Hospitals are the only large enterprises I know that require their most skilled and frequently highest paid employees, physicians, to act as data entry clerks. This policy made some sense in the case of physician trainees who were not in a position to push back and were still learning the ropes. In the case of community physicians who admit their patients to the hospital, they are not hospital employees and their work efficiency is not of major concern to hospital executives. This situation is changing rapidly with the much broader deployment of EMRs and the rapidly expanding ranks of hospitalists. These latter personnel are physicians on the hospital payroll and hospital executives are now more interested in how they spend their time. Enter the "medical scribe" into this mix, a new category of low-level hospital employees who function as a physician and nurse-extenders -- a human interface with the EMR (see: Scribes are doctors' tech support). There are now even companies that supply medical scribes to hospitals. Below is an excerpt from an article discussing this change in hospital operations:
Melissa Genove ...is the chief medical scribe in the hospital's emergency department — and one of several thousand young people pioneering a new healthcare field. Scribes are filling a necessary niche as doctors make the wrenching transition from old-fashioned paper charts to 21st century electronic medical records. The computerized system is supposed to make doctors more efficient and ensure better care for patients. Congress has such faith in the value of electronic medical records that it provided as much as $27 billion over 10 years to encourage doctors to use them, and the Centers for Medicare and Medicaid Services will penalize those who don't by cutting their reimbursement rates as much as 5%. But while the conversion is underway, doctors estimate that their productivity plummets by about 30% as they learn to cope with a complicated new system. That's where scribes come in. Like Genove, they are typically young, tech-savvy and undaunted by computers. They are willing to work for $8 to $10 an hour with no benefits. Most do the job part-time as college students and plan to go on to full-time careers in medicine or nursing. They say the experience gives them a valuable head start...."The physicians were spending too much time documenting and not enough time with the patient," said Dr. Robert Steele, chief of Loma Linda's emergency department, which began using scribes in November. "The solution was to take the doctors off the computer, put them at the bedside, and let the scribe do the transcription. It's been a huge success. The physicians love it."
It should come as no surprise that "medical scribes" are first appearing in hospital Emergency Departments. The action in such units is fast and furious and patient throughput is the name of the game. No time for physicians or nurses to peck away at the computer keyboards. Even the deployment of tablet computers in such settings could serve as a distraction. As noted above, the scribes will be working at minimal wages and the doctors will be much happier. So what's the problem?
The problem is that healthcare IT and EMRs are supposed to provide superior documentation at a lower cost. Secretaries are disappearing in many organizations as company managers, even high ranking ones, manipulate their own on-line calendars and communicate with customers and colleagues via email. Show me a business other then healthcare where they are hiring "scribes" for computer data input. Our EMR user-interfaces are often poorly designed and antiquated. By 2010. physicians should be documenting patient examinations, progress notes, and medication orders using advanced voice recognition (VR) technology. Instead we are adding yet more specialized personnel to the inpatient teams and making healthcare process even more complicated and expensive.