What are medical scribes?

A study conducted at University of Wisconsin Health showed that before being assigned a scribe, 70.3% of physicians reported burnout. This number dropped to 51.4% after pairing with a scribe—a 26.8% decrease. Source

If medical notes are the nervous system of healthcare, scribes are the glial cells, supporting accurate and swift transmission of patient information. Scribes provide essential connections between observations, documentation, and follow-up action across various medical settings. Take a closer look at this important, often misunderstood segment of the healthcare industry. This article explores why scribes are essential, how they work alongside healthcare providers, and the evolving landscape of medical scribing.

Key Highlights:

• Growing documentation demands, exacerbated by increasing patient volumes, necessitate scribe services.
• Key role in reducing physician burnout by alleviating the documentation workload.
• Crucial for improving clinical efficiency by handling documentation processes.
• Scribes operate in various environments: directly in patient visits, via real-time remote listening, or through post-visit transcription analysis.
• Scribes are employed through various models, from independent contracts to AI scribe services, accommodating different budgets.
• The future points towards AI-assisted documentation, with scribes or other professionals overseeing quality, training, and system customization.

How do you become a scribe?

Medical scribes play a vital role in the U.S. healthcare system by managing a vast expanse of electronic medical record (EMR) documentation. They receive comprehensive training in medical terminology, charting, and clinical processes, and then support doctors by recording patient data, easing the administrative burden across healthcare settings.

The rise of electronic health records (EHRs) has significantly increased documentation demands, making scribes essential in optimizing clinical workflows, especially in emergency rooms. The American College of Medical Scribe Specialists reports that the number of scribes grew from 20,000 in 2015 to an estimated 100,000 by 2020, underlining their importance in healthcare. However, their adoption outside the U.S., such as in Canada and Australia, remains limited.

U.S. training for medical scribes varies, including programs by commercial entities and hospitals, and aimed at premedical students, focusing on both technical skills and certification importance, like the Medical Scribe Certification Exam (MSCE) by the American Healthcare Documentation Professionals Group (AHDPG). These certifications ensure scribes' proficiency in healthcare terminology and EMR systems, upholding documentation standards.

The industry seeks to mitigate scribe labor shortages, high costs, and doctors' desire to oversee their clinical documentation through flexible and thorough educational programs. Certified, skilled medical scribes are key in maintaining high-quality patient care documentation, highlighting their crucial role in addressing the healthcare industry's needs and labor challenges.

Why are medical scribes important in healthcare today?

My dad, a pediatrician with 36 years of experience, epitomizes the need for medical scribes. He spends many nights under the soft glow of his bedside lamp, caught in the tedious task of clinical documentation as my mom watches Grey’s Anatomy beside him. Irony aside, notes are a significant burden felt by healthcare professionals.

Research underscores this burden, revealing emergency room physicians spend 43% of their time on data entry, overshadowing the 25% dedicated to direct patient care. Such administrative demands contribute to a concerning trend: a 2021 AMA survey found a 63% burnout rate among physicians, largely attributed to these tasks.

Dr. Neda Laiteerapong from the University of Chicago Medicine captures the sentiment concisely:

“It is not hard for clinicians to see one more patient—we do this all the time for family and friends or neighbors who ask us, ‘Oh, I got this thing on my arm. Can you take a look?’. We do this all the time, but if you make me document that note, that's the thing that I don't want to do.”

– Neda Laiteerapong, MD, University of Chicago Medicine [Source]

This highlights an essential issue in healthcare today—the system's administrative inefficiency is hampering the willingness and commitment of doctors to see more patients.

Integrating medical scribes into healthcare teams presents a strategic solution. Scribes take on the documentation. The Journal of the American Board of Family Medicine reports that clinics utilizing scribes see a 10% boost in patient flow alongside enhancements in system processes, including reduced wait times and more attentive doctor-patient interactions.

Despite advancements in EMR systems, challenges like "note bloat" — excessive and disorganized entries — persist. Medical scribes excel at navigating these hurdles, streamlining documentation into coherent and structured notes. This expertise not only aids in clinical communication but also supports essential aspects of medical practice such as continuity of care, regulatory compliance, referrals, and billing.

By addressing the administrative challenges head-on, medical scribes play a pivotal role in modern healthcare, ensuring that professionals can dedicate their efforts to what they do best: tending to patients.

What do Medical Scribes do? How do they work?

Operational Workflows

Medical scribes adapt to a variety of visitation workflows. All in all, they pull charts, write notes, and file them away. They can adjust to multiple healthcare workflows, categorized by their presence during patient interactions and documentation timing:

1. Direct In-Patient Visits: Scribes physically present in the room act as real-time documentation partners, capturing the clinician-patient interaction on-premise as it unfolds. This immediate transcription ensures accuracy and allows for instant clarification of medical data, minimizing errors and omissions.
2. Real-Time Remote Listening: By leveraging live telecommunication, scribes also operate remotely, listening in on consultations via secure channels. This model has gained traction, especially in tele-health settings, providing the benefits of scribe services without the need for physical space in the examination room.
3. Post-Visit Transcription Analysis: In situations where live documentation isn't feasible, scribes review audio recordings or notes taken during patient visits, translating them into structured, coherent medical records. This method, while delayed, ensures comprehensive documentation that adheres to clinical standards.

Employment Models and Associated Costs

Medical scribes are employed under various models to suit healthcare needs and budgets:

• Independent Contracting: Flexible, with costs varying between $20 to $40 per hour.
• Direct Employment: Offers stability for large settings, with salaries ranging from $30,000 to $45,000 annually.
• Scribe Service Agencies: Provide certified scribes on a contract basis, with monthly fees from $2,000 to $4,000.
• Remote Scribes: Cost-effective, ranging from $1,000 to $2,000 per month, suitable for tele-health.
• AI Scribes: While average costs for AI scribe services exceed $100, some customizable platforms like SwiftyNote provide services at a more affordable rate of only $29.

Scribes by specialty

The versatility of medical scribes extends into various specialized fields, each with its unique documentation challenges and requirements:

• Pediatric Medical Scribe Documentation Support: In pediatrics, scribes tackle the unique challenge of accurately capturing symptoms and concerns voiced by both young patients and their caregivers, facilitating more focused and compassionate care.
• Emergency Department Medical Scribe Services: Emergency department scribes navigate the high-stakes environment by documenting critical information swiftly, ensuring efficient patient flow and immediate access to vital data for acute care decisions.
• Orthopedic Surgery Scribe Documentation Solutions: Scribes document surgical procedures, pre-operative plans, and post-operative instructions, ensuring detailed records for follow-up care. Their role is critical in capturing the complexity of surgical interventions and outcomes.
• Cardiology EHR Support: Cardiology scribes specialize in documenting detailed diagnostic tests and treatment responses, crucial for managing complex heart conditions and tailoring  care plans.
• Remote Medical Scribe for Telehealth Appointments: Scribes ensure comprehensive documentation of virtual consultations, including patient concerns, clinical advice, and follow-up plans. They play a key role in expanding tele-health into continuous patient care.
• Medical Scribes for Dermatology Clinics: In dermatology, scribes excel at documenting visual diagnoses and treatment plans, ensuring precise and thorough records for ongoing skin care management.
• Radiology Departments: In radiology, scribes document imaging orders, findings, and interpretations, linking these to the patient's overall medical history. This documentation is essential for accurate diagnosis and treatment planning.
• Neurology Clinical Encounter Scribe Services: Scribes document complex neurological assessments, test results, and treatment plans, ensuring neurologists have precise and detailed records to support assessments and plans.
• Occupational Therapy: Scribes document therapeutic strategies, patient progress, and outcomes, supporting therapy goals and compliance. They ensure accurate records of therapeutic sessions, equipment recommendations, and patient responses, which are crucial for rehabilitation and care continuity.

The Future of Medical Scribes

The future of medical scribing is in the midst of a transformative shift, largely driven by advancements in artificial intelligence (AI) and natural language processing (NLP). These innovations are already reshaping the landscape of medical documentation.

While useful, traditional methods of medical transcription and scribing come with their own set of challenges, including high costs and long turnaround times, sometimes extending over 72 hours. AI-powered medical transcription technologies, such as those developed by companies like DeepScribe and SwiftyNote, are emerging to get the job done faster and give providers more control. These AI solutions offer an affordable and scalable alternative to traditional scribing, promising to save clinicians as much as 3 hours a day.

AI scribes can now facilitate the entire clinical documentation workflow - from transcription to writing notes and filing them away. Nuance, in particular, is recognized for its AI-powered voice-enabled ambient clinical capture, which enhances the healthcare experience for both providers and patients by enabling more natural and efficient patient encounters.

AI and NLP technologies will not only streamline medical documentation processes but also elevate the role of medical scribes to analysts and quality assurance experts. This shift will likely see medical scribes overseeing AI-generated notes to ensure their accuracy and clinical relevance, thus blending the best of human insight with AI efficiency.

As we stand on the precipice of a new era in healthcare documentation, it's clear that AI-powered medical scribes represent a pivotal step toward alleviating the documentation burden on healthcare providers, enabling a world where every practitioner has a writing partner, burnout is eliminated, and patient care is streamlined like never before. The integration of AI into medical scribing is creating a whole new playing field, reinventing how patient care is documented and ultimately, delivered.