Scribes fill a unique role as doctors make the transition from decades of using paper-charts to integrated electronic health record systems (EHR). Doctors who use scribes report greater productivity, more efficient delivery of services, enhanced patient engagement and higher job satisfaction.
Medical Scribes Reduce Documentation Burden on Docs
Adopting EHR practices has created an unexpected challenge in exam rooms at hospitals and private medical practice: while EHR systems improve access to and portability of medical data, these systems have simultaneously burdened doctors with an overload of documentation and administrative tasks that hinder efficiency and divert attention from attentive patient care.
A recent research report by Rand Corporation identified that, for many physicians, current EHR technology significantly worsened professional satisfaction in multiple ways. Common sources of dissatisfaction included time-consuming data entry, disruption with face-to-face patient care, and degradation of clinical documentation.
"Even with electronic records, we still face the challenge of trying to complete charts during a shift, in which case the doctor isn't seeing patients; it's not a viable option," said Dr. Hans Notenboom, Medical Director, Emergency Department at Sacred Heart Medical Center, River Bend, OR.
The alternative is to complete charting at the end of the shift, which puts exhausted doctors to work in front of a computer for another 2 to 3 hours. Documenting at the end of a shift, after a doctor has seen 20 or more patients, often results in a lapse in detail about the patient encounter.
This problem is compounded in medical settings where doctors work back-to-back shifts with little sleep in between. Too often charts are not complete until days after the patient encounter.
To relieve the documentation overload, healthcare providers have turned to medical scribes. A scribe assists a physician by managing documentation in the EHR, gathers information for the patient's visit, and coordinates administrative tasks. It is estimated that 10,000 scribes work in healthcare settings across the U.S.
"We all train a mental muscle to remember incredible amount of detail, but it's not as good as documenting contemporaneously," said Dr. Notenboom. The emergency department at Sacred Heart began using PhysAssist scribes about three years ago.
"The scribe allows us to give our full attention to the details in a patient consultation, reduces the pressure we feel when we are trying to dictate notes concurrently with an exam and entering data into an EHR."
Dr. Notenboom, who also is the physician lead for informatics, explained that since they began using scribes there has been a dramatic improvement in timely completion of charting, communication between providers, and higher ratings of patient experience with the doctors and overall care during treatment.
Dr. Michael Murphy, an ER physician who co-founded ScribeAmerica a decade ago, added "with real time, in parallel data gathering and EHR documentation the physician's individual productivity and patient throughput increase, so that the goal of providing cost effective, quality medical care is achieved."
Enhanced Patient Care & Medical Decision Making with a Scribe at the Doctor's Side
Other studies have reported when physicians spend too much time looking at the computer screen they might miss important nonverbal cues from patients, which can diminish patient engagement. The multitasking that goes on during a patient exam results in reduced eye contact, which patients perceive 'the doctor isn't listening.'
"Before we used scribes, the biggest complaint we'd see in evaluations was the patient feeling the doctor spent more time looking at the computer or the chart than listening to them," added Dr. Notenboom. "That kind of disengagement from the patient also bothers doctors."
Physicians who use scribes are better able to focus on the patient encounter while their scribe compiles labs, images or other clinical data for the next patient to be seen. Additionally, when a doctor is more efficient, it leads to better charting and better communication with colleagues or healthcare providers outside the hospital with whom a patient will have their follow-up appointment. All of which increases patient satisfaction with their medical experience, enhances medical decision-making, and makes doctors better at being doctors.
"If the out patient doctor can't see my chart because I've not been able to complete documentation in a timely manner, then that doctor has to question the patient all over again. Now, with scribes, our chart completion rates are significantly improved and we're far more efficient at communicating within our own organization and with other healthcare providers."
Scribe Training & Patient Privacy
Scribes are pre-med students or recent college graduates who are competitively recruited and trained by scribe management companies (see list). Training includes HIPPA compliance practices. Some have raised concerns that scribes don't have sufficient medical education. According to Dr. Murphy, "it can be argued that medical scribes have more medical education than a medical assistant and MA's are in almost every patient encounter." Certification for scribes is available.
Another concern has been for patient privacy, especially for sensitive exams such as with urology or gynecology. Practitioners consider every patient encounter on it's own terms, taking special care to insure a patient is comfortable during sensitive examinations such as with urology or gynecology.
"If the patient is uncomfortable for any reason, or if the type of examination requires more privacy, then we don't include the scribe in that patient encounter," said Dr. Notenboom. "We are sensitive to a patient's personal needs, modesty and the appropriateness of having the scribe present or not."
Scribe Training & Providers
American College of Medical Scrive Specialists
Medical Scribe Training Systems
KarenZupko & Associates. EMR scribes: real-time tech support boosts physician productivity & reduces "paper care" hassles. White Paper. February 2011. Accessed February 4, 2014.
