Scribe use may hinder EHR design improvement

While the use of scribes may be of value to physicians and hospitals in the short term, it could stifle technological improvements to electronic health records and put patients at risk, according to a viewpoint published in the Journal of the American Medical Association.

The scribe business is booming, with at least 22 companies providing scribes to physicians and hospitals in 44 states, according to providers from Texas-based CHRISTUS Health. There's now an American College of Medical Scribe Specialists, and a certification program. The number of scribes has been doubling annually, with 20,000 estimated scribes at the end of 2014. In six years there may be one scribe for every nine physicians.

However, the providers say, providers shouldn't lose sight of the fact that scribes are merely an adaption to the "suboptimal" state of current EHRs.  

"If physicians and hospitals use medical scribes as an effective workaround, dissatisfaction with the state of technology likely will decline, potentially reducing collective market pressure on industry to evolve EHR usability," they say. "New product development, innovation, and continuous refinement driven by demand are more costly and initially less profitable than maintaining and reselling the same, suboptimal product. By reducing market demand and pressure on industry for needed improvements, the medical scribe industry [and inadvertently its customers] may contribute to an unintended, undesirable outcome: a deceleration and possibly stagnation in EHR technological improvement."

They recommend that providers, instead, demand better EHR products from vendors.

Scribes also pose a risk in that they may create functional creep, the researchers say. Although the Joint Commission bars the use of scribes for order entry, physicians may allow scribes to do so anyway, which increases the risk to patients.

While some physicians view scribes positively--as methods for increasing revenue, improving patient interaction and freeing up time--others express concern about their use and cost.

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