I have been covering the growth of the medical scribe industry in Lab Soft News for almost five years (see: Shift of Hospital EMR Data Entry Tasks from MDs to Scribes). You could see this trend coming for a long time. I believe that hospitals EHRs are not well designed and physicians and nurses are seeking some relief from the work burden imposed on them by these systems. A recent presentation of NPR provided some more details about the growing need for medical scribes in hospitals (see: Public radio examines explosive demand for medical scribes). Below is an excerpt from it:
The medical scribe industry is booming....“In the past year alone we have tripled our growth to probably just under 7,500 employees in 47 states,” [according to] Sarah Lamb, chief operations officer of Fort Lauderdale, Fla.-based medical scribe company Scribe America....,[It has been forecast] that the scribe workforce will quintuple from 20,000 today to 100,000 in 2020....“Unless we have some futuristic component where a physician can do live documentation while walking down the hall, there will always be a need for scribes,” said Lamb. Fueling the demand is the complexity of electronic medical records. “These records are way more comprehensive than the paper files or computer spreadsheets the hospital used to use.” [An emergency physician] at Cheyenne Regional Medical Center in Wyoming, Dr. Amy Tortorich, sees about 30 patients per day in the emergency department, and it takes about 10 minutes to document each encounter. “That’s an extra five hours charting. So [it's nearly] half my shift..... With this kind of time requirement, it is well worth the $13 an hour that lead ED scribe Tyrell Kirchhefer makes as he works toward his goal of getting into medical school, Tortorich said. However, Dr. George Gellert, medical informatics officer at Christus Health, Irving, Texas, argued that the medical scribe industry actually is standing in the way of progress by giving EMR developers a disincentive to improve the documentation functionality of their products.
I came away from reading this article with a few conclusions about this medical scribe trend:
- This article is one of the first I have seen that presents an estimate of the time required by physicians for their EHR efforts -- nearly half of the workday for the physician quoted. Some of my PCP colleagues tell me that they can't complete their "paperwork" requirements during their usual shift and need to complete the work at home. Decreases in physician and nurse productivity as well as the salaries of medical scribes contribute to the high operating requirements of EHRs. The capital cost of EHRs was listed in my post of yesterday discussing why I think that EHRs, as presently designed, are unsustainable over the long run (see: Ten Reasons Why the Current Hospital EHR Model Is Unsustainable).
- Note the reference above to the fact that the deployment of medical scribes is, in part, serving as a deterrent to the need to seek improvements in the EHR user interface (UI) and work flow design. Hospitals that have hired scribes may feel it is less necessary to try to influence their EHR vendors to improve the systems. In my "Ten Reasons" note of yesterday, I suggested that the influence of hospital CEOs on the EHR vendors was already rapidly diminishing due to the near-monopoly exercised by the companies and also due to the fact that the EHR vendors exercise control over many of the hospital strategic options.
- My "Back to the Future" caption for this post was triggered by my recollection in the far past of physicians "dictating" to hospital ward clerks their orders such as "lytes times three for patient Johnson." It was originally thought that having physicians entering orders directly in EHRs was efficient because they were the most knowledgeable about patients. Now, due to the inefficiency of EHR input and workflow, we are returning to the need for scribes who, like in the past, trail physicians and transfer their orders into the (now electronic) patient records.