Hate Dealing With an EHR? Use a Scribe and Profits Increase

Neil Chesanow


February 27, 2014

In This Article

Medicine's Best-Kept Secret?

Like many doctors, you may have resigned yourself to life with an electronic health record (EHR): the torturous clicking, the precious minutes ticking away, the patients squirming in their seats as you squint at the screen, and the hour or two it takes you at the end of each day to catch up on your charts.

It doesn't need to be this way.

A growing number of doctors are saying, "Enough!" They are hiring medical scribes to enter notes, test results, and other data into the software while the doctors devote their full attention to their patients. When the visit is done, so is the patient chart, ready for doctor review.

Patients love it. When scribes are used, patient satisfaction scores increase, often dramatically, studies show.[1,2,3] Doctors love it too. Documentation is so thorough that a higher-level Current Procedural Terminology (CPT) code is often earned.[4] The scribe suggests which codes to use, sends electronic prescriptions to the patient's pharmacy on the doctor's behalf, and generates referral letters to specialists.

Between patients, the doctor reviews the scribe's work in the EHR and does whatever tweaking is necessary. A few moments and it's done.

Asfer Shariff, MD, an ENT surgeon in Toledo, Ohio, as well as Founder and Chief Medical Officer of a scribe service called Physicians Angels, says he is now able to review 15-20 scribe-produced charts in as many minutes in his practice. Without a scribe, he was spending up to 2 hours at the end of each day updating charts in the EHR. "I got my family back," he says.

Physicians who work with scribes see, on average, one additional patient an hour, experts maintain. Despite this greater productivity, at the end of the day, all the charts are done. This is true even for high-volume specialists who may generate 50-75 charts per day.[4] The doctors are free to go home at 5 or 6 PM.

Scribe Boom Sparked by Dissatisfied EHR Users

That doctors are seeking help with their patient records isn't a new phenomenon. Transcription services have been around since the 1960s. In the 1990s, a few doctors hired stenographers to follow them from exam room to exam room, taking dictation and later typing up a transcript of what was said to file in paper charts. They were known as scribes. But the idea never caught on.

The adoption of EHRs changed all that. Five years ago, only 10% of hospitals and outpatient practices used EHRs.[5] Now, thanks to meaningful use incentives offered by the Centers for Medicare & Medicaid Services, nearly 70% do.[5]

For many doctors, it was and is a marriage made in hell. According to a 2013 report by the RAND Corporation produced for the American Medical Association, "Aspects of current EHRs that were particularly common sources of dissatisfaction included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information, and degradation of clinical documentation."[6]

Cheryl Toth, MBA, a consultant and writer at KarenZupko & Associates, a practice management consultant in Chicago, Illinois, points out that physicians' initial hopes that EHRs would improve workflow were quickly dashed.

"Research shows a physician using an EHR sees, on average, 11.2 patients fewer per week -- a potential revenue loss of up to $3800 per month -- than before adoption of an EHR," Toth says.[4]

EHRs also cost a bundle in inefficient use of physician time.

"A doctor's cost runs up to $4 a minute or $240 an hour," Shariff observes. "Would you pay $240 an hour to have someone type and click information into an electronic medical record? Would you take your most expensive employees and make them data entry staff? That's what has been happening."

"An EHR is no different from a CT scanner or EKG machine," he offers by way of perspective. "An EHR is a data-acquisition device. You don't see the radiologist operating the CT or the cardiologist operating the EKG. They have technicians, thus allowing their mental energies to be devoted to the interpretation of data and management of the patient."

But if a doctor isn't going to type and click information into the EHR, however laborious it may be, who is? Enter the modern medical scribe.


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