Scribes help doctors focus on patients, not computers

Electronic medical records had arrived in Dr. Samuel Harmon's office and he was not happy. The Noblesville ear, nose and throat specialist felt that he was spending too much time staring at the screen instead of interacting with his patients. And rather than making his job easier, he found himself staying at the office until 8 or 9 each evening to finish his notes.

Then about a year ago came salvation in a most unexpected form: a medical scribe — a sort of court reporter for the exam room.

Medical scribes enter alongside doctors and take over the keyboarding and diagnostic-coding responsibilities, allowing the physician to focus on the patients. No wonder doctors like Harmon are embracing the concept.

"That frees me up to actually sit and talk to the patient and figure out what they need and interact and not have to worry about computer work and letting the computer come between us," said Harmon, who works with Community Ear Nose and Throat Care.

More and more, doctors are agreeing. ScribeAmerica, which provides the scribes on whom Harmon and other Community Physician Network doctors rely, has about 4,200 scribes working in 470 hospitals in 41 states. About 340 of those are emergency departments, 100 outpatient facilities and 30 in-patient sites, said Dr. Michael Murphy, the company's founder and chief executive officer. Murphy is an emergency room physician who did a stint as a scribe before entering medical school.

Indiana has more scribes on the job than any other state. Community Health Network and Franciscan St. Francis Health are among 30 Indiana hospitals using scribes.

Scribes are particularly popular among emergency room doctors, who work under intense pressure to move patients in and out as quickly as possible, while also handling complicated and serious cases, said Murphy, who started his company about 10 years ago.

"They're going to be completing their notes at the end of the day and they're not going to remember the two cardiac arrests that they had," he said. "When you have somebody there tracking all of the labs ... and completing your notes in real time, you can provide the most effective care."

It didn't take long for out-patient physician practices to climb on board.

Typically a doctor may spend about five minutes face-to-face with a patient and 10 minutes documenting that encounter, Murphy said. Adding a scribe to the equation may mean the doctor can see the patient for eight minutes, as the scribe does all the computer work.

That gives the doctors an extra seven minutes, allowing them to see more patients in a day.

For practice managers, that may make the cost of hiring a scribe worth it.

Using scribes may also help practices retain physicians, Murphy says. Doctor burnout is at an all-time high and healthcare reform has increased the pressures for physicians to see as many patients as possible in day.

Scribes like Christine Callahan, 22, ease such pressures. Callahan started part time as a scribe during her senior year at Purdue. When she graduated about a year ago, she started doing it full time, working mostly alongside Harmon.

In keeping with scribe guidelines, she does not interact with patients but she listens intently to document everything they say. Her job, she says, has been providing invaluable experience for becoming a physician assistant, her ultimate career goals.

"Dr. Harmon challenges me a lot, asks me questions," she says. "When I watch him with a patient, it makes me want to provide the same kind of care that he provides to a patient."

Scribes start at about $10 an hour and can make up to about $20, depending on experience, Murphy said. About two thirds of those he hired are women, the average age is 23 and about 70 percent plan on going to careers in health-care related fields.

The scribes go through a specialized training process, and Community Physician Network scribes also attend training through that organization. ScribeAmerica, based in Aventura, Fla., then bills the practice.

No patient has ever complained about the scribes, said Mary Jane Lowrance, nurse executive for Community Physician Network.

Catherine Jackson, one of Harmon's patients, likes having a scribe in the room with her. Jackson, 38, New Castle, has no other doctors who use scribes and sees a difference.

"Dr. Harmon was able to take a few more minutes to look at me when I was talking," she said. "Beforehand the doctors would be so busy having to type in everything that they needed, they didn't have time to look at me."

For Lowrance, the biggest challenge with using scribes in the Community practices comes when she has to explain to doctors why they can't all have one.

"If you could open scribes to every physician, they would take one in a heartbeat," she said. "It brings some joy back into the physician's life."

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter @srudavsky.