To Scribe, or Not to Scribe

Thomas R. Collins


The Hospitalist. 2015;19(10):1, 26-27. 

In This Article


The hospitalists at six Illinois hospitals, physicians who are provided by Best Practices Inpatient Care, were grappling with some issues that might sound familiar to hospitalists around the country. The issues revolved around the electronic health record (EHR).

First, "it's a pain," says Jeffry Kreamer, MD, chief executive officer of Best Practices. The Long Grove, Ill.-based practice also wanted EHRs to include notes that were standardized, not limited by a template.

The big issue, however, was job satisfaction.

"Our docs are very smart people. If they would have wanted to do a clerical-type job, they would have done a clerical-type job," Dr. Kreamer says. "They want to be doctors. They don't want to be keyboardists.

"It makes no sense to take your most experienced asset, which is our physician, and then deploy them for a clerical task which can be done for a much lower cost."

That's where medical scribes come in. Scribes work as assistants to physicians and are responsible for entering information into the medical record with physician oversight. Scribes have a history that goes back a decade in emergency medicine, a setting in which doctors traditionally spend much more time in face-to-face contact with patients than they do in documenting the encounter.

Although scribe use in the emergency medicine and hospital medicine settings is growing, with supporters praising programs for boosting volume and allowing physicians to focus on patient care, not all attempts at using the scribe model of care have worked well. Some suggest scribes are a crutch for cumbersome EHRs and excessive administrative work that most doctors would prefer not to deal with.

Dr. Kreamer, however, says the majority of his scribe programs are tapping into a growing segment of the medical industry. There are now more than 15,000 scribes represented by the American College of Medical Scribe Specialists, and the numbers are increasing along a steep curve. There are still far more scribes working in EDs than alongside hospitalists, but as their track record in the inpatient setting lengthens, the number of inpatient scribes is likely to continue to grow.

Dr. Kreamer sensed that scribes would work as well in the inpatient setting as in the ED—maybe even better. He got in touch with the head of ScribeAmerica, the company that provides most of the scribes that work in U.S. hospitals.

ScribeAmerica had been providing scribes to hospitals for use in the inpatient setting, but in a limited way. With Dr. Kreamer's input, the company developed a more elaborate plan to provide medical scribes for hospitalist programs.

Dr. Kreamer says scribes save his groups' hospitalists a little more than 10 minutes per chart, or about three hours of productivity per day on a typical 18-patient census. There's also less physician fatigue, and documentation is better, he adds.

Michael Murphy, MD, an emergency medicine physician by training and co-founder of ScribeAmerica, was introduced to the scribe concept when he was an undergraduate in California. He was asked to start a scribe program by a friend who was a physician and an attorney.

"The overwhelming benefit that I saw was that, A) Physicians were super-happy when they had a scribe," says Dr. Murphy, now CEO of ScribeAmerica. "B) The patients were happy. The docs sat down and did different things," allowing more interaction.

"We saw that huge benefit and said, 'Why don't we start this on a national level?'"

In 2004, ScribeAmerica was launched. It expanded to 32 hospitals through 2009. Since then, its client base has exploded to 610 hospitals.