One of the limiting factors when it comes to EMR systems is that it requires some amount of training to use an EMR system. Doctors are in the habit of writing down notes, or dictating them into dictaphones for transcribing later. So the idea of an EMR system that requires typed input can easily face some resistance, just based on the process change it requires. And hence the rise of a new class of health IT worker – the scribe.
Having a scribe taking notes at hand would’ve seriously helped me like my doctor better at my last appointment. This was someone whom I was meeting on account of a referral – I didn’t already have an established relationship with the doctor. The doctor and an assistant spent about a third of their time figuring out how to enter my scans into the EMR system. I don’t know what was at fault – the newly acquired iPad or an EMR they didn’t know how to use. They were effusive with their apologies but I couldn’t help feeling that I got the short end of the stick when the doc rushed through the rest of my visit and quickly ushered me out. A competent scribe, well versed in their EMR of choice, might have really helped.
There have been a slew of articles about the rise of scribes in health IT. They started sounding really promising to me, especially when I considered how one could tail a doctor on his/her rounds with patients, and gain some insight into the business of being a doctor from the ground up. I checked out a couple of companies (ScribeAmerica, EM Scribe Systems) that train medical scribes and source them out to ERs. EM Scribe Systems’ application form states that it requires a one or two year commitment, wants to know what your future med school plans are. The pay anywhere is between $8-$16/hour (scroll to the bottom of the page). The higher end of that range gets paid with scribe experience.
(Seriously? If medical transcription can be outsourced to India and Philippines, why set the bar so high for medical scribe jobs? Or alternatively, if the bar is so high, why not pay better?)
I guess the pre-med scribes are approaching it from a different aspect – the real payback for them comes from understanding the medical aspect. The EMR system is merely a tool to an end.
While I generally agree w/ John on most issues, I generally disagree w/ the scribe solution. In some cases, like ER providers where sometimes both hands nee to be free to hold an aorta together, it makes perfect sense.
But in the case of small partnerships and Community Health Clinic with tight budgets, it is just not feasible to add a whole new set of FTE’s. In these cases providers and administrators need to find creative ways to “fumble” through that learning period (i.e. more training time, lighter schedules, etc).
Let’s not forget that the EHR incentives are meant to off-set the cost of that extra training time and those lighter schedules.
There is another option that costs less than scribes AND encourages physicians to put fingers on keyboards, or touch screens. It is outsourced data abstraction services. Here’s how it works.
Nurses, coders and other ancillary clinical staff are employed (directly or through an outsourced agreement) to hand-key patient data into the new EMR templates. Information such as meds, allergies, family history, social history, and medical history are manually transferred from paper charts or legacy EMRs to the new system.
Physicians get complete patient information on day one or first patient visit. Much easier for MDs to simply update existing information than manually key everything right there, on the spot. Saves them about 30 minutes per visit.
There may still be a need for scribes going forward, but at less cost and frequency.
Thanks for your insightful comments.
Wes Kemp, I’m beginning to see the expenditure behind health IT products. You’re right, having a scribe makes no sense for small practices, especially as FTEs. Maybe contract/PT scribes will lessen the outlay?
Beth Friedman, I thought something along the same lines for a doctor friend of mine, who said he had no problems with entering data into the EMR for new patients, but was daunted by the amount of work with all the older paper records. But I’d be interested in knowing how much these services cost. Would they be more economical than hiring a part-time scribe?