Are Medical Scribes Hurting EHR Development?

The use of medical scribes hired to enter information into electronic health records (EHRs) has increased substantially, but can pose potential risks, according to a new Viewpoint article in JAMA.

According to data from the American College of Medical Scribe Specialists, in 6 years there will be 1 medical scribe for every 9 physicians in the US. However, the authors—George A. Gellert, MD, MPH, MPA; Ricardo Ramirea, LVN, and S. Luke Webster, MD, from CHRISTUS Health—view the increased use of medical scribes as a workaround of the suboptimal state of EHRs. They argue that if physician dissatisfaction with EHRs decreases because they interact with the technology less, then collective market pressure to evolve EHR usability will reduce.

“By reducing market demand and pressure on industry for needed improvements, the medical scribe industry (and inadvertently its customers) may contribute to an unintended, undesirable outcome: a deceleration and possibly stagnation in EHR technological improvement,” they write.

Furthermore, the authors expressed concerned about the use of medical scribes for computerized patient order entry (CPOE). The Joint Commission has noted that scribes may assist with EHR navigation, retrieval of diagnostic results, documentation, and coding, but cannot enter orders in a patient’s electronic record. Meanwhile, CMS has stated that it does not believe anyone should be allowed to enter orders using CPOE.

Despite the prohibition on the use of scribes for order entry, some physicians advocate the use of medical scribes for CPOE and regard it as clerical work. However, Gellert et al argue that only trained physicians can appropriately interpret decision support alerts that appear during CPOE.

The authors conclude that scribe support is not the answer to today’s inadequate EHRs. Rather, they encourage physicians to demand improved products to foster the rapid evolvement of EHRs.

“The rise of the medical scribe industry should not be a substitute for much-needed EHR innovation and transition to more highly effective and more functionally efficient EHR systems,” they write.