According to the Centers for Disease Control & Prevention, approximately 87% of office-based physicians utilize an Electronic Medical Records (EMR) or Electronic Health Records (EHR) system. Such significant adoption does not come without consequences, as physicians struggle to learn to use the systems in an efficient manner and time traditionally devoted to patients becoming reallocated to their making notes in the electronic system during the visit.
In recent years, many practitioners have chosen to employ scribes, who are tasked with functions including entering critical information into the system on behalf of the physician. The use of scribes is common in the majority of healthcare settings and specialties. Patient feedback has been positive, as many perceive doctors as spending more personal time tending to their care.
Thus far, there is very limited evidence of regulation, standards, or educational qualifications for those working as scribes. The Joint Commission has some requirements that providers sign data that is entered by scribes to authenticate the entries. Organizations have developed that specialize in providing scribe candidates to medical practices, hospitals etc. These staffing companies may have some requirements for scribes such as comprehension of basic medical terms, familiarity with EMR systems, and formatting templates.
There is no licensure process for scribes and many simply are hired and trained on-the-job to properly transcribe, place orders, respond to patient messages and more. A recent study conducted by the Doctors Company showed that the tasks that scribes are handling vary widely. Several critical factors are all coming together rapidly that may bring cause for concern including:
- Massive adoption of scribes among medical providers; the profession is among the fastest growing in the healthcare arena
- The absence of training standards or experience
- Continued EHR system development & complexity
- The critical nature of the data being documented
- The potential for “function creep”, which occurs when empowered to complete increasingly complex functions
The term “function creep” generally refers to the addition of critical tasks such as interpreting existing data or other discretionary activities. When practitioners recognize the increased ability to direct more of their focus to patient care, there is often a natural tendency to transition more functions viewed as time-consuming or undesirable to a scribe. As the scribe begins to assume more tasks, it heightens their value to the organization, which they are unlikely to object to because it clearly justifies pay increases. Many in the healthcare arena are calling for the implementation of standards, competency, and training to avoid potentially dangerous outcomes that could lead to costly medical malpractice claims.
Although many facilities conduct background checks as a general aspect of procedure, many smaller practices may be inconsistent in following through. In a medical setting, a position that requires solely a high school diploma is unusual. It is important that physicians, healthcare administrators, and managers begin to address these potential problems. Physicians particularly should recognize that they are in a position of assuming liability based on work completed by scribes.