Medical Scribe – Trend or Evolutionary Solution?
A recent report from the Office of the National Coordinator for Health Information Technology has shown that the adoption of electronic medical record (EHR) systems has largely increased since financial incentives and penalties were put in place. According to the healthit.gov website, EHR systems are designed to provide more accurate, up-to-date and complete information about patients, improve patient and provider interaction and communication and, among several other benefits, also help providers improve productivity and work-life balance.
In actuality, however, a 51 page report on “Physcians Use of EHR Systems 2014” from AmericanEHR and the American Medical Association (AMA) reveals that physician satisfaction with EHR systems has plummeted. Physicians have to spend more time doing data entry and clerical documentation which, in turn, affects the number of patients they are able to see as well affecting the physician and patient interaction during patient visits. According to this report, 42 percent of physicians thought their EHR system’s ability to improve efficiency was difficult or very difficult. Even more notable, 72 percent thought their EHR system’s ability to decrease workload was difficult or very difficult and 43 percent said they had yet to overcome the productivity challenges related to their EHR system. This is a clear indication that more modifications need to be done to the existing EHR systems in order to meet the goals of improving physician productivity and work-life balance.
As physician satisfaction with EHR systems plummet, however, a new trend is occurring which, in its initial stages, appears to be improving on physician satisfaction. That new trend is the rising use of medical scribes. The medical scribe is a trained individual who assists the physician by entering information into the EHR system under clinical supervision. The medical scribe frees up the physician to be able to see more patients and thereby generate more revenue while at the same time providing efficiency and accuracy for clinical documentation. The use of scribes is not entirely a new idea. As reported in a Medscape article “back in the 1990s, a few doctors hired stenographers to follow them from exam room to exam room, taking dictation and later typing up a transcript of what was said to file in paper charts.” However, at that time, the use of scribes never really caught on.
In today’s world, the climate has changed and the use of medical scribes is being more widely accepted and welcomed, mainly spurred on by the decreasing physician satisfaction with EHR systems. Dr. Michael Murphy, co-founder and CEO of Scribe America, estimates that about 10,000 medical scribes are working in hospitals and medical practices around the country. In current years, the number of medical scribes has been doubling annually, according to the American College of Medical Scribe Specialists (ACMSS), and is expected to increase to 100,000 by 2020.
There are two basic concerns derived from the use of medical scribes by physicians. One is the concern that the drive to continue to improve upon the efficiency of the EHR systems themselves will decline and the concern for patient privacy during patient visits with the physician. Experts propose that without the pressure from physicians and their suggestions for improvements, the medical scribe industry will be contributing to the weakening of technological improvements to EHR systems. Their hope, however, is that those physicians using medical scribes will continue to demand continued improvements in EHRs. In addressing the privacy concerns, physicians report that once the patient understands that the scribe allows the physician to devote full attention to the patient, acceptance of the presence of the scribe by patients is welcomed. During visits that require a more intimate physical exam or interview of more intimate, personal matters, the scribe generally sits outside the room and will get a summary of the visit’s findings from the physician afterwards. Another growing trend in the medical scribe industry that addresses the privacy issue is that of the virtual medical scribe. The virtual scribes enter data into the EHRs and process patient visits in real time remotely through secure internet connections.
Regardless of the concerns raised by the use of medical scribes, many experts feel that medical scribes are here to stay as physicians attempt to deal with the difficulties of the current EHR systems and switch their focus back to patient care and away from clerical documentation. Whether medical scribes are a temporary stop-gap fix to dealing with difficult EHRs or an ongoing evolutionary solution, it appears for now that the medical scribe industry is contributing to providing more accurate, up-to-date and complete information about patients, improving patient and provider interaction and communication and helping providers improve productivity and work-life balance.