Medical Scribes Examined: Benefits, Drawbacks, and Long-term Outlook

Last week I wrote about the benefits that come from employing a medical scribe when working with EHRs. The response has been interesting for two reasons: 
• An unusually high number of readers left comments on the site and two engaged with me in extended e-mail conversations.
• Each commenter who had worked with or as a medical scribe was extremely positive about the experience.

Other than agreement, the feedback fell into three rough categories: additional positives, cautions, and questions.

Additional positives
In addition to confirming that scribes increase physician productivity and profitability by improving work flows, several commenters shared these observations:
• Medical scribes can improve the profitability of any practice with or without an EHR, independent of specialty.
• A physician's ability to focus on the patient, facilitating effective communication between him and the patient, improves physician satisfaction.
• Patients tend to be happier with the practice because they appreciate the physician's full attention, and are more compliant with treatment plans because they have a better understanding of both the what of the current situation, and the why of the next steps.
• Being a medical scribe can be a great introduction to medicine for anyone preparing for a career as a nurse, PA, or physician.  It can also provide a much needed career path for a medical assistant.

Cautions
Even the best tools can fail to deliver the expected benefits, and everything has a downside.  Forewarned is forearmed. Here are a few of the cautions:
• The improved physician/patient communication is only actualized if the physician wants to engage with the patient.  There probably are physicians who appreciate the excuse that a full schedule and an EHR provide for not engaging.
• The physician is the only person who should record certain pieces of health information, and they need to be sure not to abdicate their responsibilities.
• Patients may be made uncomfortable by the presence of another person in the exam room, especially if the exam or the issue is particularly intimate.  The patient needs to have some way of expressing his discomfort and having it addressed.

Questions
• Where would a practice find a medical scribe candidate?  Are there schools/training programs/certifications?
Googling "Medical Scribe Training" yielded more than 1.5 million hits.  It turns out that there is at least one professional society, the American College of Medical Scribe Specialists (ACMSS).  There are a lot of training programs, many of them tied to medical transcription training programs.
• How about using voice recognition software or a transcription service?
Neither addresses the root problem of entering structured data: conforming the provider's language to the EHR's organization and vocabulary.  Scribes are much better able and more willing to translate to EHR-ese than a physician.  I think this will be even truer with the advent of ICD-10.
• Will scribes no longer be necessary as middle-aged and older physicians who may not be as adept with technology (such as typing quickly and accurately) retire?
I reject the proposition that physicians' difficulty with EHRs is due to lack of comfort with technology. The root problem is that current EHR software is immature, adolescent at best.  In time, it will become more usable, more accommodating to the natural flow of work, and more of an enabling tool than an adversary.  Even then a scribe may still make sense.

Scribes can significantly increase profitability in paper-based practices. They are not just a band-aid to facilitate EHR use. They enhance physician satisfaction, patient satisfaction, and practice profitability.  Once these extended benefits of medical scribes become apparent, I doubt that physicians will be willing to give them up.

How do you view the evolving role of medical scribes in healthcare? Do you think they will become a staple of the medical practice team? Or do you think they are a temporary fix that will lose momentum as the years go by?