The Game Changer When it Comes to EHR Use: Medical Scribes

Last week I had my first patient experience with a medical scribe. I liked it. Not only did I have the physician's full attention in the exam room, the atmosphere was completely relaxed. Only after I was in my car did I realize that I had been in and out in record time. Some might call it miraculous. Here is a recap of the experience and the observations of someone whose business is increasing physician satisfaction and profitability.

How it worked
The physician entered the exam room several minutes before the scribe. He greeted me, reviewed my chart and the data gathered by the medical assistant, and asked me several questions.

By the time the scribe came in, there was productive work for her to do. My doctor was ready to discuss some tests he wanted, as well as prescriptions and further action on my part. As he spoke to me in a very conversational manner, the scribe began to enter the orders into the EHR.

The physician never touched a keyboard or looked at a computer screen. The scribe entered quantitative data and orders into the EHR. The physician spoke to me, referenced documents produced earlier in the visit or in my paper chart, and wrote his notes for the visit in my chart.

When my doctor and I were done, he said goodbye and moved to the next exam room, while the scribe finished the electronic documentation and orders. I had just enough time to gather my things and walk to the desk to check out.

Important observations
1. The physician and scribe were not joined at the hip. They operated in a complementary but independent manner. As a consequence, neither of them was ever idle waiting for the other to complete a task.

2. Everything my doctor did in the exam room required his personal attention (me), his skill, or his license. Every moment was the highest and best use of his time for the visit.

3. The scribe was able to focus on the task of navigating the EHR and entering data. She was adept and comfortable with the system, and I am reasonably certain that she was a fast and accurate typist.

4. My physician was able to offload clerical tasks he had previously done by hand to the scribe. As a result, he was (and is) able to see significantly more patients in a day or clinic session, at a more relaxed pace.

5. The combination of the scribe and the EHR are allowing him to focus on practicing medicine instead of data entry. The only changes to his pre-EHR routines were welcome.

6. Documentation was contemporaneous. At the end of the day, the physician must review and sign off on the encounter, but that takes far less time than creating all of the documentation.

Medical scribes are probably the closest we will come to a silver bullet for effective EHR adoption and use. An EHR by itself is often a serious drain on physician productivity. The combination of a scribe and an EHR has the potential to significantly increase physician productivity over previous levels, at the same time it increases both physician and patient satisfaction.

What experiences have you had with medical scribes in your practice or in other practices? What are some of the key challenges and benefits associated with their use?