Is the integration of urgent, emergent, inpatient and
care of patients with
acute medical conditions.
Recently, the Report on Medicare Compliance (from Atlantic Information Services) published an opinion article about the use of scribes in healthcare. The premise of the article was that hospital executives and physicians should re-examine the benefits of scribes because compliance risks grow when scribes are allowed to make entries into electronic health records. Furthermore, the article questioned the gains in physician productivity from scribe utilization.
Are these authors practicing physicians themselves? Do they understand the growing clinical pressures and demands placed on healthcare providers today? Have they ever used an EMR in an acute care setting (like an ED) where providers are expected to see upwards of 3 patients per hour? My guess is that they have not.
I believe that the authors are not only misinformed, but that their article will hinder the advancement of EMRs and the modernization of the healthcare workforce.
Compliance risk is inherent in all forms of medical documentation. For this reason, hospitals have policies on timely completion of medical records—sometimes allowing up to 72hrs (or longer) for completion. Despite these policies, there are always some compliance risks.
Scribes generate the medical record during the patient encounter, contemporaneously. Furthermore, the providers themselves review 100% of the records and are responsible for the entries. So, how does using a scribe increase compliance risk? It doesn’t. It reduces compliance risk.
Does the criticism of medical scribes come from those who benefit directly from promoting EMR as a “game changer” for the healthcare industry, promising to increase physician productivity and cut healthcare costs?
The purpose of scribes is to document at the physicians’ direction during treatments so that the doctor can focus on patient care. Some doctors have commented that their shifts 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—and this delay can lead to inaccuracies.
To people who make and service expensive EMR systems, the existence of a scribe may look like competition and a threat to their business interests. Not only do I disagree with this, I think scribes could be the Trojan horse EMR companies so badly need.
EMR companies should harness the value of these tech savvy scribes who grew up in the Internet age. EMR companies should invest in training scribes to become “experts” on their EMR system.
Once fully trained, expert scribes can assist the providers on how best to use an EMR to full capacity. EMR companies could even write modules to help scribes manage and introduce the ‘bells and whistles’ to the team.
Scribes could be the conduit to enable EMR to start living up to its potential. With their technology savvy and close proximity to the healthcare team, scribes could start unleashing the power in EMR. In fact, I think they could be so valuable that EMR companies should start by paying their salary.
Trackback from Perspectives on the Acute Care Continuum
“Daddy, I want an iPad.” This is a common request heard by parents, but this one was coming from my daughter in medical school, who already possessed a MacBook and an iPhone! Just beginning her clinical rotations in her ... ...
And note that this is an "opinion" referenced in Dr. Ruben's comments. And would less thorough documentation (done by the physician rather than a scribe) pose a compliance/malpractice/quality risk? Risk is unavoidable. Managing risk is part of the necessary skills in EM.
I agree! EMR companies should train scribes to help launch their products in the hospital instead of sending expensive consultants to sit onsite for months. It would save money on both sides and the physicians would benefit from having the extra assistance with their charting.
I know physicians to be extremely careful when it comes to compliance risk and do in fact review all their records. Scribes are well-trained to know their roles and physicians are educated on how to use them appropriately and effectively. Many administrators, nurses, and providers that have scribes speak highly of the use of scribes. Scribes are a growing workforce because they greatly benefit the hospitals, physicians, and patient care (indirectly) at a low cost.
Great stuff. Thanks! One question few can answer in the EMR debate is "Who is going to enter all that patient data into these software tools?" If the answer is, "The doctor," then you've reduced your most highly-trained and biggest wage-earning professional int he healthcare food chain to being a $10-an-hour data entry clerk. Now that millions and millions have been invested in healthcare IT, it's time to start investing in and creating the healthcare workforce that is going to manage this IT -- scribes, data managers, whatever you want to call them.
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