Fixing electronic health records is good

Adding scribes is even better.

Scribe Warren Lam (right) works on notes, as attending physician Dr. Laura Burke (center) and Dr. Daniel Willner discuss a patient case, at Beth Israel Deaconess Medical Center Emergency Department on April 19, 2016, in Boston, Massachusetts. Kayana Szymczak for STAT

Scribe Warren Lam (right) works on notes, as attending physician Dr. Laura Burke (center) and Dr. Daniel Willner discuss a patient case, at Beth Israel Deaconess Medical Center Emergency Department on April 19, 2016 in Boston, Massachusetts. Kayana Szymczak for STAT

By Jared Pelo, STAT September 27, 2016

The bold admission by Athenahealth CEO Jonathan Bush that electronic health records (EHRs) “inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating” caught my attention. Those are strong words from the head of a company that makes a widely used EHR.

While Bush’s company is trying to design ways to decrease the amount of time that clinicians spend working on the EHR, here’s a more immediate and practical solution: medical scribes. Let these trained professionals interact with the EHR while doctors interact with their patients.

I learned during medical school how onerous it is to document every detail of the work I did while seeing patients. Fortunately, I landed an emergency medicine residency at the University of Virginia, where every resident works with a medical scribe. These aren’t passive copyists, as medieval scribes mostly were. Instead, using mobile technology and a HIPAA-secure cloud, 21st century scribes follow their doctors to every encounter and do the clicking, typing, and record keeping while the doctors examine and talk with their patients.

When it came time to find my first job out of residency, I wanted to work in a clinic that had scribes. So I joined the main hospital of a small health system in central Virginia. Later, I became the medical director for the emergency department in a smaller hospital that didn’t have scribes. For the first time in my medical career, I had to do all of my own documentation.

It was incredibly frustrating to sit and type while the waiting room filled with patients who needed my attention. Much of my time was consumed by medical documentation, which kept me from being a doctor for the patients who needed my help. I was the rate-limiting resource, not to mention the most expensive and most highly trained one. It’s like asking an airline pilot to fly the plane and also schedule the flight, assign the seats, and load and unload the bags.I became so convinced of the value of medical scribes that I started my own company, iScribes. It is one of several companies that train virtual medical scribes and connect them with health care systems.

The medical scribe business is generally growing at internet startup speed because these professionals add significant value by letting doctors work with patients instead of the EHR. Across the industry, they document tens of thousands of patient encounters each month, saving doctors thousands of hours of medical documentation time. We’re also giving doctors their lives back. I know this because I often get emails like this one: “No more charts!! I can take my kids to school in the morning because I don’t have to get to the office an hour early to catch up on dictations.”

The medical scribe approach is closely in line with the American Medical Association’s Steps Forward Team Documentation, which is all about “allowing doctors to spend more time with patients by sharing responsibilities with staff.” I believe that we are at the beginning of a massive shift that will lead to other professionals doing nearly all medical documentation chores while doctors focus on their patients.

EHRs have value for collecting data about patients, providing safety checks, and making it easier for patients to their medical records. But as Jonathan Bush pointed out, the EHRs our country’s medical professionals use every day need to be better designed for easier use. A more important and more immediate fix is for most medical documentation to be done by professionals other than the doctors, so doctors can do what they were trained to do — focus on their patients.

Jared Pelo MD, is an emergency medicine physician and founder of iScribes, based in Durham, N.C.
Jared Pelo can be reached at Follow Jared on Twitter @JaredPelo

Source STAT

Also see
Electronic health records ‘inflict enormous pain’ on doctors
HIPAA turns 20. It opened the door to better doctor-patient communication STAT
AMA Practice Improvement Strategies Steps Forward

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