Are Scribes the Missing Link Between Physicians and EHRs?

Hospitals across the country are implementing electronic health records as they work towards meeting meaningful use requirements and receiving incentive payments. Physicians and other healthcare providers may need to alter their workflow as they transition from paper to electronic records. Physicians in the emergency department, however, may have more difficulty fitting EHRs in their workday due to the fast-paced environment.

"There are huge benefits [of EHRs] in terms of sharing information and data mining, for epidemiological reasons and billing reasons; but there's just that missing link," says Jason Ruben, MD, director of CEP America's Scribe Program. To integrate EHRs into the ED without disrupting physicians' time with patients, Dr. Ruben helps hospitals develop scribe programs, in which people, typically pre-med students, follow ED physicians and enter their data into the EHR for them. Dr. Ruben explains the benefits of scribes and why they might be used hospital-wide in the future.  

Scribes
"For almost all ER physicians, [using the EHR] dramatically slows down their ability to see patients in a timely manner," Dr. Ruben says. In the ED, a delay in time could mean the difference between life and death for some patients. In addition, the EHR creates a barrier between the physician and the patient, according to Dr. Ruben. "There's no way to be present with a patient while you are entering information into a computer," he says.

Scribes allow physicians to maintain their productivity and relationship with the patient while also storing information in the EHR. "They are a bridge between the new technology and physicians," Dr. Ruben says. Scribes are typically undergraduate students who are interested in medicine. They receive training in medical vocabulary and in using the EHR and shadow current scribes in the ED before working directly with the physician. The opportunity to learn firsthand about medicine, particular for those interested in medical school, makes the job competitive, meaning the program can choose the "best and brightest," Dr. Ruben says. In addition, the program pays scribes, many of whom, according to Dr. Ruben, would be willing to gain the experience for free. He says paying scribes heightens their dedication and reliability, which is important given that CEP America requires a minimum one-year commitment.

Benefits and challenges
While developing a scribe program necessitates an investment of time, money and other resources, once it's running it becomes self-sustaining, Dr. Ruben says. The payoff of an upfront investment is similar for the hospitals using the scribes. The hospital's cost of scribes' salaries is offset by the resultant increase in ED physicians' productivity and efficiency. Furthermore, the physicians enjoy working with the scribes because they become mentors to enthusiastic, driven people, Dr. Ruben says.

Recruiting scribes may present a challenge when the hospital is not near a university, however. Looking to people such as medics and EMTs and offering potential scribes a higher wage to compensate for travel to the hospital can help overcome this challenge.

Growth
When Dr. Ruben started working with scribes in 2008, there were four or five EDs using the program and approximately 45 scribes. Now, there are 22 sites, roughly 300 scribes and 12 programs slated to be started in 2012.  Dr. Ruben predicts the number of scribes will grow to 400 or 500 by the end of 2012 because of the overwhelming response from EDs. Furthermore, he thinks scribes may expand from the ED to other hospital departments. "The emergency department is the tip of the iceberg in terms of the use of scribes," he says. The need for scribes in the ED is more urgent because of the work environment and time constraints, Dr. Ruben says. But over time, he believes other physicians will see a benefit in having an intermediary perform data entry while they spend more time at the bedside. "Even if the perfect electronic system was created, there is no reason, no downside from a physician standpoint and even from a patient standpoint, from having a scribe."

Learn more about CEP America.


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