When Scribes Don’t Pay Off

Posted on June 30, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Since scribes first hit the scene, there’s been a lot of debate about the benefits of having them in place, as well as what duties they should handle.

Critics have suggested that using scribes only sidesteps the need to look at larger industry issues. On the other hand, some physicians have found scribe support to be a big relief. Many have reported that scribes have reduced their paperwork and reestablished their face-to-face connection with patients.

Those happy doctors include Peter Leavitt, primary care physician with Bend, OR-based St. Charles Family Care. Dr. Leavitt told a local newspaper that using the scribe cut the two hours per day he spent entering notes into the EMR by 40 percent.

But Leavitt won’t have scribes available much longer. St. Charles Health System, the PCP practice’s parent organization, has decided to drop scribe support for primary care offices on July 1st. The health system said that the $480,000 it invested in scribes didn’t produce enough benefits to justify the expense.

Starting in spring of last year, St. Charles has gradually brought a total of 20 scribes on board.  In an effort to test out their impact, the system brought scribes to only four of the clinics.

St. Charles hoped that rollout within the primary care practices would boost physician morale, increase patient throughput and give doctors time to improve their chart notes and documentation. As it turned out, however, adding the scribes didn’t accomplish what execs had hoped.

Yes, the roughly 20 doctors who used scribes seem to be happier once they came on board. But the scribe experiment seemed to fail by other measures. The clinicians were only able to see one-half patient more per day, which didn’t meet execs’ expectations. What’s more, documentation didn’t improve, in part because scribes can’t perform key functions like ordering tests, Leavitt suggested.

What’s more, the health system ran into some unexpected obstacles. In particular, some patients refused to let scribes stay in the exam room, and others would only share private information with the doctor once the scribe left the room.

It’s impossible to say whether the results seen by St. Charles would be duplicated elsewhere. After all, there are a ton of potential confounding factors which could have influenced the results of this trial, including the nature and level of training the scribes had received and the extent to which the clinics‘ existing processes could support workflow improvement.

Though we’ll never know for sure, it could be that if the scribes had a better education or the workflow around documentation was improved, St. Charles would have gotten better results. And it could be that the EMR is so hard to use that even scribe use couldn’t put a dent in the problem.

Regardless, we don’t need to know much to conclude that the health system may have significantly undervalued the benefits of physician satisfaction. I don’t know what dollar value execs assigned to the happiness of doctors, but even a raw number based on physician recruitment costs and the time needed to train them on your EMR would might capture such benefits.

Meanwhile, I’d argue that the metrics St. Charles used to measure scribe value – patient throughput and improved documentation — may or may not be the best way to approach the problem. I’d love to see a similar pilot rolled out which measures success strictly by patient and doctor satisfaction levels.  After all, you can’t lose by making physicians and patients happy.