Scribes may be the answer to EMR adoption

One of my favorite HIT writers, Joe Conn, just published a two part article in Modern Healthcare about the use of scribes by physicians using EMRs - part 1 and part 2. He pointed out the increasing use of scribes in ER departments, as well as some early projects in primary care offices.

Here are some of the key quotes from this article:
Today, however, organizations seeking to implement the latest wrinkle in medical record-keeping, electronic health-record systems, are looking to new generations of scribes—to increase physician productivity and to overcome the pitfalls of the still typically clunky physician/EHR interface, and to ease the strain of EHR implementations and replacements...scribes do more than transcriptionists by assisting physicians in fully documenting a patient encounter, most recently, entering encounter data in an EHR.

Randall Oates is a family physician who founded an EHR-system development company, Soapware, Fayetteville, Ark., with software products designed for office-based physicians. Oates said the combination of scribes, EHRs and practice redesign, could provide the saving grace for economically threatened primary-care physicians.
The current approach to EHR implementation, in which the physician is supposed to document the encounter on a computer, is, Oates said, “complete insanity, turning doctors into data-entry clerks. We're going to look back on these days the way we look back on bloodletting with leeches."

Physicians using the system have one computer in the exam room with the patient and another computer in a room set aside for the scribe, who listens in via a microphone in the exam room and documents the encounter. “Both the scribe and the physician have to be able to control the desktop,” Oates said. “The scribe is creating the documentation, but most of the documentation is already collected before the doctor ever gets in the exam room. If the patient is in for hypertension, the scribe will know to automatically pull up the vital signs in a view. The doctor should not have to do that navigation. The doctor should be able to be empowered to do the high-touch patient care."

The system radically accelerates patient throughput, according to Oates. “They're scheduling eight an hour with very high patient satisfaction, structured data entry and the note is completed at the end of the encounter,” Oates said. “The bottom line, and I'll make it real simple, the family practitioner only has to see one extra patient every three hours to cover the cost of the remote scribe and the technology.”

And then my part at the end:
Lyle Berkowitz is a physician informaticist who has written extensively on the need for an improved interface between computers and physicians. He uses an EHR in his outpatient internal medicine practice in Chicago. Berkowitz said he has never used a scribe, but in doing personal research on high-performance “superpractices,” he has run across several examples of physicians who do.

Berkowitz said he doesn't view scribes as an interim measure, but “as part of the evolution to get to the better solution.”

“A scribe is the ultimate of artificial intelligence,” he said.

Well, I know what I meant, but I think it makes sense to explain further. I think the ultimate holy grail is when the physician can walk into a room and the EMR can be the perfect assistant - gathering history from the patient ahead of time, displaying exactly what is needed to help the physician make a decision, listening to the physician and documenting the visit as well as creating orders, making pertinent suggestions at the right time…

But while that level of EMR artificial intelligence is not yet available, a scribe can fulfill many of those same functions. The result is that the physician can concentrate their time on the patient and not on the computer.

In other words, we have to decide "what is the doctor's job". Is it to take care of patients, or document that they took care of a patient? I think we will all agree that it is the former, and so we have to start rethinking the current paradigm where doctors are using EMRs more like data clerks than healers. This will likely be a combination of (1) making documentation a BYPRODUCT of care, and (2) Figuring out other ways to get our care documented in the system easily - whether that be from scribes or voice recognition combined with artificial intelligence that supports both care and documentation.

Well... at least until the computers overtake everything we can do and tell us to go retire!

UPDATES
* Electronic medical records systems create need for scribes to input data (April, 2011)