Wednesday, January 15, 2014

Medical Scribe: Emergence of a New Occupation?

Yesterday’s New York Times carried an article about what may be an emerging occupation: the scribe who inputs medical records while a physician interacts with a patient.

The need for these workers arose because of a provision of the Affordable Care Act: the requirement that physicians keep electronic records of patients and use these in exchanges of information. The purported reason is to reduce paperwork and administrative costs, but another important consideration is the ability of researchers to use the digitized data in (anonymized) records to study the effectiveness of various medical interventions. I could add a third reason: data security. Although it is often assumed that paper records are more secure than electronic records because of the risks of computer hacking, paper cannot be as easily stored offsite in redundant copies. (I learned of this vulnerability when my all of my daughter's medical records were lost at her pediatrician’s office.)

Before electronic records, physicians either jotted down notes or dictated comments into a voice recorder for later transcription to paper, perhaps by a medical assistant. Some physicians resent the switch to electronic records because keying data into a laptop during interactions with patients pulls physicians’ attention in two directions at once. They find that the nature of their job has moved away from the work tasks that drew them into this profession.

Medical scribes relieve physicians of these duties by being the one holding and using the laptop during interactions with patients. Scribes key in all of the information produced during sessions with patients, freeing physicians to give patients their undivided attention. Obviously, there is a monetary cost to hiring these workers, but it is offset by the amount of time scribes save for physicians (an average of three minutes per patient visit, according to one study cited in the Times article), which allows physicians to see more patients over the course of the day. That’s not to mention how medical scribes change the nature of physicians’ work tasks by removing the clerical element.

On the other hand, having a third person present during every session with a patient may reduce the feeling of privacy that exists between physician and patient. Another study cited in the article found that, in clinical settings, “roughly 10 percent of patients were uncomfortable with having the scribe present.”

One company that provides medical scribes to hospitals and medical practices estimates that almost 10,000 scribes are now at work, and businesses such as ScribeAmerica and PhysAssist Scribes have been established to meet the growing demand. These companies train the scribes in a program that takes about two or three weeks.

But is this a new occupation, or merely a specialization within an existing occupation, medical assistants? It would be easier to recognize as a distinct occupation if it had a formal educational credential. However, I would argue that it is an occupation in its own right because its work tasks are highly specific. It is unlikely that medical assistants are dividing their workdays to handle these tasks part of the time or that some of the work time of medical scribes is being diverted to doing tasks that medical assistants perform, such as measuring patients’ vital signs or scheduling appointments.

My guess is that this occupation will flourish for a few years but that voice-recognition software will eventually be adapted to the specific needs of recording data from sessions with patients. Some physicians are already using voice-recognition software in limited ways.

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