Frederick L. Greene, MD
Clinical Professor of Surgery
UNC School of Medicine
Chapel Hill, North Carolina
Over the past several decades, new and interesting medical and paramedical occupations have been created to reflect the changing complexities of our health care system. We have seen the proliferation of hospitalists, surgicalists and laborists (in-hospital obstetrical specialists) on the physician side, and patient navigators, physician extenders and patient ombudsmen in the nonphysician cadre. Now, there is an additional and intriguing job title that may gain some traction even in the high-tech era of the electronic medical record (EMR): the “medical scribe.”
The medical scribe, also known as a “clinical scribe,” “ER scribe” or “ED scribe,” is a trained medical information manager who specializes in charting physician–patient encounters in real time. Although originally spawned as an adjunct in the emergency medicine environment, this clerical resource has been introduced now into the inpatient and office settings.
Traditionally, physicians would complete their history gathering, physical examination and discussion with patients before writing or dictating notes that eventually would be included in the paper file. With the advent of the EMR, data are usually prepopulated by nursing personnel and then completed either during or after a patient encounter. One of the unintended and unfortunate consequences of electronic data recording is scenarios in which physicians literally face the computer screen rather than their patients in order to populate data in the EMR. The time that physicians spend during a patient visit capturing and entering data rather than focusing on the patient can be a major hindrance to the overall quality of care. Here is where the medical scribe may play a very important role. The medical scribe is an unlicensed individual hired to enter information into the EMR or chart at the direction of the physician or licensed independent practitioner. In-depth guidelines were released by the Joint Commission in 2011, and include the duties and supervisory issues of the medical scribe (www.jointcommission.org/mobile/standards_information).
In my opinion, this concept may help correct some of the negative consequences foisted on all of us by the EMR. I sense that in the inpatient setting, the time that physicians, and especially physicians-in-training, are spending at the patient bedside has been drastically reduced in order to spend more time with EMR entry and review. In deciding whether to actually see patients or to complete the EMR entries before going to the OR each morning, the lure of the EMR frequently, and unfortunately, wins. It would be a true benefit to have clerical support to document and transcribe, in a real-time fashion, the events of physician–patient interaction on rounds and to enter the data accordingly.
The same concepts apply to the office setting where our time should be spent interacting face-to-face with our patients, while having office notes completed by the medical scribe in real time during patient encounters. This may improve the overall quality of documentation for both granularity and specificity. Such granularity might be translated into improved billing codes and remuneration. This also would reduce the necessity of finalizing notes and EMR data after a busy clinic day. Think of the wonderful possibilities in terms of time management!
The positive results created by working with a medical scribe are legion. These benefits may become more apparent especially as physicians continue to face the morass of data acquisition created by the launching and promulgation of the EMR and the real barriers that this disruptive technology creates for patients and physicians alike.