Medical scribe

A medical scribe is a person, or paraprofessional, who specializes in charting physician-patient encounters in real time, such as during medical examinations. Depending on which area of practice the scribe works in, the position may also be called clinical scribe, ER scribe or ED scribe (in the emergency department), or just scribe (when the context is implicit). A scribe is trained in health information management and the use of health information technology to support it. A scribe can work on-site (at a hospital or clinic) or remotely from a HIPAA-secure facility. Medical scribes who work at an off-site location are known as virtual medical scribes and normally work in clinical settings.^[1]

A medical scribe's primary duties are to follow a physician through his or her work day and chart patient encounters in real-time using a medical office's electronic health record (EHR) and existing templates. Medical scribes also generate referral letters for physicians, manage and sort medical documents within the EHR system, and assist with e-prescribing. Medical scribes can be thought of as data care managers, enabling physicians, medical assistants, and nurses to focus on patient in-take and care during clinic hours. Medical scribes, by handling data management tasks for physicians in real-time, free the physician to increase patient contact time, give more thought to complex cases, better manage patient flow through the department, and increase productivity to see more patients.^[2]

An increasing body of research has shown the use of medical scribes is associated with improved overall physician productivity, cost- and time-savings, and patient satisfaction.^[3][4][5][6] An in-depth study conducted by The Vancouver Clinic in Vancouver, WA from 2011-2012 found that medical scribes improved the quality of clinical documentation and allowed doctors to see extra patients, while noting the risks associated with scribe turnover and doctors' unfamiliarity with the scribe concept.^[7] Notably, research has recommended that healthcare providers employ medical scribes to reduce time spent performing data entry and other administrative tasks, which can increase physician fatigue and dissatisfaction.^[8][9]

ER scribe

An ER scribe works in the emergency department (ED) of a hospital. Their duties may include overseeing the documentation of each patient's visit to the ED and acting as the physician's personal assistant. A scribe works with one physician per shift and is generally assigned as that physician's personal scribe (often working regularly with the same physician), although they may work for multiple doctors.

A prospective scribe is required to learn a large and extensive amount of medical terminology, as well as become familiar with human anatomy. Each program has their own training regimen and some are more structured than others. For example, some programs require that all new scribes take an official graded course prior to working which includes extensive knowledge. Other programs allow the scribe to start in the ED immediately, but only under supervision which is sometimes referred to as bedside training, that is gradually reduced. Training is extremely intensive and lasts from as little as three shifts, to about one month under the direct supervision of an experienced scribe.

The first scribe programs were based in Reno, Nevada. In 1995 Dr. Elliott Trotter, M.D., a physician practicing in Fort Worth, Texas discovered the Nevada program and decided to start a program at Harris Methodist Hospital. Dr. John Geesbreght, an emergency room physician at Harris Methodist Hospital, with approval from Texas Christian University (TCU) administration, recruited four pre-med TCU students to establish what is now PhysAssist Scribes, the oldest medical scribe company in the United States.^[10][11]

Medical scribe programs quickly expanded to other cities. Some of these programs have retained the original program paradigm, while others have elected to create their own from scratch, using the original as a template. Technology advances have seen the introduction of "portable tablets" within some hospitals thus reducing the risk of error in scribe transcription.

There are a few programs, however, that have expanded beyond the original model and its core subjects, including more pertinent and up to date information. Even fewer programs have included advanced training levels beyond the basic training received by all scribes. These programs utilize standardized tests to certify scribes as being adequately prepared to work in a clinical environment. They also include periodic updates to keep the programs on the "leading edge" of medicine.

For each patient seen in the ED, a scribe will:

• Accompany the physician into the exam room
• Document the history of the patient's present illness
• Document the Review-of-Systems (ROS) and physical examination
• Enter vital signs and keep track of lab values
• Look up pertinent past medical records
• Keep track of and enter the results of imaging studies
• Prioritize the physician's time by bringing critical lab results to his/her attention
• Type progress notes
• Enter the patient's discharge plan and any prescriptions

Scribe positions are often filled by college students pursuing careers in medicine, with some organizations providing assistance with college fees. Many of those college undergraduates plan to attend medical school to earn their MD or DO degrees. A smaller number plan on becoming a physician assistant (PA). Pre-health students benefit from the experience they gain working in the emergency department. These students are also able to build relationships with medical practitioners who are usually willing to write letters of recommendation for professional school applications on the students' behalf. Some scribe organizations have opted to not hire college students pursuing medical careers, due to the subsequent high rate of attrition. Also, due to this relationship between the doctor, scribe and professional school applications, some scribe programs limit the positions to seniors of undergraduate programs.

Joint Commission guidelines

The Joint Commission released guidelines for the use of medical scribes July 2012. The Joint Commission's guidelines explained: "A scribe is an unlicensed person hired to enter information into the EHR or chart at the direction of a physician or practitioner (Licensed Independent Practitioner, Advanced Practice Registered Nurse or Physician Assistant). It is the Joint Commission’s stand that the scribe does not and may not act independently but can document the previously determined physician’s or practitioner’s dictation and/or activities. Scribes also assist the practitioners listed above in navigating the EMR and in locating information such as test results and lab results. They can support work flow and documentation for medical record coding. Scribes are used most frequently, but not exclusively, in emergency departments where they accompany the physician or practitioner and record information into the medical record, with the goal of allowing the physician or practitioner to spend more time with the patient and have accurate documentation. Scribes are sometimes used in other areas of the hospital or ambulatory facility. They can be employed by the healthcare organization, the physician or practitioner or be a contracted service."^[12] The American Health Information Management Association also published guidance in its November 2012 edition of Journal of AHIMA for physicians on the use of medical scribes, echoing and elaborating on The Joint Commission's guidance by explaining that "a scribe can be found in multiple settings including physician practices, hospitals, emergency departments, long-term care facilities, long-term acute care hospitals, public health clinics, and ambulatory care centers. They can be employed by a healthcare organization, physician, licensed independent practitioner, or work as a contracted service."^[13]

Major scribe companies all over the world

Currently there are a number of scribe providers in the United States and in India. With the medical scribe position so prevalent in the American medical community, several companies have formed since the position's genesis to provide a gateway through which people (generally pursuing a career in the health industry) can apply for and work at designated hospitals with which the companies have formed relationships. It is becoming a very established industry as physicians appreciate the help of the scribes^[14] and the scribes gain experience as well as invaluable connections from working alongside physicians and other health professionals for their future endeavors such as medical school.^[15] In India, the company named as S10 health care (physicians angels) a medical scribe organization where they providing scribing for the physicians with the help of internet.

References

External links

• News Article: "Aiding ER doctors"
• "Scribes let doctors focus on patients not computers"