Today, however, organizations seeking to implement the latest wrinkle in medical record-keeping, electronic health-record systems, are looking to new generations of scribes—to increase physician productivity and to overcome the pitfalls of the still typically clunky physician/EHR interface, and to ease the strain of EHR implementations and replacements.
“The word is biblical,” said Linda Pierog, practice manager for Emergency Medicine Services of Orange County, or EMSOC, and its ScribeMD service, which provides scribes as part of its emergency room physician staffing program.
“Transcriptionists came out of this whole thing, too—somebody who either takes the written word or the spoken word and puts it on paper,” Pierog said. In contrast, scribes do more than transcriptionists by assisting physicians in fully documenting a patient encounter, most recently, entering encounter data in an EHR.
Emergency rooms have given scribes a toehold in modern healthcare record-keeping operations because, unlike in some other medical specialties, ER records are created concurrent with patient care, said Pierog, who holds both an MBA and a master's degree in nursing.
Today the group in Orange, Calif. has 50 scribes working on 13 physician shifts a day, Pierog said. And the group is just beginning to branch out beyond the ER to provide scribe services to a hospital-based cardiology group and is in discussions with several primary-care offices, she said.
Scribe candidates are college graduates, many of whom are multilingual and “highly motivated,” Pierog said. Typically, the person she is looking for to join her staff is “someone who has an intense interest in medicine and is looking to go on to something else,” quite often medical school.
“It's not hard to find scribes,” she said. “The program has a 300-person waiting list.”
Pierog said she still enjoys working at least one shift a week as a scribe, as she has since EMSOC started its program in 2004.
“I like patient care,” Pierog said. “I think all the scribes feel they are all part of the patient care experience.”
Michael Murphy is a physician and former U.S. Army Ranger who in 2003 co-founded and is now CEO of ScribeAmerica, Lancaster, Calif., which provides both scribe consulting services and turnkey operations, taking over the training and staffing of hospital-based scribe programs.
About half their hires are students in pre-med, pre-nursing or physician-assistant or nurse-practitioner programs who go on to those professions after gaining invaluable, on-the-job educational experience working as scribes, Murphy said.
“We had a person at UCLA this year, in medical school, who knew so much, knew the tests to order, knew the differential diagnoses, they actually suspected her of cheating, because she knew way too much,” Murphy said. “It's now generally regarded as being the best pre-med job.”
Another 30% of ScribeAmerica hires are what Murphy described as “horizontal secretaries gone vertical. We have those people in the doctors' offices who were sitting down in chairs and they're walking around now.” The remaining 20% of scribes come from various walks of life, he said.
The scribe business is booming, according to Murphy, with his firm providing more than 500 scribes to support 36 healthcare organizations under contract. The company has eight teams ready to travel to set up new programs, he said.
There is no trade association for scribe companies and no professional organization for scribes, so hard data on the fledgling service industry are unavailable. Murphy estimates the three major companies and a couple of smaller ones probably have contracts with more than 150 hospitals, staffing them with about 2,000 scribes. In addition, there are another 30 to 40 “home-grown” programs with another 500 scribes, he said.
Still, with 4,500 emergency departments in hospitals nationwide, “a big market is left wide open for a scribe infiltration,” Murphy said.
Sarah Esquibel, chief operations officer for ScribeAmerica, graduated from the University of California at Santa Barbara with a bachelor's degree in biology and a plan to enroll in medical school. Murphy recruited her roughly four years ago to work as a scribe at 419-bed Hoag Memorial Hospital Presbyterian, Newport Beach, Calif., near her home in Irvine. She has since moved up at ScribeAmerica, where she has been setting up scribe programs for 2½ years.
“I still believe that one day I will end up in medical school, but at this point I'm content with working with the company and extending the business,” Esquibel said. “In the past year, I've probably lived in six states.”
Depending on the size of the hospital, getting a program off the ground takes anywhere from three to six months. “What takes so long is we have a pretty rigorous training schedule we put them through,” Esquibel said. Applicants are not the problem. In one engagement at a hospital in Lafayette, Ind., near Purdue University, Esquibel said she sent a couple of e-mails out to departments at the university and in three days had 65 applicants for 22 positions.