We know that having the most highly paid and educated employees at our hospitals (physicians) spending more than 50% of their time in front of a computer rather than providing front line care is not efficient or sustainable. We also know that added computer work is driving many physicians to burnout. Scribes have been discussed for years as a remedy for this problem, but the use of scribes hasn’t picked up much traction. Why is this?
After the passage of the HITECH Act in 2009 and the Affordable Care Act in 2010, all healthcare facilities (both inpatient and office-based) began implementing electronic health records (EHRs). The movement toward the universal use of EHRs has been driven by multiple goals, including: improving care quality, safety, and efficiency, reducing health disparities, and improving care coordination and population health. Although the jury is still out on whether the universal use of EHRs has improved quality and patient safety, it is clear that they have not improved efficiency.
Multiple studies have documented the significant time commitment that EHR documentation requires, and the disproportionate time health care providers spend using the EHRs versus providing direct patient care. This has been documented in multiple health care settings, including the outpatient setting, the emergency department, hospitalist practice, and specialty practice.
Time spent using electronic health records is inefficient, particularly for the most expensive, most educated employees in healthcare organizations. These inefficiencies have spurred discussion about whether scribes or some other healthcare worker should be used for documentation in the EHR, freeing up the clinician to have more time for patient care. Although some data shows emergency department scribes improve efficiency and are cost-effective, there is currently little data supporting scribe use in other healthcare settings. Efforts to document the improved efficiency have been limited.
In many other industries, when a task can be performed at a lower cost, there is a movement to transition in that direction over time. Few industries would use their most highly paid and educated employee to perform tasks that another employee could do. However, medicine is a data-driven profession, and the lack of reproducible data showing a specific financial benefit tied to scribe use has limited their adoption.
If we can’t demonstrate the financial benefits of scribes, does that mean they are not cost effective? Or have we not figured out how to alter physician workflow in a way that would make them cost effective?
The large portion of time frontline clinicians are spending in EHRs is not efficient or sustainable. It seems the drag on efficiency and resources use is an unintended consequence of the widespread adoption of EHRs in healthcare. It also seems obvious that 10 years from now providers will not be doing their own data entry into EHRs. The only real question is how do we get from now to then.