People and firms never react to a government policy or incentive in exactly the way the geniuses coming up the initiative expect, although careful analysis ahead of time would provide a warning that there may be an unintended consequence or two. An article in the Journal of the American Medical Association reflects this tendency in describing the growth of the medical scribe position. (JAMA Article) Physicians, and other clinicians, have been overwhelmed by the Medicare program, and some other payers, imposing all kinds of new regulatory burdens on them, all in the name of quality improvement or cost reduction. A particularly burdensome initiative is the “meaningful use” program, which so far hasn’t made a meaningful difference in anything but provider cost structures. To obtain meaningful use, and at this point avoid losing some Medicare reimbursement, the provider must install an EHR with certain functionality and show that they use it for certain purposes, all of which supposedly will magically make care much more coordinated and the patient’s health much better.
Since physicians were already feeling like an excessive amount of their time was taken up with administrative tasks, the meaningful use program for many was a last straw that completely disrupted work routines and impeded spending quality time with patients, which is what most doctors want to be doing. Because EHR interfaces are so pathetic and time-consuming, physicians now are hiring “medical scribes.” A medical scribe is a low-paid, unlicensed worker who basically follows a physician around and does their charting and administrative data entry for them. The scribes learn the EHR and other systems in the doctor’s office and many come from specific medical scribe training programs that have sprung up. The rapid and widespread growth in their numbers suggest that they produce a significant return for medical practices, probably by allowing doctors to spend more time more productively seeing patients, which typically allows the generation of more revenue, or for at-risk provider systems, means that costs per unit of patient revenue are lower. As the JAMA article notes, the rise of scribes is clearly a workaround to sub-optimal (what a nice euphemistic way to say shitty) EHRs. While JAMA suggests that scribes may become obsolete as EHRs improve, I don’t think so and I don’t think it even would be desirable. Research shows that patients don’t like it when doctors are on the computer during the visit and doctors don’t always see a high value in EHRs. The best thing is to let physicians spend as much time as they can interacting directly with patients. And maybe the real solution is to get rid of the meaningful use rules and let doctors have the flexibility to figure out how to use HIT in the manner that they feel helps improve patient care the most, instead of having ideologues at HHS decide that for them.