Scribes Are Back, Helping Doctors Tackle Electronic Medical Records

Apr 21, 2014
Originally published on April 21, 2014 8:43 am

Like many other doctors across the country, Dr. Devesh Ramnath, a Dallas orthopedic surgeon, recently made the switch from paper to electronic medical records. This meant he no longer had to just take notes when he was examining a patient — he also had to put those notes into the computer as a permanent record.

"I was really focused on just trying to get the information in, and not really focusing on the patient anymore," Ramnath says.

In fact, he found he was spending an extra two to three hours every clinic just on electronic records. So he hired medical scribe Connie Gaylan. Acting a bit like a court reporter, Gaylan shadows Ramnath at every appointment. As the doctor examines a patient, Gaylan sits quietly in the corner, typing notes and speaking into a handheld microphone. Once she's finished with the records, she gives them to Ramnath to check and approve, saving him hours of administrative work and allowing him to concentrate on his patients.

"I would more than happily sacrifice a significant chunk of my income for the improved quality of life I have," Ramnath says.

Medical scribes are in high demand nationally. Any doctor who doesn't make the switch from paper to electronic records by 2015 will face Medicare penalties, and this deadline is fueling the demand.

PhysAssist, the country's first scribe staffing company, is on the second expansion of its Fort Worth, Texas, headquarters and has opened another office in Chicago. Alex Geesbreght, the company's CEO, says the firm is growing by 46 to 50 percent every year. In 2008, PhysAssist had 35 scribes; now it has 1,400. The other big scribing companies — Medical Scribe Systems and Scribe America — each have thousands more, and the demand keeps growing.

PhysAssist trains scribes from across the country every week in its Fort Worth mock emergency department, where instructor Brandon Torres shows students the right way to fill out an electronic medical record. There are thousands of record systems, and scribes need to know how to put in the right billing codes and medical terminology at lightning speed. Torres says it's important not just to be able to multitask, but also to be able to listen to multiple things at the same time.

"You're listening to the physician, you're listening to the nurse, you're listening to the patient," Torres says. "And you're gathering all that information and presenting it back to the physician."

That last part's crucial. The physician has to approve the scribe's notes, because ultimately the doctor is responsible for the record.

Medical scribes make $8 to $16 an hour. Many of them are medical students who say they find it an invaluable experience. But it's not clear that scribes make things better for patients.

Dr. Ann O'Malley with Mathematica Policy Research in Washington, D.C., points to one study done in an emergency department in New Jersey that found that doctors with scribes were able to see more patients on average — which means more money for the institution. But that same study found that the amount of time a patient spent in the emergency department didn't decrease. Medical scribing also raises some privacy concerns, O'Malley says. Some patients may not like having an extra person in the exam room.

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In ancient history, scribes were the literate people in society, the ones who held all the knowledge. Modern scribes are now playing a similar role in many doctors' offices.

Lauren Silverman of member station KERA reports.

LAUREN SILVERMAN, BYLINE: Dr. Devesh Ramnath used to see his patients alone. Now he is always with Connie Gaytan.

DR. DEVESH RAMNATH: Good morning.

UNIDENTIFIED WOMAN: Good morning.

RAMNATH: Remember Connie...

SILVERMAN: Think of Connie as a court reporter in the doctor's office. She's Ramnath's scribe and sort of like his shadow. As the doctor examines the patient's neck, she sits quietly in the corner, typing notes and speaking into a handheld microphone connected to her laptop.

CONNIE GAYTAN: She states she is feeling much better than before. Follow up as needed...

SILVERMAN: Just a few months ago, Ramnath switched from paper to electronic medical records, which meant he no longer just had to take notes. He had to also put them into a computer as a permanent record.

RAMNATH: I was really just focused on trying to get the information in and not really focusing on the patient anymore. Also, I was spending an additional two to three hours every clinic just trying to get my medical records done.

SILVERMAN: Now, a scribe does all the electronic note-taking while the patient is in the office, saving Ramnath hours every day.

RAMNATH: I would more than happily sacrifice a significant chunk of my income for the improved quality of life that I have.

SILVERMAN: Plus, with Gaytan, he gets a scribe who can also translate Spanish.

Scribes are in high demand across the U.S.. The country's first scribe staffing company called PhysAssist is on the second expansion of its Fort Worth headquarters and opened another office in Chicago.

ALEX GEESBREGHT: It's been about a 46 to 50 percent growth rate every year for several years.

SILVERMAN: Alex Geesbreght is CEO. He says in 2008, the company had 35 scribes in hospitals. Today, 1,400. The other big scribing companies have thousands more scribes each.

The company PhysAssist trains scribes from across the country every week in its Fort Worth mock emergency department. Seriously, it's a replica ER, with TVs anchored to the wall and sliding blue privacy curtain.

MATT PETERSON: And let's try clicking positive on the respiratory distress.

SILVERMAN: This morning, an instructor is going over the right way to fill out an electronic medical record. There are thousands of record systems, and scribes need to be able to put in the right billing codes and medical terminology at lightning speed.

, INSTRUCTOR: Probably the biggest skill that I've learned as a scribe is not just multi-task but to listen to multiple things at the same time.

SILVERMAN: Brandon Torres started scribing a few years ago and now works as a trainer.

, INSTRUCTOR: You're listing to the physician, you're listening to the nurse, you're listening to the patient and any overhead pages that might occur. And you're gathering all that information and presenting it back to the physician for him.

SILVERMAN: And that's crucial. The physician has to approve the notes of a scribe because ultimately, the doctor's responsible for the record. A scribe makes just $8 to $16 an hour. Many of them are medical students who say it's an invaluable experience, but is it helping patients?

ANNE O'MALLEY: This is not an area that's received a lot of research attention.

SILVERMAN: Anne O'Malley is a physician with Mathematica Policy Research in Washington, D.C.

O'MALLEY: One study of scribes that was done in an emergency department in New Jersey found that scribes were associated with more patients being seen on average per doctor. And so that clearly results in more money coming into the institution.

SILVERMAN: But that same study found the amount of time a patient spent in the emergency department didn't decrease. And while most patients are fine with having an extra person in the exam room, there are concerns about privacy and training standards.

O'MALLEY: On the flip side, scribes could be viewed as physician's recognizing that they can't do everything and, you know, there has to be some delegation and teamwork in care regardless of the setting.

SILVERMAN: The physician-scribe collaboration is also fueled by a deadline. Any doctor who doesn't make the switch from paper to electronic records by 2015, will face Medicare reimbursement penalties.

For NPR, I'm Lauren Silverman, in Dallas.

INSKEEP: And that's your health for this Monday morning.

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