Medical scribes are now in high demand in hospitals and large clinic settings. These personnel are basically "electronic transcriptionists" who were first deployed in hospital Emergency Departments (EDs) to transcribe clinical data into the EMR on behalf of nurses and physicians (see: The Emergence of EMR Scribes as a New Category of Hospital Employees; Shift of Hospital EMR Data Entry Tasks from MDs to Scribes; Medical Students Recruited to Serve as EMR Scribes in Toledo). The use of such scribes is now increasing, both in EDs as well as other healthcare settings. Mr. HIStalk posted this recent note about the trend (see: Monday Morning Update 11/14/11):
A Jacksonville, FL woman starts a booming business that provides scribes to do patient care documentation for ED physicians. The scribes, often pre-med or nursing students, are contractors billed out at $20-25 an hour, a bargain according to the company’s medical director. “For every hour we spend, we get about 15 minutes at the bedside of patients and 45 minutes of every hour documenting everything … part of it’s insurance. Part of it’s medical-legal. Part of it is a federal mandate to have everything documented electronically.”
This movement toward greater use of scribes is on the rise. It seems to be a return to my medical school days when house officers would walk past the inpatient unit clerk and say to him or her something like: Lytes times three for Patient Jackson. I can envision the same scenario occurring these days with the scribe sitting in front of a PC instead of recording the order on the lab or pharmacy order slips.
Regarding data input into EMRs, it never made sense to convert the most highest trained and priced personnel in a patient unit into clericals. On the other hand, I can also understand the rationale of having the healthcare professionals who make patient care decisions entering such data. I just don't see this happening ultimately, however. Medical scribes are a logical category of physician and nurse extender. Therefore, the movement toward more EMR scribes will be inevitable. If the trend works in the EDs, it will also be relevant and appropriate in critical care units.
Obviously, patient unit and clinic personnel such as nurses and secretaries can function in the capacity of an EMR scribe in addition to personnel who function exclusively in such positions. There will thus be a need for a "scribe policy" in hospitals and clinics such as the one that I found on the web for Washington University Physicians Family Practice Plan. Here is an excerpt from it. Note the need to document the identify of the scribe who enters clinical data:
For the purpose of this policy, a scribe is defined as an individual who is present during the physician’s performance of a clinical service and documents (on behalf of the physician) everything said during the course of the service....The use of scribes by Washington University teaching/attending physicians is acceptable. However, residents, interns and fellows may not act as scribes. Ancillary providers such as NPs, MA’s, RNs, secretaries and other staff may serve as scribes. Individuals serving as scribes must sign a scribe agreement prior to scribing. Scribed documentation must clearly support the name of the scribe, the role of the individual documenting the service (i.e. scribe) and the provider of the service. The physician is ultimately responsible for all documentation and must verify that the scribed note accurately reflects the service provided.
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