But when TeamHealth ran numbers to explore scribes in its hospitalist programs, they found that it likely doesn’t make sense in most markets.
“We have investigated several programs and pilots but have not been able to demonstrate a significant uptick in productivity to justify the costs of the scribes,” Dr. Gundersen explains. “That does not mean that scribes is not a workable model; it just requires a better review and adjustment of workflow. Our ED colleagues have had more time to deal with these adjustments and are able to demonstrate the necessary productivity changes.”
Scribes also would mean a fundamental shift in the function of a typical TeamHealth hospitalist, he says. Most studies show that hospitalists can spend less than a quarter of their time on direct patient care, and Dr. Gundersen says TeamHealth is actively working on new pilots and programs for implementing scribes.
The overwhelming benefit that I saw was that, A) Physicians were super-happy when they had a scribe. B) The patients were happy. The docs sat down and did different things, allowing more interaction. —Michael Murphy, MD
“There is an appetite from our physicians looking for the efficiency that we just haven’t seen before,” he says. “I think that is where we are going to see the program’s success. It must be embraced and driven from the providers.
“We are also facing physician shortages in several markets. Scribes have the potential to extend the current provider workforce and improve quality of life for our doctors.”
A well-run scribe program, he says, has the potential “to bring the provider back to the bedside and with the patient where they belong.”
Shifting Savings?
Kendall Rogers, MD, CPE, FACP, SFHM, chair of SHM’s Health IT Committee and associate professor and chief of the hospital medicine division at the University of New Mexico Health Sciences Center in Albuquerque, says he checked with colleagues at SHM and did not get much feedback on the use of scribes. His own center, he says, has “not even considered scribes.”
“I have not given it a lot of thought, though my initial impressions are if the EHR was better designed, there would be no need for scribes,” he says. “My hope would be to put our efforts there first. I think scribes are merely a coping mechanism for poorly designed documentation processes within existing EHRs.”
There are also some broader concerns about the potential effect of scribes on EHRs. In a recent op-ed in the Journal of the American Medical Association, a Texas physician sounded concerns that the use of scribes could stunt the evolution of better EHRs, since scribes can be used as a kind of workaround, lessening the demands for EHR improvements.2
There is an appetite from our physicians looking for the efficiency that we just haven’t seen before. I think that is where we are going to see the program’s success. It must be embraced and driven from the providers.—Jasen Gundersen, MD, MBA, CPE, SFHM
“Use of medical scribes to relieve physicians from using EHRs may limit this process by increasing physician acceptance of and satisfaction with an inferior product,” wrote George Gellert, MD, MPH, MPA, regional medical informatics officer at CHRISTUS Santa Rosa Health System in San Antonio.
Dr. Gellert wrote that while The Joint Commission prohibits scribes from performing computerized physician order entry (CPOE), an “unintended functional creep” could arise.
“Even physicians who understand that prohibition may, under pressure of a busy practice, ask a scribe to enter verbal orders,” he wrote, adding that this is something that can’t be monitored by the Joint Commission.