Scribing, particularly in Emergency Medicine (EM), has been something of a phenomenon during the past decade. Scribes are typically employed by third party vendors such as Scribe America as well as directly by provider groups. Scribe America has experienced phenomenal growth and now employs over 2500 scribes; physician group Vituity a employs over 600 scribes for their ED and Hospitalist Practices. What accounts for the scribe boom, and how do we measure the impact of scribes on the Acute Care Continuum?
Scribes appear throughout ancient history as “record keepers” who copied legal texts and other documents. Scribes also appear many times in Scripture. They were influential in government and religious circles until the printing press essentially killed the demand for scribes. Flash forward to the 1970s, when a study in the Annals of Emergency Medicine found that scribes who “shadow physicians” and act as “human tape recorders” improved ED efficiency. However, between the 1970s and early 2000s, scribes were rare. An oncology practice where I consulted in the 1990s used scribes, but I saw very few of them in emergency medicine until recently.
What accounts for the phenomenal increase during the last decade? The dramatic, government-incented increase in the use of electronic health records (EHRs) created the need. EDs in post-EHR implementation often experience a significant decrease in productivity as providers struggle to interact with systems that are not always user friendly. So, ironically, advances in technology resulted in a rebirth of one of the world’s oldest professions–scribes, of course. (What were you thinking?)
Anecdotal evidence indicates that scribes improve the quality of providers’ work experience. There is also evidence that scribes, by allowing providers more clinical time and less administrative burden, improve ED throughput and thereby reduce ED overcrowding. Validating this anecdotal evidence, concrete metrics show the impact of scribes on acute care: