The introduction of electronic medical records (EMR) into medical practices has occasionally—in some cases, frequently—resulted in frustration and complaints from physicians. Many of these frustrations center around EMR interference with patient interaction and the extra time needed to complete charting.
Enter the scribes. These individuals, who usually have at least some medical background, work under the direction of the physician to perform the data entry and management associated with charting.
“Scribing is not listening to what the doctor says and writing it down; that could be done with voice recognition software,” said Sidney Lipman, MD, a private practice physician with ENT
Specialists in Erie, Penn. “We like to call our scribes “data management specialists” because only a human can effectively manage data at the level we need. They are managing the entire realm of data in the patient’s EMR.”
Current EMRs are heavily templated, making pure narrative charting no longer viable. In addition, test results and old notes are spread out over the computer instead of located in specific sections of the paper chart. Scribes can typically find this information faster, and for less money, than physicians can. “Would you pay a doctor’s wage of $240 an hour to have someone type and click information into an EMR?” asked Asfer Shariff, MD, with ENT Physicians, Inc., in Toledo, Ohio. “You don’t see radiologists operating their own CT scanners; they have technicians so their mental energies are devoted to interpreting data and managing the patient. By asking doctors to become data entry clerks, we are expending their energies incorrectly.”
Adding a scribe to a practice can make an impressive difference. Dr. Shariff, who also owns Physician’s Angels, a company that links offsite “virtual” scribes with physician practices, said he is seeing approximately $50,000 a year in increased profits per physician per year across multiple specialties with the addition of a scribe. Dr. Lipman’s group found revenue was up 32% within a few months.
Revenue enhancements may not be the most important outcome to the physician. Quality of life issues are often cited. “Doctors go home sooner because there’s no documentation to do after clinical hours,” said Cheryl Toth, practice leadership and implementation coach with KarenZupko and Associates in Chicago. “They don’t have to log in from home or stay at the office until 7 o’clock each night to complete their charting. Basically, when the clinic is done, the charts are pretty much finished and ready to be signed off.”
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.
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.”
The scribe issue really boils down to what the individual physician wants and needs from his or her practice. “It is a decision based on how much you want to work, what you enjoy doing, and your future plans,” said Dr. Shariff. “I like a busy office, and hanging out with patients is the best part of my day. No doctor likes the paperwork, so anything we can do to lessen it leaves more time for the patient and our family.”
Kurt Ullman is a freelance medical writer based in Indiana.