EHR IMPLEMENTATION:Medical Scribes to the Rescue

Jason Ruben, MD

Electronic health records are supposed to revolutionize healthcare. Why now the physician backlash? As a practicing emergency physician I can attest that current EHR systems are so poorly designed that most emergency physicians I know loathe using them.

In the current geopolitical atmosphere, EHR software vendors feel compelled to rush their products to market, regardless of how poorly designed they might be. With healthcare reform and EHR Federal Mandate deadlines looming in the near future, these vendors would be crazy not to.

Will leading EHR systems like Allscripts, Cerner or Epic really revolutionize the healthcare industry? I doubt it. If the deep pockets of Google Health failed, what’s next?

The HITECH Act, the EHR Federal Mandate, and the Federal Stimulus Package are all designed to expedite adoption of EHRs. Unfortunately, many hospital executives are pressured to purchase EHR systems that “fit” into their existing IT platform regardless of physician usability. As a consequence, a 15-30% drop in physician productivity after EHR implementation has been well documented.[1] Furthermore, one study suggests physicians are ordering more tests because of EHR implementation.[2]

To offset this drop in productivity, many emergency departments now use medical scribes. Scribes work alongside physicians, nurse practitioners and physician assistants to provide real-time charting and a variety of other clerical tasks. Scribes are trained in medical terminology and documentation, and they are experts in their department’s specific documentation system.

The purpose of scribes is to document at the physician’s direction during treatments so that the doctor can focus on patient care. Some doctors have commented that their shifts with scribes are more rewarding because they get to take care of patients instead of having to sit in front of their computers. Many physicians without scribes complete charts at the end of their shift, or even days later--delays that can lead to inaccuracies.

The Joint Commission has already acknowledged the value and service of scribes and has published guidelines on their utilization.[3] To people who make and service expensive EHR systems, the existence of a scribe may look like competition and a threat to their business interests. This couldn’t be father from the truth.

EHR companies should harness the value of tech-savvy scribes who grew up in the Internet age. Once fully trained, expert scribes can assist physicians on how best to use an EHR to full capacity. EHR companies should invest in training scribes to become “experts” on their systems. The companies could even write modules to help scribes manage and introduce the “bells and whistles” of the system to the team. Ultimately, scribes could be the conduit that enables EHRs to start living up to their potential.

It will take more than the perfect EHR system and the use of scribes to rescue our healthcare system, but I’m optimistic nonetheless. As Dr. Atul Gawande observed in his 2011 commencement address at Harvard Medical School, “Where people in medicine combine their talents and efforts to design organized service to patients, extraordinary change can result.”[4]

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Dr. Ruben, an emergency physician at Marin General Hospital, directs the Scribe Program for CEP America.

Email: jasonruben@cep.com

References

1. Bhargava H, Mishra A, “Electronic medical records and physician productivity,” Social Science Research Network (Nov. 1, 2011).
2. McCormick D, et al, “Giving office-based physicians electronic access to patients’ prior imaging and lab results did not deter ordering of tests,” Health Affairs, 31:488-496 (2012).
3.  Joint Commission, “Use of unlicensed persons acting as scribes,” www.jointcommission.org (May 18, 2011).
4.  Gawande A, “Cowboys and pit crews,” New Yorker News Desk (May 26, 2011).