One answer to EMR data entry: Hire a scribe to do it

A practical look at information technology issues and usage

By — Posted July 14, 2008.

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The medical scribe industry is poising itself for serious growth in the next few years.

Companies that provide scribes to handle typing and interfacing with an electronic medical record for a physician or staff say the national push for EMR adoption will increase the demand for these services.

The news surprises some EMR vendors, who use as a selling point that a practice can save money by eliminating transcriptionists.

"I don't understand why anyone would [hire a scribe]. That doesn't make sense to me because they'll never get out of the learning curve," said Jack Callahan, the vice president of corporate development for an EMR company that sells to small practices.

Scribe companies, which previously had concentrated on hospitals, say they are finding demand for their services from individual practices.

Here's how it works: The scribe takes notes during the clinical exam and enters them into the appropriate place in the EMR, relieving the doctor of the note-taking and data-entry responsibilities.

The common criticism of medical scribes is that their use adds one more layer of bureaucracy, and keeps physicians from unlocking the potential of their EMRs because they're never interacting with them.

But medical scribe companies counter that they help physicians interact more with patients, because scribes handle the technology.

"If anything, the need for the scribe is validated and necessitated with the implementation of an EMR," said Lindsey Edwards, executive director for Phys-Assist Inc., a medical scribe staffing company in Dallas.

"What has driven EMR adoption has been the need for better documentation," said Andrew Topliff, MD. "The big problem is that EMRs demand a large amount of time, and they take physicians away from one-on-one time with patients."

Dr. Topliff founded Elite Medical Scribes, in St. Paul, Minn., earlier this year, when he saw an increasing number of doctors hiring scribes after EMR implementation. His company trains and places scribes in area hospitals and is looking to expand its scope to the practice setting, and its geographic reach beyond the Twin Cities.

Edwards said her company has mostly done staffing inside hospital emergency departments, but it is expanding to hospitalists and specialty groups.

Dr. Topliff believes that as more scribes who are well-trained in EMR usage enter the picture and help make implementation less scary, EMR adoption rates may go up.

Edwards agrees. Implementing an EMR can change daily activities and work flows. Some doctors bring in a scribe to help facilitate data entry and minimize the burden.

Tom Roovers, president of the Wausau, Wis.-based consulting firm TG Roovers and Associates, said that the use of scribes is one of many approaches groups can take to encourage physician adoption of EMRs.

"With many medical groups, the most effective means of achieving 100% adoption is to have the more resistant caregivers use scribes," Roovers said.

Many practices see the value in having someone else do that work but have found alternatives to scribes.

When Toni Stockton, MD, a dermatologist from Phoenix, implemented an EMR in her solo practice two years ago, she initially tried to do all the data entry herself. "It just didn't work."

Dr. Stockton now employs medical assistants who double as scribes in the exam room. She said having someone versed in medical terminology has resulted in cleaner transcription. And it makes the exam rooms less crowded.

The medical assistant would be in the room anyway, she said, and since the assistant is the one who goes over exam results and new orders, it's a smooth transaction.

But is the cost of a scribe simply a shift in the money that used to go to transcriptionists?

No, Edwards said. First, the going pay for scribes is half of that for transcriptionists and the result is cleaner, more complete records.

Roovers agrees that scribes can be a good investment. Many hospitals require the physicians who use them to pay for them themselves. But since those physicians can sometimes see 15 to 25 additional patients per month, that easily pays for the scribe, he said.

Dr. Stockton said it's still important for doctors to take the time to learn the technology. If her office is short staffed, or if she has a simple postop follow-up visit, she can do her own documentation.

She also logs into the system several times a day to check the accuracy of clinical notes.

If she didn't know how to use the system, Dr. Stockton said, an average day could easily become a nightmare.

Ultimately, it's the doctor's responsibility to make sure the files are accurate, so there needs to be some level of oversight, Dr. Stockton said, which is impossible if the doctor doesn't know at least the basics of the system.

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