Scribes in Healthcare Continue to Grow At Major Hospitals–Proof that Medical Records Systems are Still Not User Friendly Enough And Can Disrupt Physician Time With the Patient

I am foremost and upfront all about having medical records and if you have read this blog long enough you know that I developed and wrote one years back, thus my comments tend to be realistic and I comprehend the fact that we can’t just jump on every new piece of software or algorithm that appears.  In every business today the formulas and algorithms are more complicated and the programming is work in progress.  When the tech folks (like me) who have to support all the various forms of software that are out there, begin to complain, you there’s a problem. 

Hospital Relies on High-tech 'Scribes' To Follow the Doctors and Enter Data to be Paperless

When you have spent time working with doctors first hand and as a partner to develop a system that will help them you learn to eat your own dog food right off the start and it is team work.  I started talking about the Common User Interface a couple of years ago and I still this is a good idea.  One young doctor told me he had to learn 5 different medical records system to get through his internship.

Medicine information is getting more complicated today too with all the information that has to be reviewed.  These doctors that like scribes may not at all be tech luddites, is just the amount of information and work flow needed and something have to give.  Of course the physician has to review what the scribe has entered to ensure this is correct. 

Using Scribes at the Hospital – Some Doctors Really Like This Idea

The good side about scribes is that many are med students working for not much more than minimum wage and it is a learning process for them as they go through school.  Here’s an interesting quote from this article:

T”he companies that develop and sell electronic medical records systems are "in total denial" about how complicated they are for doctors to use, Strumpf said. "They know these systems need scribes," he said. "They work with us to train our scribes on their systems, but they don't want to be public about it."

Again I mentioned the open source Common User Interface that could be adopted by any medical record company and this is the screens only and

the rest of their system could stay in place as is for other functions.

Microsoft Common User Interface for Health Applications- Silverlight...and Windows Presentation Foundation

Here I am using and and doing a walk through back in 2008, so you can see this is not brand new.

Competition and who can build the best input algorithms are at the heart of all of this.  Back when I was writing if someone has something easier for clinicians to use, heck I was all over it as my ego was not that big, and this is a bit of a territory battle here. 

Here’s a doctor/developer in New Zealand that I know who is working with it in format and he’s not even using Microsoft code to do it, so enough about the complaint that you have to spend a lot of money to use format.

Common User Interface – EHR Development Work in Progress

Back at HIMMMS 2008 I was there helping promote Tablet PCs and I used from one of my MSDN meetings, a prototype that had

been around before the Common User Interface.  It was kind of funny as I wanted to be not promoting any system to be impartial and all the other EMR vendors I met with at the time showing off the tablet were asking “who’s system is that”, in other words it got attention.  Here’s a short video I did after HIMMS with the prototype.  I had already hung up my coding shoes at this point.

Electronic Medical Records of the Future

Back in 2006 I was already adjusting my program to work on Tablets too and if you are curious the link below has a few screenshots.  Keep in mind this was back before we had a lot of the new innovative code and system we see today so not bad though and it even changed colors for the user’s preference.

What Does an Antiquated EMR (Electronic Record System) Look Like

“More scribes are on the way. Ronald Reagan UCLA Medical Center, Emory University Hospital in Atlanta and Beth Israel Medical Center in New York City said they are exploring the idea. Physicians in other specialties, including urology and family practice, also are starting to adopt scribes.”

Again we all want electronic medical records and more importantly they need to address the needs and formats of the end users, doctors, nurses, etc. and time for programmers and businesses to eat a little dog food along this path.

Again, I like all of this and see the value but again I can’t jump on and promote every single program whether it’s for the consumer or for the clinician, as what seems to be practiced today with some jumping on every thing that shows up. I interface with people from all walks of life but I remember the physician side and the creation process and thus so, consumers would be wise to keep this in mind before going into attack mode with doctors who are not quite readily ripping their way through  medical records with expeditious input,   

Consumers also need to remember that their doctor is creating the equivalent of an income tax 1040 form for every visit and that can be 20-3- a day, so think of it this way, as a consumer how would you like to be filing your incomes tax forms 20-30 times a day, I think I made the the point. 

Remember some get the short form, some have to be itemized and some get audited (denied), so just think of the administrative time that goes into those 3 functions above and you have a pretty good idea of how complicated and detailed the record/billing side of healthcare is.  I’m not trying to give Scribes a big line of promotion here, just looking at things realistically and how they have evolved.  That coding in my background and working hand in hand with doctors writing an EMR a few years ago really helps me include what I feel is a realistic spin on all of this, nothing like first hand experience rather than listening to magpies.

(This is the Medical Quack and not the Medical Magpie) <grin>

Even UCLA is looking into scribes and they are one of the most connected and wireless capable facilities in California, so this has nothing to do with how wired a place is and how fancy the software is – it’s all about having a system that doctors and nurses can use without immense disruptions with patient care and if it takes a scribe to help them weather all of this, then so be it.  BD

Melissa Genove has dreamed of becoming a physician since childhood. To help her prepare, she spends as many as 35 hours each week shadowing emergency room doctors at Loma Linda University Medical Center. The 23-year-old listens intently as they examine patients, records their treatment plans in a laptop computer, and follows up on prescriptions, lab tests, consultations with specialists and anything else the doctors order.
Genove is not an intern, or even a medical student. She is the chief medical scribe in the hospital's emergency department — and one of several thousand young people pioneering a new healthcare field.

But while the conversion is underway, doctors estimate that their productivity plummets by about 30% as they learn to cope with a complicated new system. That's where scribes come in.
Like Genove, they are typically young, tech-savvy and undaunted by computers. They are willing to work for $8 to $10 an hour with no benefits. Most do the job part-time as college students and plan to go on to full-time careers in medicine or nursing. They say the experience gives them a valuable head start.

Leaders of the three biggest companies providing scribes estimate that about 200 emergency departments in community hospitals and academic medical centers currently use them. More scribes are on the way. Ronald Reagan UCLA Medical Center, Emory University Hospital in Atlanta and Beth Israel Medical Center in New York City said they are exploring the idea. Physicians in other specialties, including urology and family practice, also are starting to adopt scribes.

Scribes let doctors focus on patients - latimes.com

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