Scribe Criticism is Unwarranted

The following is a guest blog post by Michael Murphy, MD CEO of ScribeAmerica.
Michael Murphy
It is clear there is a major amount of tension around the cumbersome technology associated with most electronic health records (EHRs). Unfortunately, some are blaming the technology’s limitations on the ever-popular Medical Scribe. Many have gone as far as to insinuate the use of medical scribes is the reason why technology is not developing quickly to resolve EHR problems – this is like saying that citizens paying their taxes are to blame for the government not seeking to balance the budget and exercise appropriate fiscal control. Can you honestly believe that the small minority of providers who find EHR acceptable due to scribes are what is preventing EHR companies from making improvements? No, it is a result of system and technology limitations.

A more comprehensive understanding of the scribe industry is needed instead of blaming them for the problems facing EHRs. Importantly, the scribe industry has developed over the years to improve patient care, protect the sacred provider/patient relationship and help to prevent physician burn out. Statements that The Joint Commission (TJC) cannot regulate or monitor scribes, are analogous to saying the local police department has no control over a city. There will always be “bad actors” willing to act outside of accepted industry norms, however, that does not mean that the TJC does not have control over the Scribe industry.

A few recent, ill-informed articles have recently circulated about Medical Scribes and it is only a matter of time before other writers rely on the incomplete information and slanted view of the article when gathering information on the topic. This will result in a continuous cycle of blaming scribes for a variety of shortcomings in the medical field beyond the original intended topic of the need for advancement in EHR technology.

Articles that improperly suggest a scribe would document services that were not performed to increase patient billing only serve to take focus away from any medical providers that may engage in fraudulent billing practices. Scribes do not share in revenues received from the physician’s practice and would have no reason to falsify services to increase revenues. Any concern over billing patient’s for services that were not provided should be directed at the medical provider who engages in such practice. Instead, the use of scribes will hopefully deter such unethical practices by physicians in the future as they will no longer be entering the information into a medical record with no one around to see what they are doing or question them on their actions. A scribe will act as a check and balance in the system by documenting only the services that are provided.

What about the providers who work sans scribe and document a full H&P and never took their stethoscope out of their pocket and only conversed with the patient once all the labs and CT results are back? Again, these providers are a minority in the grand scheme of things but to infer that adding a scribe into the equation increases the risk of chart copying or excessive over documentation is completely unfounded. If anything, the scribe adds an extra layer of accountability for the provider who might otherwise be tempted to ride the line of integrity due to the downward pressure by administration to see more patients faster and with greater quality.

The use of EHRs may have increased the demand of medical scribes recently, but there are many other factors that have contributed to the increase. Physicians went to medical school for four years and completed their residency programs to treat patients, not to become secretaries. Physicians truly want to engage their patients, take care of them and not be hamstrung with meaningful use, ICD­10, PQRS, or Core measures.

In the future scribes can assist with population health management data collection, which will free physicians to provide much needed patient education and will be vital to the solvency of Accountable Care Organizations. Additional pressure on physicians comes from falling reimbursements, which are forcing everyone to do more with less, an impending physician shortage and smaller health insurance networks. This all adds up to physician burnout, which is the primary driver of increased medical scribe utilization, not EHRs. Burnout has been reported nationally and will continue to increase if physicians do not seek assistance. Patients seek treatment with physicians based on their medical knowledge and skills, not based upon their data entry skills or knowledge of technology. Patients want to be treated with respect, which includes being seen promptly and being able to converse face to face with their physician while discussing their health concerns instead of being ignored while the physician is focusing on the data entry instead of the symptoms. The use of a scribe will allow the physician to focus on the patient and will most likely be in a better mood than the physician who is frustrated that his time is spent on data entry and not practicing medicine.

I applaud anyone in their desire to see EHR technology advance and improve, but suggest that more research be done on the topic instead of misplacing blame on the scribe industry just to publish an article on the topic. Collectively, we can and need to address the shortcomings of current EHR solutions and the resulting physician burnout.

Michael Murphy, MD CEO of ScribeAmerica
ScribeAmerica is a provider of medical scribes to hospitals and medical practices. Co-founders Michael Murphy and Luis Moreno met in 2002 and founded ScribeAmerica the following year in Lancaster, California. ScribeAmerica is the largest independent scribe company and they are committed to helping improve patient care by doing what we do best, continue to save doctors – one. click. at. a. time.

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1 Comment

  • I’ve observed a wide range in the use of scribes. In one ER that has ‘finally’ gone to an EHR instead of paper, the nurses usually do their own entry, but the doctors have a scribe walk around with them with some form of computer. The scribes sort of fade into the background and help the doctor pay more attention to the patient. However, there is still a problem there regarding work flow; the doctor does not seem to enter orders for test until he has completed a round of visits to patients, thus greatly delaying EKG, Xray, lab and other tests. Clearly someone does not yet fully understand that EHR is not just about taking notes.

    In an opthamology practice I use, doctors can do their own entry plus they have scribes who may also be ‘techs”. The younger doctors tend to do more of their own entry depending on what office they are in and what they are doing, but most of what happens is note taking. A tech runs off to another room to do an e-prescribe – and frequently that gets messed up as a result of losing the interaction with the patient while that gets done. They don’t quite fully get it, but at least their notes tend to be quite complete.

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