Earlier this week a bill that creates a pilot program in VA facilities to improve patient care by allowing for the use of medical scribes, or physician assistants, passed the House.
This legislation is a sign of things to come, and perhaps a sign of things that are already happening under our noses that we haven’t been paying all that much attention to. Scribes are all the rage, and physicians practices around the country are embracing the concept at an ever increasing rate. Becker’s Hospital Review reports that over 100,000 scribes will be employed throughout the U.S. by 2020.
Wikipedia defines a medical scribe as “a person, or paraprofessional, who specializes in charting physician–patient encounters in real time, such as during medical examinations.”. Scribes range from trained individuals with high school diplomas or GEDs, through to medical students and formally trained physician assistants.
While the VA pilot program is new news, the legal existence of a scribe has been codified for some time. The 21st Century Cures Act contains a provision that permits physicians to delegate EHR documentation — providing they or another physician reviews and signs off on that documentation.
Scribe pay is highly variable ranging from $9 to $17 per hour. The variability in pay is reflective of the range of positions that are available and the complexity of the tasks the scribe must perform. Scribes have found their way into the ED, the physician practice, and a range of other environments, and it is likely that they will continue to extend their reach to anywhere you will find a doctor.
By now you are surely scratching your head and wondering how it’s possible that adding a scribe’s salary into the overall equation of medical practice can do anything but increase medical costs to the patient. In a startling result, a recent study of a cardiology clinic showed 10% higher results for physician productivity, resulting in total additional revenue for the practice of $1.4 million at a cost of roughly $99,000 for the employed scribes.
The other clear benefit for having scribes is that nurses can now be freed from taking histories, reconciling medications, and a range of other activities that distract them from the other high-value endeavours they could be taking part in. This is obviously highly desirable given the current shortage of trained LPNs and RNs.
As a technologist, I see the economic benefit of the scribe but have to restrain myself when thinking of the role of the EMR and all the money we poured into the HITECH act. Weren’t these systems supposed to reduce the cost of medical care, and yet here we sit, all these years later, trying to reduce the same costs by having typists shadow doctors?
It’s easy to look for further technical solutions to the problem. Perhaps we need telecommuting scribes (it’s been tried), or perhaps we can have the patient dictate their own information into an Alexa or Siri type system that will automatically fill out their chart?
The reality is that all of these ideas are unsatisfying. Patients still want to tell a story about their condition, and they want to tell it to another human being.
Scribes are here to stay.