In two recent posts, I have reported on the growing use of EMR scribes in hospitals (see: Shift of Hospital EMR Data Entry Tasks from MDs to Scribes; Medical Students Recruited to Serve as EMR Scribes in Toledo). It makes no sense to use physicians and nurses as data entry clerks for the EMR. The user interfaces of these systems are still too awkward for these personnel to perform the necessary tasks quickly and efficiently. Hence, hospitals associated with medical schools are turning to medical students to serve as EMR scribes. These students bring to the job some knowledge of medical nomenclature and benefit from the early exposure to the patient care environment. Other hospitals are turning to college students or other suitable candidates in the community after some training. A Google search for the terms medical student, scribe, and EMR yielded 6,880 hits. A search for scribe and EMR yielded 83,300 hits.
As you might expect, some roadblocks to this EMR scribe scenario are now being encountered. They are detailed in the blog note by Douglas Perednia, MD (see: Scribes lead to unintended consequences from electronic medical records). Below are some details excerpted from the note:
- ...[It appears] that the [EMR scribe] phenomenon is is here to stay for as long as most “conventional” EMRs remain fundamentally defective. As [has been astutely observed in the past], “you should not have to work around something that is not in the way.”
- Only $8-$10 per hour for these [student] folks? Of course, all of this assumes that the average medical clinic is willing to hire someone who is: (1) virtually guaranteed to be a temporary and/or part-time employee; (2) hand them a computer; (3) train them in the use of the current EMR du jour (a process which typically takes months to years); (4) cater to their college classes with complex clinic coverage schedules; and (5) then do the same with dozens of other students who will fill in for the rest of the working hours.
- The good news is that [emerging commercial] scribe services train these young bucks and does for you, so that your office, clinic or emergency room doesn’t have to. The bad news? Now their services, “typically cost $20 to $26 an hour, said Alex Geesbreght, president of PhysAssist Scribes in Fort Worth.” Gosh, that’s a lot more than $8-$10 per hour. Let’s see. That amounts to just about $50,000 per scribe per year. What the heck will all of this cost?
Whenever a hospital announces an anticipated "cost" of an EMR, you need to take a hard look at the number. I won't go into details but you need only ask the following question: what's the total cost of ownership (TCO) for the new system? Suffice it to say that you will generally need to double or even quadruple the dollar figure that comes out of the C-suite. It's usually in the executives' best interests to ensure that the projected cost for a new EMR is large enough to engender respect for the project but not so large that people faint. When looking at the figure, it's important to differentiate between operating costs and capital costs. We now come to understand with this discussion of EMR scribes that the former may begin to escalate (see: Is Cerner Modifying Its EMR Business Model?). With a new EMR, this can happen in two ways. The first is that the productivity of physicians and nurses begins to decline if they spend large parts of their days inputting data into the system. Alternatively, the hospital can hire incremental EMR scribes that can cost ~$50,000 per year to perform this additional work.