The Medical Scribe Dilemma

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The position of medical scribe has been largely created by the EHR industry, but it still carries with it many of the issues that EHRs cause, including questions of security and management. Photo via gpointstudio/Shutterstock.

When Alex* graduated from college, he wasn’t prepared to apply to medical school right away. He’d only just decided that he wanted to be a physician, and he knew that he needed a few more years of experience and apprenticeship.

Initially, Alex spent his days at a community health clinic in his hometown, where he took charge of training the clinic’s volunteers in the art of electronic data management.

A year later, Alex followed his girlfriend to Boston and again found himself searching for a job that would prepare him for medical school. During one particularly long day of job searching, he came across a listing for a “medical scribe.” He was intrigued.

Today, Alex works as a medical scribe, assisting a physician at Beth Israel Deaconess Medical Center (BIDMC). He describes the job as a good learning experience, but one that has become controversial in terms of the data he can access and the work he’s allowed to do.

“A Medical Scribe is essentially a personal assistant to the physician; performing documentation in the EHR, gathering information for the patient’s visit, and partnering with the physician to deliver the pinnacle of efficient patient care,” one scribe agency writes. Other agencies describe the position as that of a “physician collaborator,” working with “some of the nation’s finest healthcare providers, in some of the most prestigious hospitals and clinics in the world” to lighten the burden created by electronic medical records.

Typical to many medical scribes, Alex was hired to work with one physician in particular: a 68-year-old primary care physician who “isn’t very good at computer stuff.” As the physician’s executive assistant, Alex sees every patient with him, manages patient data and completes administrative tasks, like following up on prescription orders and answering emails.

“We have desktops in each exam room, so I sit in there with him. He goes about his patient encounter like normal, and I type it out,” Alex says.

He notes that a medical scribe’s main job is to save physicians’ valuable time. Electronic medical records must be dealt with either during a physician’s free time or between patients; but with a medical scribe, Alex’s physician can simply focus on his patients, as he’s always done.

Jerina Gani, MD, another BIDMC physician, says that hiring a medical scribe allows her to spend more time with her family. She’s a new mother. “Due to extended documentation and not enough time, I decided to hire a scribe,” she says. “My scribe strictly does the typing of my notes, gathering all info, then writing my assessments with my advisement. And I find it very helpful – no more notes at home, more time with my family, and I’m less burned out. There will definitely be more scribes in the future.”

Many physicians, like Gani, rave about the help that a medical scribe might provide them in terms of job satisfaction and time management. But here, it seems, lies one major problem with the position: Who really manages the scribes? Agencies hire out medical scribes to physicians, specifically, not to the hospital organizations where they work. According to Alex, Beth Israel’s administrators recently discovered that, in a blatant breach of the organization’s security protocols, many medical scribes at the hospital were using their physicians’ logins to access and process patient information.

“My login has no significant access,” Alex says. “So me logging in with my physician’s information improved our workflow. I did this all the time, but all under his supervision and express direction. We’d get a call from the pharmacy, for example, and he couldn’t get to it. So I’d do it for him. It was practical and more efficient, but the BIDMC legal team was horrified by it.”

This conflict raised the question of who actually employed the scribes at BIDMC. The physicians? The scribe agency? The hospital? The agency pays Alex’s bills, but the physician hired him. The hospital, though, appears to hold precedent in the day-to-day rules and processes that scribes must follow.

According to Alex, BIDMC has since spoken with their medical scribes, chastising them for their non-secure behavior and enforcing the use of their own logins, rather than those of their employers. Alex says that this has slowed down his workflow and impeded his ability to help his physician. Because of privacy concerns, he wonders if medical scribes will ever reach their full potential.

Regarding procedures, Alex says that he and his fellow scribes were trained in HIPPA before they began working, and he has always kept his patients’ information confidential. According to several scribe organizations, scribe training usually includes more than 120 hours of coursework to develop clinical competency. But privacy and security remain strong issues at the core of implementing effective electronic health records systems, and many scribes find themselves lost as they try to navigate what is currently a very murky rule book.

“I’m his proxy,” Alex says of his physician. “I don’t know where they should draw the line with all of this – a more rigorous process of choosing scribes, perhaps.”

The position of medical scribe is fairly new, with the American College of Medical Scribe Specialists (ACMSS) having been created as recently as 2010. According to the ACMSS, medical scribes will likely become even more common as physicians will be penalized, beginning this year, for not using electronic medical records. In an editorial in the Journal of the American Medical Association last year, authors estimated that 20,000 medical scribes would be working in the U.S. by 2015, a number likely to swell to 100,000 by 2020.

Perhaps only time will tell of scribes’ usefulness as individual hospital organizations deal with questions of the necessity of the position – and the privacy issues it raises – in an increasingly digitized medical environment.

*subject’s name has been changed for job security reasons.

Jenni Whalen

Jenni Whalen

    Jenni Whalen is the Executive Assistant of Editorial at Upworthy. She was previously MedTech Boston's Managing Editor and has an MS in Journalism from Boston University, as well as a BA in Psychology from Bucknell University. Whalen has written for Greatist, Boston magazine, AZ Central Healthy Living and the New England Journal of Medicine, among other places. She has also worked as a conference planner, ghost writer, researcher and content developer.

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