Another frequently voiced complaint is that EMRs require physicians to enter data with their backs to patients. Instead of interacting with the patient, these physicians are interacting with their computer screens.
Explore This IssueOctober 2014
By asking doctors to become data entry clerks, we are expending their energies incorrectly.
—Asfer Shariff, MD
“Communicating with the scribes means I also communicate with the patient,” said Dr. Shariff. “I have to verbalize everything I am doing so the scribe can enter the information in the EMR. The patient also hears what I am saying and better understands my thought processes [and] the implications, and is provided additional information that they need.”
Main Models of Scribe Interaction
There are three basic models for a scribe-assisted EMR program:
- The scribe has a laptop and follows the physician through the day;
- The physician uses offsite personnel connected via Internet and voice communications; or
- The physician uses a hybrid model with practice employees in another room.
The major drawback to the first option is that the scenario puts another person into an already cramped exam room. In addition, the physician’s thoughts may be disrupted as she and the scribe pass the computer back and forth to allow the physician to access patient information during the exam.
In both the remote and hybrid models, the scribe and physician are connected by phone or computer. The physician sees the patient and describes what she is doing and viewing while the scribe follows along, accessing the template information.
At her convenience, the physician accesses a computer terminal, communicates additional information that she wants charted, validates prescriptions and test orders, reviews the coding information, and signs off. She is then free to see the next patient, have lunch, or go home.
The offsite scribe model has some advantages. The scribes typically work with more than one set of physicians, making a larger pool of workers available. Losing one or two scribes to vacation or sick days does not cause the coverage problems that it might in an office-based system.
Onsite personnel, on the other hand, may already know the systems and get up to speed faster. Dr. Lipman minimizes coverage problems by cross-training medical assistants and nurses as scribes. “Medical practices are notorious for hiring someone and assuming they know everything in a week,” said Toth. “If you are getting a scribe, you have to commit to training [and] orientation and know [that] for the first month they will be learning. You haven’t failed because things did not go well right away.”