T

he bold admission by athenahealth CEO Jonathan Bush that electronic health records (EHRs) “inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating” caught my attention. Those are strong words from the head of a company that makes a widely used EHR.

While Bush’s company is trying to design ways to decrease the amount of time that clinicians spend working on the EHR, here’s a more immediate and practical solution: medical scribes. Let these trained professionals interact with the EHR while doctors interact with their patients.

I learned during medical school how onerous it is to document every detail of the work I did while seeing patients. Fortunately, I landed an emergency medicine residency at the University of Virginia, where every resident works with a medical scribe. These aren’t passive copyists, as medieval scribes mostly were. Instead, using mobile technology and a HIPAA-secure cloud, 21st century scribes follow their doctors to every encounter and do the clicking, typing, and record keeping while the doctors examine and talk with their patients.

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When it came time to find my first job out of residency, I wanted to work in a clinic that had scribes. So I joined the main hospital of a small health system in central Virginia. Later, I became the medical director for the emergency department in a smaller hospital that didn’t have scribes. For the first time in my medical career, I had to do all of my own documentation.

It was incredibly frustrating to sit and type while the waiting room filled with patients who needed my attention. Much of my time was consumed by medical documentation, which kept me from being a doctor for the patients who needed my help. I was the rate-limiting resource, not to mention the most expensive and most highly trained one. It’s like asking an airline pilot to fly the plane and also schedule the flight, assign the seats, and load and unload the bags.

I became so convinced of the value of medical scribes that I started my own company, iScribes. It is one of several companies that train virtual medical scribes and connect them with health care systems.

The medical scribe business is generally growing at internet startup speed because these professionals add significant value by letting doctors work with patients instead of the EHR. Across the industry, they document tens of thousands of patient encounters each month, saving doctors thousands of hours of medical documentation time. We’re also giving doctors their lives back. I know this because I often get emails like this one: “No more charts!! I can take my kids to school in the morning because I don’t have to get to the office an hour early to catch up on dictations.”

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The medical scribe approach is closely in line with the American Medical Association’s Steps Forward Team Documentation, which is all about “allowing doctors to spend more time with patients by sharing responsibilities with staff.” I believe that we are at the beginning of a massive shift that will lead to other professionals doing nearly all medical documentation chores while doctors focus on their patients.

EHRs have value for collecting data about patients, providing safety checks, and making it easier for patients to their medical records. But as Jonathan Bush pointed out, the EHRs our country’s medical professionals use every day need to be better designed for easier use. A more important and more immediate fix is for most medical documentation to be done by professionals other than the doctors, so doctors can do what they were trained to do — focus on their patients.

Jared Pelo, MD, is an emergency medicine physician and founder of iScribes, based in Durham, N.C.

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  • Wonderful article. I am an emergency department scribe in Rochester, MN and love coming to work and hearing that my doctors will get to go home on time for a change. Tonight my doctor saw 30+ patients, cleared her pod, and went home right on time with no left over dictations or charts. I also love working as a scribe because I get to learn from every patient and procedure to help shape my future practice as well!

  • As a patient, it is frustrating to lose the patient-doctor connection as your doctor spends most or all of his/her time entering data into the EHR. A meaningful conversation discussing the patient’s “story” and a thorough physical exam can be rushed and ineffective when too much of the doctor’s time is spent with the computer screen. Scribes are an excellent answer to this pervasive problem and should be seen as a required addition to the medical team.

  • The use of medical scribes completes the divorce of the record from any semblance of relevance to clinical care. It finally becomes only the legal and financial instrument it was never intended to be. Consulting physicians who deliver only episodic care and their patients may not lose much in this transition, but it is a serious threat to the integrity of longitudinal primary care. I know scribe utilizing physicians who currently brag, “I haven’t looked at a patient’s chart for months.” How can that be a good thing?

  • Wait, so first the Obama administration forces EHR down all of our throats as part of Obamacare and touts it as both cost-saving and quality-enhancing. But now we find we need to employ another trained professional to tag along with each doctor to make EHRs work?

    The “Affordable” Care Act is a sad joke. I’m not even going to go into how my individual insurance premium went up 50% and my deductible doubled (the first year) and it has gone up 15%+ every year since then.

    • Brett, I agree! At 53 I needed to find a less physical type of work and chose medical coding. While I am not yet certified, I find it very difficult to find a job that does not require at least two years of experience. It seems as though hospitals are keeping their budgets tight and not hiring extra office staff for the lack of funds. Rural hospitals especially seem to have the hardest budget problems. Finding a EMR/EHR program that will work and fit their system cost quite a bit of money! I imagine this may be the reason many have waited to implement these programs. I am hopeful we will have a president that understands the horrible downfalls of Obamacare and will act quickly to strike it down. Then perhaps physicians and healthcare facilities payments will be more in line with the cost of treating patients.

  • This is just the tip of the iceberg. When I requested a copy of my medical records from MGH I found many mistakes. Some were very basic but potentially consequential. EX listing me as someone that never smoked when indeed I had smoked for a good 15 years but quit.

    Worse is that the notes from one Dr were very biased. Clearly she was worried about a potential lawsuit and had transcribed the notes in a way that would absolve her. While I had no plans to sue or anything else, it was very clear what she was more interested in covering her tracks and record of non action/misdiagnosis than helping me.

    When working with a Dr in the future, I will always insist on reading and approving the notes before anything is put on record.

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