By Jeffrey A. Gold, MD, Professor of Medicine, Director of Simulation, Oregon Health and Science University 

The widespread adoption of electronic health records (EHRs) has led to a number of unintended consequences—particularly a negative effect on doctor satisfaction and practice workflow. Medical practices have tried many different solutions to help alleviate the burden, and one of the most common solutions is the adoption of medical scribes.

How does this affect the delivery of care? A number of studies suggest that scribes can enhance physician efficiency, improve physician satisfaction, and increase billing in a variety of clinical settings. Patient satisfaction can also increase, due to improved physician-patient interactions during office visits.

A Lack of Training and Standardization

In spite of the rapid growth and potential benefits of scribes, the healthcare community has generated very little regulation or standardization for scribe training, and researchers haven’t conducted any assessment of scribes’ ability to safely interface with the EHR.

Dedicated scribe organizations, which provide scribes for individual practices and healthcare organizations, may train recruits on basic medical terminology, note structure, documentation, and EHR basics. Other scribes may receive on-the-job training from the doctor who is their employer. There is no licensure requirement for scribes.

Survey Shows Variable Roles and Functions

To better understand the role and functionality of scribes, The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, and Oregon Health and Science University (OHSU) conducted a national survey of The Doctors Company’s members.  This survey, with 335 respondents, suggested that scribes are supplied from different sources, have disparate backgrounds, and their training is highly variable:

• 55 percent of scribes are trained by the doctor.
• 44 percent of scribes have had no prior experience.
• Only 22 percent of scribes have had any form of certification. 
• Around 24 percent of practices that use scribes hire them as employees.
• Nearly 13 percent of practices use scribe staffing agencies.

The study also revealed wide variability in the tasks scribes are performing, including pure note writing, data entry (such as updating allergies), data extraction (such helping the doctor find information in the EHR), and order entry.

The Risk of ‘Functional Creep’

The combination of rapid growth in scribe use, lack of standardized training, variability in scribe experience, and variability in both EHR exposure and EHR workflows raises the concern that scribes may introduce potential negative unintended consequences to either workflow or documentation.

In addition to concern over the wide variance in scribe activities, healthcare providers are worried about “functional creep”—scribes being granted the authority to perform more complex functions in the EHR over time. Given the already large number of negative safety issues associated with these complex EHR functions, it’s imperative that the healthcare community create methodology to ensure scribes can be effectively trained and their competency assessed for safe and effective use of the EHR.

Dr. Gold is director of the OHSU Simulation Center, program director of the Pulmonary Critical Care and Critical Care Fellowships, and associate director of the Adult Cystic Fibrosis Center at OHSU.

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Contributed by The Doctors Company (thedoctors.com)