated during medical appointments. These challenges are compounded for individuals with hearing impairments, low vision, or age-related memory difficulties, and are further complicated by fragmented electronic health portals that differ across hospitals and providers. Scribe works by providing patients with access to transcripts of their medical conversations, automatically generating structured notes including to-do lists, summaries, and outlines categorized by medication, exam, and plan. The tool also allows users to set reminders based on their doctors' instructions. The researchers conducted a user study with 10 older adults aged 60 to 78 in Indianapolis, all of whom managed chronic illnesses such as diabetes, hypothyroidism, and high cholesterol, and visited between 1 and 10 or more doctors regularly. Participants completed five tasks across three scenarios using the prototype, followed by Technology Acceptance Model (TAM) surveys and semi-structured interviews. The study employed open coding thematic analysis to extract experiential themes from participant responses.
Key findings
TAM results showed strong acceptance: 70% of participants extremely agreed Scribe would help accomplish tasks more quickly, 90% found it useful, and 80% extremely agreed it would be easy to learn. Thematic analysis revealed six key experiential themes. Participants valued Scribe's ability to consolidate medical information from multiple providers in one place, eliminating the need to navigate disparate patient portals. The tool was seen as particularly valuable for supporting recall — participants described difficulty memorizing medication names, exercise instructions, and other clinical details after visits. Participants with hearing impairments noted that reading transcripts was preferable to relying on listening during appointments, while those with low vision saw potential for replacing paper notes they could not easily read. A notable finding was Scribe's perceived impact on caregiver relationships: participants envisioned sharing transcripts with family caregivers to reduce the burden of relaying medical information and to increase their own independence. The study also identified stratified information access barriers across three domains — gathering, organizing, and recalling — with accessibility barriers, digital literacy challenges, and disparate health systems as cross-cutting factors.
Relevance
This research highlights the intersection of aging, disability, and health information accessibility — a domain with growing importance as populations age globally. The findings demonstrate that accessibility barriers to medical information extend well beyond screen reader compatibility or font sizes; they encompass cognitive load, information architecture across fragmented systems, and the social dynamics of caregiving relationships. For accessibility practitioners, the study underscores the need to design health technologies that account for diverse and intersecting access needs — hearing, vision, memory, and digital literacy — rather than addressing single disabilities in isolation. The identification of stratified access barriers provides a useful framework for evaluating any information-management tool serving older adults. The study's limitation of 10 participants is acknowledged, but the qualitative depth offers actionable design considerations for practitioners building accessible health information tools.
Tags: older adults · health informatics · patient-physician communication · mobile accessibility · assistive technology · caregiver support · cognitive accessibility