Scribes

I’m willing to give the Affordable Care Act several more months before I finally decide that it is as poorly conceived and executed as it appears to be at the moment. However, when it comes to the efforts by the federal government to speed the adoption of electronic health records, I’m sure that the result has been several giant steps backward for both the quality of medical care and the level of satisfaction for the physicians in this country.

Doctors who have begun to use electronic health records (EHRs) are finding that they are spending more hours of their day in front of a computer screen doing clerical work. If they can’t afford to see fewer patients, the result is an extra hour or two at the end of the day catching up with the paperless work. This means that hours of family and rejuvenation time that were already in short supply are lost. A recent survey by Mark William Friedberg of the Rand Corp. and his associates listed the burden caused by electronic health records as the leading contributor to physician dissatisfaction. Neither physicians nor their patients are happy with the loss of eye to eye contact that also accompanies the adoption of EHRs.

I suspect that most physicians continue to hold out hope that computerized medical records will prove to benefit patient care in the long run. But, their patience has worn so thin it is easy to see the frustration on their faces and hear it in their voices. Those of us who have already endured more than once the steep learning curve that comes with a new computer system have found that at the top of the curve is a plateau – a plateau that leaves us no more productive than we were when we started the painful and expensive climb, despite promises from the vendors and administrators who bought their sales pitches.

But, there may be a solution to at least some of the downside to electronic health records, namely, scribes. A scribe is an assistant who accompanies the physician as he sees patients and records the pertinent information generated from the visit in real time. The result is a completed medical record and a bill for services without the physician having to lift a pen, move a cursor, or take her eyes off the patient. It is estimated that there are nearly 10,000 scribes working in this country, and there are companies who promise to provide a turnkey operation that includes hiring, training, and updating skills. The charge for the service runs about $20-$25 per hour, with the scribe receiving $8-$16 per hour.

Scribes have been most popular in hospitals and emergency departments where the expense may be less of a hurdle than elsewhere, but they work in outpatient settings as well. The issue of confidentiality has been raised, but it doesn’t seem to have been a problem. Patients are accustomed to having a nurse or chaperone, and for many years haven’t expressed much concern about having their medical records read or listened to by transcriptionists.

If I were still in practice, I think I could easily rationalize the cost of a scribe if he or she allowed me to get home an hour or two earlier. I suspect my children would even have been willing to chip in some of their allowance to fund the service if it allowed their father to show up for dinner and in a sunnier frame of mind.

Two little wrinkles come to mind, but I think they could be easily ironed out. My exam rooms have never been terribly spacious, and now that two parents and a grandparent often accompany the patient, I wonder where we would put another warm body. And, with the increasing volume of mental health–related visits that pediatricians are seeing, I can imagine a few situations in which the presence of a scribe might be a deterrent to effective communication. However, I am sure that it would be easy to arrange a system in which the physician wore a microphone that would connect to the scribe in another room. A prominently displayed sign reminding the patient that a scribe was listening and recording would blend in with the other informational signs that paper the walls of most examining rooms and are being ignored.

So what do you think? Would a scribe system work for you? Would it be worth the expense? Can you imagine some downsides that I haven’t considered?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com. Scan this QR code or go to pediatricnews.com to read similar columns.

I’m willing to give the Affordable Care Act several more months before I finally decide that it is as poorly conceived and executed as it appears to be at the moment. However, when it comes to the efforts by the federal government to speed the adoption of electronic health records, I’m sure that the result has been several giant steps backward for both the quality of medical care and the level of satisfaction for the physicians in this country.

Doctors who have begun to use electronic health records (EHRs) are finding that they are spending more hours of their day in front of a computer screen doing clerical work. If they can’t afford to see fewer patients, the result is an extra hour or two at the end of the day catching up with the paperless work. This means that hours of family and rejuvenation time that were already in short supply are lost. A recent survey by Mark William Friedberg of the Rand Corp. and his associates listed the burden caused by electronic health records as the leading contributor to physician dissatisfaction. Neither physicians nor their patients are happy with the loss of eye to eye contact that also accompanies the adoption of EHRs.

I suspect that most physicians continue to hold out hope that computerized medical records will prove to benefit patient care in the long run. But, their patience has worn so thin it is easy to see the frustration on their faces and hear it in their voices. Those of us who have already endured more than once the steep learning curve that comes with a new computer system have found that at the top of the curve is a plateau – a plateau that leaves us no more productive than we were when we started the painful and expensive climb, despite promises from the vendors and administrators who bought their sales pitches.

But, there may be a solution to at least some of the downside to electronic health records, namely, scribes. A scribe is an assistant who accompanies the physician as he sees patients and records the pertinent information generated from the visit in real time. The result is a completed medical record and a bill for services without the physician having to lift a pen, move a cursor, or take her eyes off the patient. It is estimated that there are nearly 10,000 scribes working in this country, and there are companies who promise to provide a turnkey operation that includes hiring, training, and updating skills. The charge for the service runs about $20-$25 per hour, with the scribe receiving $8-$16 per hour.

Scribes have been most popular in hospitals and emergency departments where the expense may be less of a hurdle than elsewhere, but they work in outpatient settings as well. The issue of confidentiality has been raised, but it doesn’t seem to have been a problem. Patients are accustomed to having a nurse or chaperone, and for many years haven’t expressed much concern about having their medical records read or listened to by transcriptionists.

If I were still in practice, I think I could easily rationalize the cost of a scribe if he or she allowed me to get home an hour or two earlier. I suspect my children would even have been willing to chip in some of their allowance to fund the service if it allowed their father to show up for dinner and in a sunnier frame of mind.

Two little wrinkles come to mind, but I think they could be easily ironed out. My exam rooms have never been terribly spacious, and now that two parents and a grandparent often accompany the patient, I wonder where we would put another warm body. And, with the increasing volume of mental health–related visits that pediatricians are seeing, I can imagine a few situations in which the presence of a scribe might be a deterrent to effective communication. However, I am sure that it would be easy to arrange a system in which the physician wore a microphone that would connect to the scribe in another room. A prominently displayed sign reminding the patient that a scribe was listening and recording would blend in with the other informational signs that paper the walls of most examining rooms and are being ignored.

So what do you think? Would a scribe system work for you? Would it be worth the expense? Can you imagine some downsides that I haven’t considered?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com. Scan this QR code or go to pediatricnews.com to read similar columns.

I’m willing to give the Affordable Care Act several more months before I finally decide that it is as poorly conceived and executed as it appears to be at the moment. However, when it comes to the efforts by the federal government to speed the adoption of electronic health records, I’m sure that the result has been several giant steps backward for both the quality of medical care and the level of satisfaction for the physicians in this country.

Doctors who have begun to use electronic health records (EHRs) are finding that they are spending more hours of their day in front of a computer screen doing clerical work. If they can’t afford to see fewer patients, the result is an extra hour or two at the end of the day catching up with the paperless work. This means that hours of family and rejuvenation time that were already in short supply are lost. A recent survey by Mark William Friedberg of the Rand Corp. and his associates listed the burden caused by electronic health records as the leading contributor to physician dissatisfaction. Neither physicians nor their patients are happy with the loss of eye to eye contact that also accompanies the adoption of EHRs.

I suspect that most physicians continue to hold out hope that computerized medical records will prove to benefit patient care in the long run. But, their patience has worn so thin it is easy to see the frustration on their faces and hear it in their voices. Those of us who have already endured more than once the steep learning curve that comes with a new computer system have found that at the top of the curve is a plateau – a plateau that leaves us no more productive than we were when we started the painful and expensive climb, despite promises from the vendors and administrators who bought their sales pitches.

But, there may be a solution to at least some of the downside to electronic health records, namely, scribes. A scribe is an assistant who accompanies the physician as he sees patients and records the pertinent information generated from the visit in real time. The result is a completed medical record and a bill for services without the physician having to lift a pen, move a cursor, or take her eyes off the patient. It is estimated that there are nearly 10,000 scribes working in this country, and there are companies who promise to provide a turnkey operation that includes hiring, training, and updating skills. The charge for the service runs about $20-$25 per hour, with the scribe receiving $8-$16 per hour.

Scribes have been most popular in hospitals and emergency departments where the expense may be less of a hurdle than elsewhere, but they work in outpatient settings as well. The issue of confidentiality has been raised, but it doesn’t seem to have been a problem. Patients are accustomed to having a nurse or chaperone, and for many years haven’t expressed much concern about having their medical records read or listened to by transcriptionists.

If I were still in practice, I think I could easily rationalize the cost of a scribe if he or she allowed me to get home an hour or two earlier. I suspect my children would even have been willing to chip in some of their allowance to fund the service if it allowed their father to show up for dinner and in a sunnier frame of mind.

Two little wrinkles come to mind, but I think they could be easily ironed out. My exam rooms have never been terribly spacious, and now that two parents and a grandparent often accompany the patient, I wonder where we would put another warm body. And, with the increasing volume of mental health–related visits that pediatricians are seeing, I can imagine a few situations in which the presence of a scribe might be a deterrent to effective communication. However, I am sure that it would be easy to arrange a system in which the physician wore a microphone that would connect to the scribe in another room. A prominently displayed sign reminding the patient that a scribe was listening and recording would blend in with the other informational signs that paper the walls of most examining rooms and are being ignored.

So what do you think? Would a scribe system work for you? Would it be worth the expense? Can you imagine some downsides that I haven’t considered?

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including "How to Say No to Your Toddler." E-mail him at pdnews@ frontlinemedcom.com. Scan this QR code or go to pediatricnews.com to read similar columns.