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EMR Systems Spawn Cottage Industry: Scribes

Posted on September 19, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

One of the limiting factors when it comes to EMR systems is that it requires some amount of training to use an EMR system. Doctors are in the habit of writing down notes, or dictating them into dictaphones for transcribing later. So the idea of an EMR system that requires typed input can easily face some resistance, just based on the process change it requires. And hence the rise of a new class of health IT worker – the scribe.

Having a scribe taking notes at hand would’ve seriously helped me like my doctor better at my last appointment. This was someone whom I was meeting on account of a referral – I didn’t already have an established relationship with the doctor. The doctor and an assistant spent about a third of their time figuring out how to enter my scans into the EMR system. I don’t know what was at fault – the newly acquired iPad or an EMR they didn’t know how to use. They were effusive with their apologies but I couldn’t help feeling that I got the short end of the stick when the doc rushed through the rest of my visit and quickly ushered me out. A competent scribe, well versed in their EMR of choice, might have really helped.

 There have been a slew of articles about the rise of scribes in health IT. They started sounding really promising to me, especially when I considered how one could tail a doctor on his/her rounds with patients, and gain some insight into the business of being a doctor from the ground up. I checked out a couple of companies (ScribeAmerica, EM Scribe Systems) that train medical scribes and source them out to ERs. EM Scribe Systems’ application form states that it requires a one or two year commitment, wants to know what your future med school plans are. The pay anywhere is between $8-$16/hour (scroll to the bottom of the page). The higher end of that range gets paid with scribe experience.

(Seriously? If medical transcription can be outsourced to India and Philippines, why set the bar so high for medical scribe jobs? Or alternatively, if the bar is so high, why not pay better?)

I guess the pre-med scribes are approaching it from a different aspect – the real payback for them comes from understanding the medical aspect. The EMR system is merely a tool to an end.

New APN’s View of EMR

Posted on January 14, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I got the following message (actually on Facebook) from a previous colleague of mine. When I worked with her she was an RN, but she just finished her education to become an APN and found a job at a local well known medical provider. Here’e her message to me after starting the job (specific names removed):

Help! I need to learn [Jabba the Hutt EMR’s] charting system;-( No bueno… Mucho hard!! I like [previous job’s] EMR so much better!!

Excuse the spanglish and almost text message style feel to the message. In fact, I wouldn’t be surprised if she sent me that Facebook message from her phone. Yes, our methods of communicating are changing.

I was pretty taken a back by her message actually. Not because I haven’t heard complaints about this Jabba the Hutt EMR system (Definition of Jabba the Hutt EMR Vendors: Good in their day, but have gotten so big and bulky that they’re barely functional) before. I actually had heard similar stories, but I just didn’t expect it from her. She was always very good at computers and doing what she needed to do with the EMR when I worked with her. Plus, she’d already used a couple different EMR in her career.

I will discount part of her reaction as the knee jerk response to a new job, a new company, APN instead of RN and a new EMR software. That’s a pretty steep learning curve for anyone.

The challenge this comment provides however is how do clinics train new doctors on their EMR. In my opinion, the real problem for my friend isn’t like the EMR software, but is instead the training that she received on the EMR software. Properly trained, I’m sure she’d like using the EMR software a lot more than she just expressed.

Training new staff on the EMR is a challenge and vitally important. I was in charge of training the new staff at my previous work. I trained everyone from medical records staff to Lab Tech’s to MA’s to RN’s to APN’s to PA’s to MD’s and DO’s. I trained general medicine providers, dietitians, GYN’s, dermatologists, and a few other specialists. That’s a wide variety of people to train, but overall we did a pretty good job with most. Outside of our initial implementation where the whole staff was trained, I probably trained 50 different people. Let’s just say that people definitely learn at different paces.

About 2 minutes into the training I could tell you how good (or bad) the training was going to go. I could train a provider on our EMR system in about 45 minutes to an hour to the point that they’d feel comfortable doing their job. Certainly there were some intricacies to looking up various codes and charges, but generally they knew what they were doing after an hour. The worst case scenarios usually ended up needing about 2 hours of training where I had a little more time to let them flounder through the charting process themselves on our test install so that they could really learn in a low pressure environment.

In our case, we had a contract with an outside company where they were always swapping out providers. Luckily our nursing staff was very consistent and could assist the new providers as various questions popped up.

To be honest, I think this system of training worked pretty well. One of the keys to our success was that we had a well defined process for using the EMR. So, a technical person like myself could easily train a clinical provider. Plus, I was deliberate in only showing them the easiest route to chart (at first) even though there was almost always 3-4 ways to do something. I learned this lesson the hard way. Far too many people get confused when you train them on 3 ways to do the same thing.

My favorite story about training a doctor though was when a doctor was ill and so a replacement doctor was provided from the company we partnered with. Turns out the new doctor they sent was pretty tech savvy and confident (not to be confused with arrogant). We looked at the clock and realized him and I would only have 5-10 minutes to train him on the EMR system. This was far from ideal, but you make the most of whatever situations come. So, I cranked through the most important features and processes. Then, I wished him good luck! He had a great day with no issues. Of course, as I said above, we had a nursing staff that could assist him as needed as well.

Moral to the Story: As a clinic it’s important to have a way to train new staff on your EMR.