| Monday, January 01, 0001
Medical Scribes: A Great Idea on Paper
Medical documentation isn’t as new as we might think and has been a crucial common component of the health care puzzle for at least the past century. Back then, the physicians comprising the American College of Surgeons established a clinical framework for documenting their activities and keeping data streamlined and transmittable from one physician to another. A course of criteria was established to create consistency in data from one physician to another, a handy mnemonic device (Subjective Objective Action Plan: SOAP for short) and an implicit agreement regarding clinically-guided standards for recording information across the board.
While the method did establish a system for physicians, technological and medical developments in the 1970’s and 80’s created the need for more documentation necessities, like the rampant computerization of health information within the health care system, as well as ICD-9 developments in 1979 and CPT-4 developments in 1987, all re-tooled to include the financial-compensation component of cost, reimbursements and the capability for insurance companies and medical systems to agree on a system of “cost per units.”
The Administrative Burden
While few healthcare experts dispute these developments and their role in creating viable healthcare systems of today, many also recognize the gargantual burden of documentation and administration these developments create for physicians. As Rene Datta bemoans the dynamic of the “healthcare revenue cycle” which must continually multiply, concatenate and bundle disparate health care procedures (many of which aren’t in a physician’s specific wheelhouse) and the “brevity of paper records supplanted by the massive serialization and piecemealing of info on the modern computer record system.” As the author describes it, this problem is more than just a clerical annoyance, but a legitimate disaster of “monstrous proportions” threatening to up-end the precarious apple cart that is human health care in the 21st century.
As basic health information fragments, the reams upon reams of documentation that physicians must provide increases and the robotization of their calling removes them further and further from human connection, third party businesses aimed at easing the physician burden keep springing up. Nowhere is the administration burden more readily acknowledged than with the rise of physician scribe services which have become extremely viable businesses within the past five years.
For many overworked physicians, the rise of medical scribes has been a blessing. It’s no secret these companies aim themselves at removing the beleaguered physician’s strain. Currently, the U.S. employs roughly 15,000 medical scribes, a number that’s projected to climb to explode to 100,000 by 2020. These scribes help stressed doctors in freeing them from the bonds of patient documentation. In theory, physicians can focus 100 percent of their energy on the actual office visit, while the scribe diligently records the encounter and all the necessary documentation follows.
Indeed, it’s a noble service that’s filling a perceived gap in the industry, stepping up and addressing a need. Since scribes remove so much extra detail from the physician’s plate, it’s understood that many physicians will see substantial productivity (and revenue!) increases since they can see more patients in a day. Furthermore, with a scribe on duty to handle all the written work, the idea is that patients can get more substantial one-on-one visitation from the doctor, one that won’t be punctuated by frequent trips interruptions to the computer or hurried scratching away on a clipboard. At least, that’s how it should work anyway.
Not Quite There Yet
Though a noble service indeed, as it stands, the overall standard for medical scribes aren’t as rigorous as they could be, nor are they particularly consistent from one agency to another. Where physicians undergo years of specialized training and residency in order to fully comprehend and practice the nuanced information they’re recording, the standard qualification for a medical scribe is simply a high school diploma. Furthermore, official “certification” standards aren’t consistent across the board yet, and only about one third of medical scribes are even technically certified as such, with experience shadowing doctors before they receive their certification. Even in these instances, the certification process is completely voluntary and not pushed as a necessity for aspiring scribes.
Another problem that scribes can’t forecast is the change in environment a scribe’s presence can enact on the physician’s office. Besides throwing off the one-on-one dynamic of the visit, some physicians find patients aren’t as comfortable discussing their sensitive health matters with another individual, someone in addition to their trusted physician, right there in the room with them. For physicians who need to cut directly to the heart of the patient’s matter, clouding distractions only serve to put more distance between the patient and their improved health.
And of course, this doesn’t address the fact that scribes, as human beings, are still prone to make mistakes in their documentation. To offset this risk, physicians are encouraged to review the documentation of their scribes afterwards to ensure accuracy, but again, this does little for time-saving if the whole goal is to give physicians more time one-on-one with their patients and less time behind a computer screen documenting medical histories. There are also industry safeguards enacted to prevent scribes from entering in sensitive information like X-ray information or prescriptions, theorizing that these nuanced tasks are too job-specific and require the careful supervision of a qualified professional. While these safeguards do prevent some accidents in the short term, they also hand-cuff the efficacy of a scribe to truly “shoulder the minutia” of a physician, and create additional tasks for the physicians to complete after the office visit anyway.
Human Solutions for an Inhuman Problem
In this regard, many physicians see the overall potential that a scribe can have on their business and practice, but ultimately opt to do all the documentation themselves for safety and accuracy concerns. As of now, a primary concern is that medical scribes simply do not possess all the necessary background knowledge to enter the right info into every medical process, without slowing things down considerably. Furthermore, the enforcement mechanism which could ensure accuracy and adherence across the board isn’t quite fully formed yet. This isn’t to say that it won’t improve though. Where medical documentation is regulated with stringent rules and consistent guidelines, such stringency and uniformity in scribe training could dramatically improve their occupational perception.
Technology and EHR’s aren’t going to become less embedded in health care. “We’re forcing a technology into primetime onto physicians who don’t always know how to handle it” says surgeon Richard Armstrong in the article Medical Scribes are on the Rise but Standards Lacking. Ultimately, the administrative burden, as well as physician shortages and overall needs within the healthcare paradigm, necessitate some stop-gap measure to assist physicians. For now though, the inhuman “monstrosity” of medicine’s administrative burdens prove far too much for the inherently human limitations of medical scribing alone.
Datta, Rene. "The Administrative Monstrosity of Medical Documentation Is out of Control."
KevinMD.com. KevinMD, 06 Dec. 2015. Web. 15 Dec. 2015.
Gillespie, lisa. "Medical Scribes Are on the Rise, but Standards Lacking."
Physicians News. Physician's News, 07 Dec. 2015. Web. 15 Dec. 2015.