How will the rise of medical scribes impact EHR documentation, health information management, and data governance?
By Jennifer Bresnick on January 05, 2015
It’s no secret that EHR documentation has been a major pain point for physicians since the very beginning of the EHR Incentive Programs. Poorly designed software, a lack of familiarity with technology, the added burden of reporting for meaningful use and other quality initiatives, and a general sense that laptops are a significant obstacle in the patient-provider relationship have left a number of physicians apprehensive of using EHRs. Some physicians are so fed up with the EHR time suck that they have turned to medical scribes to do the heavy keyboard work instead.
While this initially seems like the perfect way to improve efficiency, not everyone is convinced that EHR documentation produced by these scribes – credentialed data entry experts who typically do not hold a medical license – will be a positive development for the EHR industry. A team of experts from CHRISTUS Health in Texas, led by George A. Gellert, MD, MPH, MPA, argue in a JAMA viewpoint article that scribes are just a temporary bandage for a much deeper wound: the inability of the EHR vendor community to produce software that allows physicians to do their own documentation without losing minutes or hours each day on data entry.
With the rise of data analytics pressuring the healthcare industry to produce consistently clean, complete, and accurate documentation, the focus on data governance has never been stronger. Medical scribes may not be allowed to create documentation independently of their supervising physician, according to The Joint Commission, and CMS may frown upon the notion of scribes being able to enter orders using CPOE systems, but they still create an added layer of interference between the physician and the chart, which may increase the potential for human error.
“With problems associated with EHRs so substantial—and physicians’ experiences using medical scribes so positive—are there any risks engendered by the rise of a medical scribe industry and its potential for becoming integral to US health care delivery?” Gellert asks. “Despite scribes’ reported value, this industry should be viewed as what it is: a workaround or adaptation to the suboptimal state of today’s EHRs.”
Gellert fears that the rise of medical scribes may lead EHR developers to push innovation off their lists of top priorities, leading the industry to “a deceleration and possibly stagnation in EHR technological improvement.” Relying on scribes to do the dirty work of EHR documentation may also lead physicians to relax their view of what their helpers should or should not do, and might even lead to scribes operating outside of their purview as the lines blur. After all of the progress the industry has made towards utilizing electronic data for quality initiatives and clinical analytics, will scribes push the healthcare ecosystem back into the ignoble mire of lackadaisical documentation and inadequate data governance?
Not according to physicians who use them. A 2013 study at the United Heart and Vascular Clinic in Minnesota found that medical scribes cut down patient consult prep time by one third and saved close to $2500 per patient in direct and indirect costs, says study author Dr. Alan J. Bank.
“To me, it doesn’t make economic sense to have a doctor who’s getting paid a good salary and has all the training to be sitting there typing or filling out forms,” Bank told EHRintelligence. “Someone else can do it just as well or better. And a lot of physicians are getting worn out. They’re just getting tired. But if we made things easier for physicians and took some of the paperwork away, it would be better for everybody. As doctors, we want to take care of patients. We don’t want to be typists.”
Medical scribes may indeed be a workaround for software that does not adequately meet a physician’s needs, but even Gellert admits that after years of EHR vendors competing for a white hot market of meaningful use hopefuls, the industry has not been able to conquer its data governance and health information management challenges. “Even after a decade of use, some EHRs and CPOE may not compete with the speed of a paper checklist, and may never,” he writes, but maintains that physician pressure on the commercial market, if applied consistently and firmly, will lead to heretofore unseen leaps in EHR innovation.
But while the industry is waiting for these improvements to be made, should they suffer with the potential for financial losses, the rampant dissatisfaction, and the risk of burnout that is reducing an already inadequate number of physicians operating in a rapidly changing industry? Or can medical scribes provide a useful stopgap and necessary support to physicians on the brink of calling it quits? Gellert believes that once a physician uses a scribe to relieve the pressure, it’s only a matter of time before that scribe becomes indispensable, despite the risks and perhaps despite the eventual availability of improved technology. The risk is simply too high to justify the short-term benefits, he says.
“The answer to today’s inadequate EHRs is not scribe support,” he concludes. “The use of scribes can pose potential risks to patients if they are allowed to enter orders into the EHR, and the risk of use creep is high. The medical scribe industry may impede the technological evolution of EHR products by undermining market demand for needed improvement, and it is unlikely that scribes will be used only as a temporary solution. The rise of the medical scribe industry should not be a substitute for much-needed EHR innovation and transition to more highly effective and more functionally efficient EHR systems.”