August 8, 2016
A Look At Medical Scribes
By Michael D. Shaw
The notion of a “scribe” will immediately conjure up a variety of images and thoughts for most people. The earliest scribes were part of a particular administrative class that was taught the art of writing—which itself dates back to around 3200 BC. Few people, including those in the ruling class, were literate in those days, owing to the complicated writing systems of the time.
Even as the writing systems would became more user-friendly, scribes retained a place of importance. Notably, the word “scribe” appears 129 times in the Bible. Rembrandt’s “Homer Dictating to a Scribe” reminds us how important it was to document the utterances of an epic poet, thus saving for us what would become some of the greatest stories ever conceived.
Medical records are as old as the healing arts themselves, and until quite recently consisted of handwritten charts, notes, and the occasional typewritten summary reports (often prepared by medical transcriptionists). But then came computers! Surely, information technology would be ideally suited to bring medical records out of the stone…uh…paper age, right? Not exactly.
As this column has discussed on numerous occasions, electronic medical records—aka electronic health records (EMRs or EHRs)—despite outrageous amounts of government subsidies, not to mention mandates, have proved to be anything but a rousing success.
In fact, EHRs are nearly universally despised by physicians, owing to their cost, complexity, rigidity, and lack of compatibility between vendors. Which brings us to medical scribes.
The Joint Commission (a healthcare standards-setting and accrediting body) defines a medical scribe as “an unlicensed individual hired to enter information into the electronic health record (EHR) or chart at the direction of a physician or licensed independent practitioner.” Given the ancient history of scribes operating in real time, the term implies that the scribe is at the location with the physician and patient (or attends via the Internet).
While medical scribes existed in some settings before the advent of EHRs, the rise of the scribe industry coincided with the deployment and popularization (if that’s the correct word) of the healthcare IT platforms. Not that this is a surprise. Healthcare IT guru Scot Silverstein, MD has been complaining for years about how bad these systems are. He argues that the problem is not so much in having the docs learn the EHRs, but rather is the “stuck-in-the-1980s health IT user interface.”
In fairness, anytime the physician is forced into paperwork (or data entry), as opposed to actually spending time with patients, we have terrible inefficiency. Somehow, though, this situation never really came to light until the docs were forced to delve into EHRs, seeing their productivity drop as much as 30%.
I recently spoke with Michael Murphy MD, former Army Ranger, and co-founder and CEO of ScribeAmerica, a leader in the medical scribe industry. Murphy notes that physicians spend more time in training than any other professional. Yet, unlike attorneys and bankers for example—who have always employed para-professionals—they have been slow to appreciate the value of their time, and how it must be focused on their unique skill set.
Indeed, doctors are probably their own worst enemy in this regard, invoking a bizarre combination of a Norman Rockwell derived self-image, with a supercilious air toward paperwork and coding. Of course, since virtually all doctors now really work for either insurance companies or the government, paperwork and coding (that is, EHRs) are vitally important.
So, how should physicians deal with the EHR-caused lack of productivity? Murphy lays it out: The docs could see fewer patients per day and make less money; see the same number of patients per day, and then add two or three more hours at the end of the day doing charts; or personally EHR-chart concurrently while the patient is in the room.
Even if the latter were possible in any practical sense, patients take a visceral dislike to extended wait times, coupled with an apparently inattentive or distracted doctor. No doubt, referrals will be lost, and even some existing patients may leave the practice as a result. Murphy advises that with scribes, docs will improve productivity, see more patients per day, and increase revenue.
Back in 2010, Scot Silverstein, commenting on the rise in medical scribes and thus the limitations of EHRs, observed that “You should not have to work around something that is not in the way.” And he’s right. The poorly-designed, hastily implemented, and painfully slow to improve EHRs are in the way. Fortunately, medical scribes can help (in keeping with his metaphor) to clear the path.