Scribe In The ED: A Consumer View

The other day, after a month of sore throat and sinus problems and three useless primary care visits , I hit the emergency department. It was midnight or so, and the place was very quiet for a decent-sized community hospital. I wasn’t sure what to expect.

When the doctor came in to check me out, I was pleasantly surprised to see another man, entering with the doctor, introduced as the “scribe.”  I was happy because I think the scribe model works; it allows doctors to focus on patients while making sure well-structured data ends up in the EMR.

And having structured documentation in place is increasingly looking like a good thing.  According to a study published last month in the Journal of the American Medical Informatics Association, researchers concluded that doctors who have an EMR available but dictate patient notes provide a lower quality of care than physicians do who use structured documentation.

For someone who was performing such an important task, our scribe was nearly invisible.  Without a word, he stepped in front of a wall-hung monitor and began taking notes as I discussed my issues.  (In other words, if people fear that a scribe would be intrusive, they’re probably wrong.)

The doctor and I chatted and made eye contact, and the scribe captured the essence of our conversation.  The doctor was in and out within 5 minutes, but somehow, I felt confident that we — doctor, scribe and me — had gotten the job of documenting my concerns done properly.

Folks, I have no idea what they paid the young-ish man who scribed for my doctor. But as both a patient and a professional researcher, I’m heartily in favor of the investment.  Anything that seems to both improve quality and improve perceptions of quality has got to be worth it.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

6 Comments

  • Hm, I wonder if the scribe was a displaced former medical transcriptionist. Seems like the perfect next job for former MTs.

  • Seems like a great system for the rushed environment of the ER. Would love to know how many hospitals do this.

    Also..Anne, I love your posts. I don’t see the box you can check to be notified if others respond to your posts. What’s up?

  • Ann, I’m sure this was a very pleasant experience for both you and the doctor. I would love to have a young man drive me to work every day so I can concentrate on answering emails, texting, and making calls or a young man follow me to meetings all day taking notes, writing up action lists, and allowing me to focus on the conversation but I can’t afford it. Neither can the vast majority of hospitals and practices. Scribes and Dragon hybrid EMR’s are the crutches that have developed to allow poorly developed software to function in the Emergency Department without bringing things to a complete halt. How about just designing applications that are intuitive and don’t negatively impact productivity instead? They are out there in some of the best of breeds but the HIS vendors don’t see the value in dumping resources into a module that will get shoved down the docs and nurses throat by Administration and CIO’s regardless of usability just to maintain a one vendor shop.

  • I agree with the idea of better designed apps. The ER doc should have a ‘tight’ system that easily and quickly narrows down fields to be filled out to minimize data entry needs to what is actually necessary. Depending on circumstances, a nurse or medic or PA and even the triage nurse can get a lot of things filled in; the doc can scan and ask but not have to repeat such data entry. Also, I figure that if my Android phone can take dictation of texts and emails, plus commands for navigation, then maybe some of the entry could be done by voice, though I understand that noisy ER’s could make that difficult.

    I’d also like to see the monitoring gear in an ER ‘room’ be hooked up to the patient’s EHR, so BP, pulse, O2 level, and even samples from the bedside EKG be recorded, along perhaps with samples uploaded from the medic (from an ambulance)’s EKG gear. Imagine that when they first reach a patient and record a trace that shows a problem, then administer something to correct it; once the person reaches an ER the ER’s EKG may not show what happened – but it could all still be stored in the medic’s equipment. When you think about it, everything the medic currently writes down in the field should be entered into a portable EHR related device that can get things started even before arrival at the ER. Same thing when a doctor tells a patient to get to the ER asap; when the doctor calls in the ER to let them know a patient is on the way, that should get things started with data from the doctor sent to the ER.

  • Scribes is a dead end.
    As it is already mentioned above :
    Unneeded expensive stopgap measure to poorly designed software.
    Idea is mostly supported by dinosaur vendors.

  • I’ve seen scribes used effectively in hospital settings, as well. We need to be open to allowing docs the choice of personally using an EHR while treating patients or not. If the scribe is a trusted employee that “knows” the doc inside and out from working together, this can be a win-win for all concerned: The docs treats patients as usual. The patient receives the care he deserves and the patient data gets input in the EHR/EMR. And ultimatly, the provider office meets MU ?!

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