Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Google, Stanford Pilot “Digital Scribe” As Human Alternative

Posted on November 29, 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.

Without a doubt, doctors benefit from the face-to-face contact with patients restored to them by scribe use; also, patients seem to like that they can talk freely without waiting for doctors to catch up with their typing. Unfortunately, though, putting scribes in place to gather EMR information can be pricey.

But what if human scribes could be replaced by digital versions, ones which interpreted the content of office visits using speech recognition and machine learning tools which automatically entered that data into an EHR system? Could this be done effectively, safely and affordably? (Side Note: John proposed something similar happening with what he called the Video EHR back in 2006.)

We don’t know the answer yet, but we may find out soon. Working with Google, a Stanford University doctor is piloting the use of digital scribes at the family medicine clinic where he works. Dr. Steven Lin is conducting a 9-month long study of the concept at the clinic, which will include all nine doctors currently working there.

Patients can choose whether to participate or not. If they do opt in, researchers plan to protect their privacy by removing their protected health information from any data used in the study.

To capture the visit information, doctors will wear a microphone and record the session. Once the session is recorded, team members plan to use machine learning algorithms to detect patterns in the recordings that can be used to complete progress notes automatically.

As one might imagine, the purpose of the pilot is to see what challenges doctors face in using digital scribes. Not surprisingly, Dr. Lin (and doubtless, Google as well), hope to develop a digital scribe tool that can be used widely if the test goes well.

While the information Stanford is sharing on the pilot is intriguing in and of itself, there are a few questions I’d hope to see project leaders answer in the future:

  • Will the use of digital scribes save money over the cost of human scribes? How much?
  • How much human technical involvement will be necessary to make this work? If the answer is “a lot” can this approach scale up to widespread use?
  • How will providers do quality control? After all, even the best voice recognition software isn’t perfect. Unless there’s some form of human content oversight, mis-translated words could end up in patient records indefinitely – and that could lead to major problems.

Don’t get me wrong: I think this is a super idea, and if this approach works it could conceivably change EHR information gathering for the better. I just think it’s important that we consider some of the tradeoffs that we’ll inevitably face if it takes off after the pilot has come and gone.

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.

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.