Are scribes the solution to our documentation woes?

In response to the increasing burdens of administrative work and cumbersome charting levied upon healthcare providers in recent years, medical scribes have been touted as a potential solution for streamlining the documentation process.  Interest in the use of scribes has certainly been increasing, with the American College of Medical Scribe Specialists estimating that the number of medical scribes nationally will increase from 15,000 in 2014 to more than 100,000 by 2020.

Who are medical scribes?

Medical scribes are often college students looking to gain exposure to the medical field, many of whom are planning on applying to medical or PA school in the future.  There are also those who work full-time as medical scribes. The salary of a medical scribe ranges from $13 to 18 per hour and the cost to hire a scribe is around $20 per hour.  While there are courses and certifications dedicated to medical scribing, medical scribes are not required to go through a certification process.

The precise role of the medical scribe will vary by institution, but they generally perform a variety of tasks with the goal of maximizing the provider’s workflow efficiency.  In addition to transcribing the medical chart, scribes may also obtain prior records, notify the provider of lab and imaging studies once resulted, and prepare discharge instructions.

A new twist to the medical scribe paradigm is the implementation of virtual scribes.  A virtual medical scribe remotely accompanies the physician during a patient interaction, documenting the encounter in the electronic medical records off-site.

Benefits

The most apparent purported benefit to having a scribe is increased productivity by minimizing the time spent on documentation and other secretarial tasks.  One retrospective study found that the use of scribes by emergency physicians was associated with improved overall productivity as measured by patients treated per hour and RVUs generated per hour.  A prospective cohort study at a tertiary academic ED, published in 2017, found that scribes enabled attending physicians to see more patients per hour, though they did not improve overall patient throughput.  In the primary care setting, the use of medical scribes has been associated with significant reductions in electronic health record documentation time and significant improvements in productivity.

Other benefits to using scribes, as reported by physicians who have worked with them, include better patient interactions, improved physician satisfaction, and potential mitigation of physician burnout.  Some feel that the quality of the patient encounter is improved by allowing the provider to focus more on the patient interaction than data entry.

The costs associated with the implementation of a scribe program or hiring an independent scribe are significant.  In addition to the salary of the scribe, other expenses may include costs associated with training, hardware and tech support.  Proponents of medical scribes argue that the increased productivity that results from the use of scribes offsets these costs.

Downsides

From my personal experience working with scribes, the biggest downsides are the variability in the quality of the scribes and their rapid turnover.  I found that it would take some time for a particular scribe to understand how I structure my workflow and document my charts. Our working dynamic would steadily improve, right up until they left for medical school.  A new batch of scribes would come in, and the process would have to start all over again. When working with an inexperienced scribe, I would often have to spend so much time modifying the chart to fit my documentation style or to make corrections, that I would have been better off documenting the chart on my own from the beginning.

Moreover, having an additional person in the room during the H&P also has the potential to negatively impact the provider-patient interaction.  It may even affect the accuracy of the history being obtained. I can certainly imagine a scenario where a young male would be less willing to discuss his penile discharge when a college-aged female is at the bedside transcribing the history, than if only the physician were present.  Patients are often in a very vulnerable state when presenting to an emergency department or clinic. It’s imperative that we try our best to create an environment that allows patients to speak comfortably about the most intimate details of their lives. Adding another person to the mix may hinder this.  While I have had patients tell me that they would prefer to be seen without the scribe present, some patients may not be as comfortable making such a request.

The upshot

To answer the question, whether scribes are the solution to our documentation woes, I would have to say “no.”  I’ve had great experiences working with scribes and have seen first-hand their ability to save documentation time and streamline the charting process.  However, a solution that requires every physician to have another person following them on their shift, whether it’s in-person or remotely, is not truly a solution.  Rather, it is a stop-gap measure that does nothing to address the underlying problems, inefficient EMRs, and burdensome compliance measures. The real solution will be the development of an EMR that is built with the focus on clinician usability, without sacrificing the ability to capture revenue.  With the advent of advanced speech recognition technology and artificial intelligence, which promise to simplify the way we will interact with our devices, I’m hopeful that such a system is on the horizon.

The author is an anonymous emergency physician who blogs at Efficient MD.

Image credit: Shutterstock.com

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