According to a Stanford Medicine poll of primary care providers (PCPs), 63% think electronic health records (EHRs) have led to better patient care. However, 40% think EHRs present more challenges than benefits and 44% see their primary value as data storage, not as a clinical tool. A separate survey found that when it comes to usability, PCPs rank EHRs a solid “F.”
According to research, “62% of time devoted to each patient is being spent in the EHR and half of office-based PCPs (49%) think using an EHR actually detracts from their clinical effectiveness.”
While we can debate the value of the EHR, I think we could all agree it has some distinct benefits over paper charts. Simply keeping track of paper records was a challenge. Does anyone remember going to the file room to find that the patient record you needed was missing? The next step was to send the chart clerk on a search, going from office to office and combing through stacks and stacks of folders looking for your patient’s file. Talk about inefficient.
Now we have the patient’s record always available at the point of care, which is great. But what’s happened is that physicians, nurses and other clinicians have become data entry clerks of sorts. It’s a different kind of inefficient, one we haven’t quite mastered.
In the exam room, two’s company and three’s a crowd
The impact of the EHR on the patient encounter is one we’re just beginning to understand. Now you have patients sitting there while the clinician is focused on a computer screen, following prompts, advancing through screen after screen of required questions—all of which takes precious time away from the actual patient encounter. In the meantime, the patient may be talking to the clinician, relaying details about their health issue, expecting that the clinician is hearing what they’re saying. In fact, it’s nearly impossible to capture important details while doing data entry. It’s like distracted drivers in a way. We know what happens when drivers take their eyes off the road. In the same way, distracted clinicians who take their eyes off the patient can miss critical information that can negatively influence diagnosis and treatment.
Some may ask how this is any different than using paper charts. After all, we still had to capture patient information during the exam. But it was different. Paper charts were less intrusive and more intuitive. You captured the notes in the way that worked best for you. The patient, most likely, could see that you were noting what they were saying. There were no automated prompts to slow you down, no searching for the right screen. When using the EHR, on the other hand, you likely have your back to the patient. They can’t see what you’re typing. You’re asking all these questions that have nothing to do with the purpose of the visit. The computer becomes this unnatural obstacle that inhibits eye-to-eye contact and a fully attentive clinician-patient encounter.
Enter the scribe
Medical scribes have been around for more than four decades, initially used in emergency rooms. However, they didn’t become widely adopted until the advent of the HITECH Act, which incentivized the use of electronic health records. On a positive note, having someone on-site to capture important information relieves the burden on the clinician. However, it can feel intrusive, especially in a private exam room, and may inhibit some patients from sharing embarrassing details of their situation. This is understandable since there is a real chance, especially in small communities, that the patient could run into the scribe at the local coffee shop.
One of the great benefits of using a scribe is that they can capture everything the patient says, which makes for a more informative note and a more complete patient story. This isn’t possible when clinicians have to recall encounter details after the exam or at the end of the day in order to finish their charting.
More recently, virtual scribes have become a more popular choice. They provide all the benefits of the in-person scribe but are less intrusive. Using smartphones, tablets, laptops, or Google Glass, virtual scribes can capture information both visually and/or audibly. Even better, specially trained virtual scribes can now perform additional services such as ordering labs, managing referrals, and updating clinicians on a patient’s history prior to the appointment. They can also work down backlogs of charting so clinicians don’t have to complete their charts in the evenings or on weekends, which can reduce clinician burnout and provide a better work-life balance.
Enhancing the value of the scribe with artificial intelligence (AI)
One of the benefits of having a virtual scribe is their ability to cut through the noise of massive amounts of data to get the most valuable information. But humans are fallible and will invariably miss something. AI can mitigate this risk. Sophisticated AI solutions can take on the burden of translating text and putting it together in the right place in the right way within the note. This ensures greater accuracy while the virtual scribe provides context and observational interpretations.
Together, AI and virtual scribes increase the value of the EHR as a clinical tool, giving clinicians the ability to make more timely, informed decisions. This dynamic duo also enables clinicians to spend more time on direct patient care, which enhances patient satisfaction while improving outcomes.