Monday, December 7, 2015

Tribes of Scribes: Physicians Employ Scribes to Cope with Time Lost on EHRs

Today’s Kaiser Health News contains an article on Medical Scribes “Jobs For Medical Scribes Are Rising Rapidly But Standards.”

The article's essemce? Supplying medical scribes for physicians trying to cope with time required to enter da into electronic health records (EHEs) has produced an exploding medical industry.

Twenty companies with thousands of workers have entered the scribe market. One in five physicians now employ scribes. These scribes follow doctors around as they see patients and enter information about the patient's ailments and doctors’ advice into a mobile computer.

Scribe America, the largest company in the scribe business estimates the U.S. has 15,000 scribes today. The company says scribe numbers will reach 100,000 by 2020. After buying three rivals this year, Scribe America employs 10,000 scribes working in 1,200 locations.

“This is literally an exploding industry, filling a perceived gap, but there is no regulation or oversight at all,” said George Gellert, regional chief medical informatics officer at Christus Santa Rosa Health System in San Antonio, which uses scribes. All it takes to become a scribe is a high school education and computer entry skills.

What’s going on here is doctors trying to save time to see more patients while complying with regulations to enter relevant patient information into electronic health records.

In reviewing my Medinnovation and Health Reform blog, I find I have written 13 posts on medical scribes and more than 200 posts on electronic health records, now the preferred term over electronic health records.

From these posts, it is apparent the majority of physicians do not like EHRs and do not believe they improve patient care. Instead, EHRs hamper practice productivity and distract from time spent with patients.

In a February 9, 2010 entry I quoted Charles Krauthammer, MD, the famed critic of the health law and Fox News regular . He summed up the situation in these words,

“EHRs are so absurdly complex, detailed, tiresome, and wasteful that if the doctor is to fill them out, he can barely talk to and examine the patient, let alone make eye contact – which is why you go to the doctor in the first place.” (“When Treating a Patient with Dementia: Electronic Records Fall Short,”Washington Post, February 8, 2010).

I ended one of my scribe blogs with a poem:

If you the doctor are slowed by an e-medical record.

And you seek to have your former productivity restored.

Consider hiring a medical scribe.

The scribe will promptly transcribe.

And you will no longer be slowed by the keyboard.

In other words, humanly restructure,

with less electronic infrastructure

The main reason physicians use scribes is to save time. As Peter F. Drucker (1900-2005), the father of modern management, cogently observed,

“The supply of time is totally inelastic. No matter how large the demand, the supply will not go up. Moreover, time is totally perishable and cannot be stored. Yesterday’s time is gone forever and will never come back. Time is, therefore, always in exceedingly short supply.

Time is totally irreplaceable. Everything requires time. It is the only truly universal condition. All work takes time and uses up time. Yet most people take for granted this unique, irreplaceable, and necessary resource.”

When you are a busy physician, and you have to pay your overhead, which includes installing and maintaining an EHR, and hiring people to enter the data, when you can see only one patient at a time, time is of the essence.

Surgeon Richard Armstrong of Newberry, Mich.,who helped create an organization known as United Physicians and Surgeons, said doctors, by hiring scribes, are coping with the demands of electronic health records.

“We’re forcing a technology into primetime onto physicians who don’t know how to handle it. And they’re using scribes because they need assistance,” Armstrong said.

To rephrase an old expression, “ A minute saved is a penny earned.”

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