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Medical scribes are on the rise, but standards lacking

Doctors are also responsible for reviewing scribes’ entries, making corrections if needed and signing off before leaving the patient care area, according to the guidelines.

But there is no enforcement mechanism to ensure adherence.

Some health care experts have raised concerns that sometimes scribes could be pressured to make the entries to save doctors time.

“We’re concerned that there will be a situation where inevitably these scribes are used to enter an order,” Gellert said.

Lap-Heng Keung, a scribe at MetroSouth Hospital in Blue Island, Ill., said he’s never been asked to enter orders and wouldn’t be comfortable doing so.

“We don’t have the same expertise as providers…there are so many drugs that sound the same but have one letter difference. It’s not within our scope of skill,” said Keung, who is studying information technology and taking pre-med courses at the Illinois Institute of Technology.

Even so, some scribes may face pressure to go beyond their training.

“Put yourself in the position of a 21-year-old pre-med student, here’s a doctor in the ER, you want a letter of recommendation so you can go to medical school — it’s a lot of pressure,” said Cameron Cushman, a vice president at PhysAssist. He said company officials work with scribes to help them know how to handle that situation. “We [say] …’you’re going to be starstruck by these doctors, but you have to play your role and if you don’t, there will be consequences.'”

Cushman says the company has been fired by clients 10 to 20 times — mostly by smaller emergency room providers and outpatient clinics — because it refuses to let scribes enter orders into electronic health records.

Surgeon Richard Armstrong of Newberry, Mich., said doctors are still coming to grips with the demands of electronic health records. Armstrong uses a transcriptionist to type his notes, but he enters all EHR information himself. A doctor for 34 years, Armstrong said he doesn’t use scribes because he’d have to check their work, and he’s more confident in his ability to do the job accurately.

“We’re forcing a technology into primetime onto physicians who don’t know how to handle it. And they’re using scribes because they need assistance,” Armstrong said.

By Lisa Gillespie, Kaiser Health News


Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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