Are Medical Scribes Standing in Way of EHR Innovation?

Depending on who you talk to these days, medical scribes are either seen as the saving grace for physicians dissatisfied with the poor usability of electronic health records, or scribes are viewed as “workarounds” impeding much-needed improvements to EHRs.

The growth of the medical scribe industry has been nothing short of astonishing. At least 22 companies currently provide scribe services in 44 states. The American College of Medical Scribe Specialists (ACMSS), the “industry’s only independent certification body for medical scribes,” states that the number of scribes has been doubling annually and predicts that there will be 100,000 scribes by 2020 nationwide, up substantially from about 20,000 this year.

But, George Gellert, M.D., Associate System CMIO at CHRISTUS Health in San Antonio, Tex., is a strong critic of the medical scribe industry, which he believes is counterproductive to addressing the fundamental problems with “functionally inefficient” EHRs. “The solution to the problem of our EHRs not being intuitive, navigable, easy to use, or fast enough all needs to be responded to by the industry,” Gellert tells Health Data Management.  Medical scribes, he asserts, are “taking dissatisfaction out of the equation” and are “interrupting market forces that drive product innovation and improvement.”   

In a viewpoint article published in December 2014 by the Journal of the American Medical Association, Gellert and his co-authors argue that the increasing use of medical scribes to record patient data is a major obstacle for the development of EHRs. While the article concedes that the use of scribes—unlicensed individuals hired to enter information into the EHR under clinician supervision—has allowed physicians to see more patients, generate more revenue, as well as increase productivity, the authors say the medical scribe industry is a “workaround or adaptation to the suboptimal state of today’s EHRs.”

The authors assert that the evolution of EHRs is “driven primarily by market pressure created by individual physicians, practices and hospitals as vendors endeavor to satisfy their customers.” However, by using scribes, they claim provider “dissatisfaction with the state of technology likely will decline, potentially reducing collective market pressure on industry to evolve EHR usability.” Rather than using scribes, doctors should be demanding improved products from EHR vendors, the article advocates.

However, Michael Murphy, M.D., CEO of ScribeAmerica—the largest U.S. scribe company whose tagline is “Doctors Save Lives. Scribes Save Doctors”—believes that medical scribes provide physicians with an invaluable service by allowing them to focus on patients rather than on EHR data entry. “Physicians went to medical school for four years and completed their residency programs to treat patients, not to become secretaries,” according to Murphy, whose company documented more than 21 million patient visits in 2014. “Patients seek treatment with physicians based on their medical knowledge and skills, not based upon their data entry skills or knowledge of technology.”

In addition, Murphy says that blaming medical scribes as the reason why technology is not developing quickly to resolve EHR problems is like saying that citizens paying their taxes are to blame for the government not seeking to balance the budget and exercise appropriate fiscal control. Ultimately, he believes physician burnout—not underperforming EHR technology—is the primary driver of increased medical scribe utilization.

Yet, Gellert doesn’t buy that explanation. “I don’t doubt that physicians face burnout. But, I think to focus in a singular manner on this one Band-Aid as the cure to physician burnout is ridiculous,” he argues. “Physician burnout is due to a broad range of factors and I don’t think that it’s fair to say that this is the overwhelming consideration.”