Hospitals hiring scribes to tame electronic medical records

Electronic medical records were supposed to save time and trim staff among health care providers.

But so far, they’re having the opposite effect.

A growing number of hospitals nationally and locally, including some of the campuses run by Indiana University Health, Community Health Network and Franciscan St. Francis Health, are employing scribes to help doctors fill out their electronic records on patients. Doing so is critical, they say, to keeping physicians happy and for getting fully paid for the work they’re doing.

Scribes are non-medical, typically college-aged workers that click boxes and type patient information into an electronic medical record during a patient’s visit.

Indiana University Health West Hospital in Avon hired Virginia-based eScribe last fall to provide help in its over-burdened emergency room. The unit has 22 beds, which in normal circumstances would be able to handle a maximum of 44,000 patients per year.

But IU Health West’s ER receives 50,000 visits per year, according to its medical director, Dr. Megan Crittendon.

“We’re always full,” she said. “So really not until your shift is over, and your relief comes, could you do your charting. You might be faced with 20 patients to chart.”

That workload typically adds one or two hours each day to a physician’s 10-hour shift. That jibes with a recent study led by Dr. Clem McDonald, a fixture for 35 years at the Indianapolis-based Regenstrief Institute, found that electronic medical records were responsible for “stealing” 48 minutes per day of primary care physicians’ time. McDonald said hospital administrators have gone overboard on what they require doctors to enter into electronic record systems.

Since Crittendon became medical director of the ER in 2007, she knows of no physician who left solely because of the burden of patient charting. But she is sure it contributed to the departure of some of her doctors.

“It also prevented me from recruiting physicians,” Crittendon added.

Even after spending that extra, IU Health West’s ER physicians often didn’t get all 20 patient charts done in a day, leaving three or four till the next day. That created a continual backlog.

Physicians often would not remember, hours or even days after the encounter, all the detail needed to get fully reimbursed for the care they had provided. If, for example, a doctor recorded that a patient had a cut but not the fact that it was 5 centimeters long, then the hospital would have to bill under the lower-paying codes for a shorter cut.

“We’ve never seen any repercussions in patient safety or patient care," Crittendon said, although she noted that patient satisfaction drops when physicians spend most of their time looking at a computer. B“But where we saw it was patient billing. It’s just loss of revenue, where you really saw it.”

That potential to make physicians happier and more efficient, and boost billing amounts, has helped eScribe grow rapidly since its founding in 2010. Other companies, such as Florida-based ScribeAmerica, have also been growing rapidly.

The pitch eScribe makes to hospitals is that its scribes can make physicians 40 percent more productive.

“I can give you your time back,” said Dr. Brian Clare, the CEO of eScribe. “Physicians, we’ve given away so much for so many years.”

In the case of IU Health West, Clare said, the hospital was able to handle a greater than 15 percent surge of patients during flu season this past winter without adding any more physician hours.

IU Health West now uses 20 scribes—with about two working at any given time. Most of them are pre-med students from Butler University, IUPUI or Indiana University. Getting time to shadow doctors’ each day can be helpful to them in their future studies to be doctors, Clare said, noting that two of his sons worked as scribes before going to medical school.

“It lets doctors be doctors,” Crittendon, the hospital’s ER medical director, said of scribes. She noted that her physicians have and their patients have both reported better satisfaction since the hospital starting using scribes. “We can focus on taking care of patients, rather than writing a novel about them.”

“Somewhere in between [paper records and EMRs], we became record keepers, essentially. It became more cumbersome in time, and didn’t let us do our work as physicians,” Crittendon said.

Both she and Clare, the eScribe CEO, said electronic medical records are still hugely advantageous. But Clare said the systems will have to mature a lot technologically before they achieve the time-saving everyone hoped they would.

“Where we are right now is a very primitive platform,” Clare said. “It’s the bag phone of electronic medical records.”