Use of Medical Scribes Spurs Debate About Costs, Difficulties of Electronic Health Records



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.


  1. says

    Our 85,000 doctors use the drchrono iPad app with a comprehensive and HIPAA compliant medical speech to text conversion capability so they don’t need to use a keyboard and don”t need a scribe. They simply speak and the note is created on the fly. The application is smart so it learns how to better understand the user and handles accents amazingly well. I would guess that all of the admin duties handled by physicians will be gone soon and that easy-to-use iPad applications such as drchrono will be the solution to reduce overhead and increase efficiency. No more data entry, no more paper, everything is moved to digital with automation for scheduling, reminders, referrals, improved clinical notes, and better billing. A complete end to end solution using the devices such as the iPhone and the iPad are already revolutionizing the healthcare industry. How can you run a practice if you can’t access your information via the cloud and why would anyone not want to have the best technology out there to improve the patient experience and care? A version is available at no cost and upon request we can turn the speech to text functionality for testing.

    • Hal Koiman says

      Speech to text doesn’t work. It is also glitchy and incorrect, which results in a requirement for proofreading and keyboard editing. Any system based on speech to text is doomed to fail.

  2. VB says

    Scribes can certainly be a productivity boost for doctors, and probably certain nurses too but there is a potential issue of patient privacy. Scribes are not medical professionals and as a male I am not going to disrobe or otherwise allow myself to be exposed in front of a female scribe. Large settings might be able to pair same sex scribes with patient encounters but where that is not possible there are going to be problems with some patients.

    There could also be an issue with some patients being willing to discuss personal matters in front of a scribe. That they are subject to HIPAA might satisfy some patients but not all.

  3. Randy says

    I work as a scribe in family practice and OBGYN (formerly worked in the ED) and have over >1400 pt. encounters. There was only 1 time that a someone did not want me in the room and it was not at the pt.’s request. Occasionally I will step out of the room during a PE however 9/10 privacy is provided by drawing the curtain. Overall I’ve found they do not mind our presence and are understanding of why we are there.

    It’s true we are not medical professionals but most of us aspire to be. When I first started in the ED, two of the current scribes were recently accepted into med school and on their way out. Even now, most of us are waiting on acceptances or in the midst of applying.

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