Emergence of the Electronic Scribe

The definition of a scribe is a person who writes books or documents by hand as a profession ad helps keep track of records.  This profession is found in all literate cultures and lost most of its importance with the invention of printing press. 

The modern medical scribe is more a data jockey than a hand writer.  With the advent and proliferation of the Electronic Health Record (EHR), providers are forced to add more people power to document their records.  Originally most records were handwritten and/or dictated.  The downsides of handwriting are illegibility, incoherence, and lack of completeness.  Dictated report are often incoherent and filled with mistakes.

The EHR solution where the provider would type organized, logical data collection giving the document a realistic reflection of a clinical interaction. 

This assumption unfortunately does not translate into the reality of time constraints, lack of computer skills and difficult user platforms.  Providers became data entry clerks and charts are written in "computereeze".

Administrators and providers needed solutions.  Thus was born the medical scribe- an ancient Egyptian worker to document the history of what was happening.  Scribes follow the provider and inputs data into the EHR.  In lieu of using a scribe, voice activated technology.  The provider can dictate key information directly in the EHR.  Both of these solutions still have down sides such as incoherence and providers lack of computer skills, but are better than the third option of overtime typing/clicking everything yourself.

The negatives of scribes are costs, potential lack of accuracy during the filtering process and fundamental distaste of hiring more people to function normally.  EHR technology was meant to simplify the process, not exponentially complicate it.  The creation of the EHR has also created an unfunded mandate to provide more information to the government with the goal of solving human interactions by computers.  Computers are tremendous assistants, but rarely solve interpersonal relationships with multiple variables like provider patient interactions.

Scribes have evolved into "clickers of data" and probably do not handwrite anymore.  There should be a better solution in the modern era.

Medical Scribes, Voice Activated Technology and the EHR

Back by populate demand.  The newswires have been blowing up lately with article about medical scribes and data governance.  A good article to reference this issue is Will Medical Scribes Limit Innovation in HIM, EHR Documentation?  It addresses the rise of medical scribes, EHRs, health information management (HIM) and data governance.  Take a look at the article and re-read the blog from 2013 written on the subject.  Enjoy!

 

 

 

This is an interesting problem with strong advocates on both side of the equation.

After going to the recent ACEP conference, it was apparent that scribe companies are coming "Out of the Woodwork" to offset the labor intensive enterprise Electronic Health Records being imposed on most emergency departments.  Scribes cost approximately $12 - $18 per hour each.  To offset these costs, the provider must see 2 - 3 more patient per shift.  At this point with a general reduction of 20% of productivity per provider, this is not happening overall.  Providers are struggling to stay even.  In institutions where a scribe can function as a medical assistant, a "Go-For", data acquirer from the old medical records, interact with the patients, and print discharge instructions and prescriptions, the extra work is a plus.  This is how most urgent cares function with an all-encompassing medical assistant with multiple roles.  In institutions where the scribe just inputs what the provider states, they are expensive transcriptionists and typists.

Voice Activated technology is an extremely efficient alternative to transcription at much lower overall costs. The provider can dictate key components of the history of present illness and the assessment and plan- medical decision making sections of the records.  This creates a unique non-cookie-cutter chart which helps the private MD, consultants, and your own colleagues, if the patient returns for follow-up.  The problems come in where the EHR is not directly designed without a lot of work-arounds to allow easy dictation.  The initial cost is $1,500 per provider, but transcription costs $7 - $8 chart and the money is regained in time with increased productivity.

Which one is recommended?  It depends on the work flow of the ED, the EHR, and the personality of the provider.  My personal preference is a user-friendly EHR and VAT, so you can take the savings to buy more physician assistant and/or nurse practitioner FTE's.  This hopefully will lead to increased throughput, higher revenues, and increased patient and administration satisfaction.  If my scribe is an all-purpose medical assistant, this would make a reasonable alternative.