To Scribe or not to Scribe - the EMR Data Entry Problem

Arthur L. Caplan, PhD, did a Video Blog on Medscape that as invited almost 250 responses as I am writing this.

Would a Scribe Repair or Destroy the Doctor-Patient Bond?

EMR or EHR has made tremendous strides in bringing workflow efficiency to medical practices and ambulatory clinics. Current EMR Software technology has also partially solved the remote access and data repository problem for patient disease management, but not the data entry obstacle. 

Data access and disease management won't be important if point-of-care data entry is a problem. 

EMR and EHR software may not improve efficiency for the doctor if he/she is not a good typist or good with computers and they try to do everything themselves. EMR software has certainly improved workflow and documentation in the service of the healthcare system as a whole. With improper EMR systems clinicians become data entry clerks.

I disagree with Art to some extent. Scribes may work for some types of specialists, as many doctors have noted in their comments.

There are also other methods that can solve the data entry conundrum. 

I generally start with evaluating each individual Provider and their clinic to determine their level of comfort with computers, typing speed, speech recognition, comfort with templates and perhaps a combination thereof. 

Usually I find that the best option is a judicious use of all methods. 

  • MA/PA/Nurse (you can call them scribes) enter chief complaints, review of systems, even basic HPI, vitals, refill requests. Before the provider goes in the exam room, chart is pulled up with lab/pathology/radiology results on the screen.
  • Dr. views the note that MA created before entering the exam room from their own office (like viewing the paper folder before entering the room).
  • In the exam room, Doctor does minimal necessary clicking after spending essential time with the patient one-one. The level of 'clicking' involves diagnosis, procedures/orders, medications. After the patient has gone, Doctor dictates findings (detailed HPI, impression and plan) with Dragon software or voice dictation for transcription. This should not take more than 2-3 minutes.

This kind of approach results in saving providers time and allows them to go home early. Sounds optimistic? Not necessarily. Involve your vendor or consultant to help you create an efficient workflow for yourself to create a truly rewarding patient engagement without wasting time with computer screens.