AHDI and the Medical Scribe Question

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There is an interesting conversation going on right now on AHDI Lounge about the role of the medical scribe in the documentation of patient clinical encounters.

Something that bothered me about AHDI ACE last summer was that rather than discussing what should be done to preserve dictation and transcription as a viable means of documenting patient care (and there is much that can be done to do this!), the focus of some of the AHDI leaders seemed largely to be on, “how do we turn MTs into something else?”

These “something else” positions often support exactly the form of documentation that we previously stated as contributing to the degradation of the quality of clinical information.  But those forms of information capture seem to be ok as long as the MT is doing the work.

Remember the conversations about needing to preserve the “patient story” in the medical record, and needing to make that story available in the EMR? Do you think medical scribes are creating narrative around the physician – patient encounter? No. They are capturing clinical facts. They are following the template in the EMR. They are not capturing the physician’s intuition and thoughts about that patient visit.

Worse – they are often in the position of determining what information to capture in the patient record, and how. They are interpreting the physician – patient encounter. Does anyone else besides me find this to be alarming? Yes they do.

I was at a healthcare provider site several weeks ago – a very prestigious one – who stated flat out, “we want scribes gone” for that very reason.  They see the scribe’s interpretation of the encounter as a major risk to the quality of information, to the organization, and to patient care. Unlike an MT, who transcribes what the physician dictates – those scribes with their limited clinical backgrounds and experience are interpreting the physician-patient interaction and deciding how to document the encounter.

AHDI previously expressed concern that eliminating dictation and transcription as a form of information capture because the physician can perform direct-data entry into the text boxes of an EMR would cause the degradation of the quality of health information – would cause us to lose the patient story.

So why then are these same methods of information capture just fine as long as we are transitioning MTs to be the person doing the work instead of the doctor? Why is it ok to lose the “patient story” as long as it is an MT performing the direct data entry?

My point is this – AHDI claims its vision is: To direct the evolution and ensure the integrity of healthcare documentation and data capture.

AHDI has always had a credibility issue. It has never been taken seriously by many in healthcare when compared, for example, to AHIMA. This latest conversation is a good example of why this is. AHDI is largely looked at as only trying to save transcription for the sake of saving transcription. They are not looked to as authorities on health information.  Wavering on its stance about how a particular method of information capture contributes to the quality and usefulness of health information will only contribute to that perception.

Making MTs aware that there are other opportunities out there and helping them to find information and training is one thing. But embracing the medical scribe profession as part of AHDI is another thing entirely. It changes what the organization is.

Are you AHDI – in support of the integrity of health information? Or are you in support of anything that provides jobs for MTs regardless of the method used to capture the information?

Each of those is fine. Each is even admirable. But you can’t be both.

If the core value of AHDI is to “ensure the integrity of healthcare documentation” then that must be the guiding principle behind all of its decisions.

All the best as always,

13 Responses

  1. Regarding scribing, I am not sure that this position is much of a future for current MTs, though this could change. I was on a conference call with the owner of Scribe America last year and he made it plain that “medical students” and “nursing students” were who he wanted to hire, and that they needed no help getting trained people to work in ERs (which is where most of the work is at this time).

    I was very surprised to see that TRSi had recently teamed up with Scribe America (hence Kristen Hagen’s apparent interest in the subject at the AHDI lounge) to offer scribing training.

    In my experience, scribes are currently lower-paid workers in ERs, mostly, who follow the doctor with the EHR on a tablet computer and do point and click data entry.

    I have some some medical assistant-type positions do scribing-type work, where the doctor will dictate information live and the medical assistant (MA) will “peck” it into the EMR in the office. I can forsee people with very rudimentary MT-type training doing this, especially in doctor’s offices and large clinics–I think this is a great idea, in fact–but I would expect this to be more of a blend of the traditional front/back office MA role rather than a transcriptionist role.

  2. Geez, Lynn, I have to admit something. I didn’t read much of your post before I jumped in with my response just now. I glanced at “scribes” and saw AHDI’s name and then posted what I said about scribing being more of a medical assistant’s function.

    Now I see that you and I were totally on the same page about this. This is not a position for transcriptionists. And the data entry by a scribe–a person with the most minimal of training in most cases, as I said “a medical student” (ha)– can indeed foul data integrity.

    Right on! Do you want transcriptionists to correctly capture data and notify you of inconsistencies, like an alternating Coumadin dosage of 5.5 to 7.5 mg in one paragraph and 7 to 7.5 mg in the next paragraph? Or do you want garbage in garbage out?

    • Exactly…. I have absolutely nothing against finding alternative roles for MTs. But if we are here to support the integrity of healthcare documentation, is the scribing process aligned with that? If we don’t think direct-data entry and point-and-clicks allow for comprehensive, complete, and useful documentation – then it doesn’t matter who does the clicking. 🙂

  3. You make some excellent points that seem to be missed by many in the Association. Great job.

    • Thanks Chad.

  4. As a transcription student, I have been very interested in all the discussion in AHDI about “re-tooling, re-educating, re-inventing” medical transcription. It got to the point where I was questioning whether schools should even be offering training in this field any longer.

    I wonder if you would consider a post elaborating on your statement that there is much to be done to preserve dictation and transcription as a viable means of documenting patient information?

    There is so very much talk about how our jobs are dwindling away, there is less money to be made, etc. And yet the Bureau of Labor Statistics says that the job prospects for transcriptionists are good, especially for credentialed workers, that overseas outsourcing is expected to only supplement the demand for transcriptionists, that SRT continues to need skilled MTs to edit, correct and create a final document.

    Where is the disconnect here?

    • Hi Mary: First of all, I apologize for taking so long to respond to your comment. I lost track somehow! I’m sorry about that, because your question is SO valid and SO timely! There is no doubt that the transcription industry is facing challenges right now. Many people think that with the adoption of the EMR, dictation and transcription is no longer needed. So there is, absolutely, a decrease in transcription volume in some sectors.

      However! and this is a big however, there is still a great deal of transcription out there. And it will take a long time to go away. If the industry is smart about presenting its value beyond merely being “typists” – then transcription has so much to offer to any health provider.

      SRT absolutely DOES require a skilled MT to do the editing. Anyone saying otherwise is not living in the real world – or is focused on cost and not quality. There are providers out there who have attempted to remove transcription and found that physicians left to their own devices will not produce the quality they require for patient care, for medico-legal use, and for revenue cycle management. Not to mention the fact that an MT can do much more than transcribe….we’re going to be writing more about that in coming weeks so please stay tuned and good luck!

      In the meantime, I will reach out to see what others think about your questions.

      Thanks once again for commenting!

  5. Mary, we do have a future. Right now the health care community is in utter turmoil dealing with new regulations. At the same time there’s all this sexy, shiny new technology coming about. But it’s only a matter of time before the hand hits the forehead in the medical field and it will become clear that discrete pieces of data are not useful without the entire story. For example, a 200-pound patient might be normal, or totally abnormal, depending on whether or not you have that all-important other piece of information, the height. Each piece has its own merit, but doesn’t provide a full picture until combined with the entire story. One wrong click of the mouse and a medical record can go from accurate to dangerous. WIth “point and click” and ” drop-down” data entry there is a savings of time, but how do you validate its accuracy? It’s all about the context, and you only get that with the full narrative. Over time I think the shiny will wear off a bit on the technology and the underlying fundamental concept of telling the patient’s story will win out. To do that properly, either providers will need to spend a great deal of time validating documentation, or they will learn to trust the transcription community to act as that “second set of eyes.” Call me an unshakeable optimist.

    • I agree Crystal! Thanks for your response!

  6. Thanks for the post, Lynn. However, while I see your point, I don’t understand why, with the vital modifications needed to make this data collection safe (i.e. remove the scribe/middle person) this “scribe” function would still be classified as medical transcription. Why don’t these clinicians walk around with hand-held devices or around-the-neck devices and talk as they go? I’m sure we’ve all experienced this before anyway. Seems to me to be another information drop-out problem with solution being to reinvent the wheel instead of doing some research into which already-existing professionals could cover this need.

    • Hi Liz: I would not classify the scribe function as medical transcription. That’s my point. Well, part of my point anyway…

      I agree with you about reinventing the wheel – and its a very expensive an inefficient wheel to boot.

      Thanks for your comment!

  7. I believe each case to be different. In my case, I have transcribed for the same physicians for over 20 years in a specialty field. I do know what levels are therapeutic for protimes and how to recognize when the patient’s medications list reflects a listing of two ARBs or that the patient is on an ACE inhibitor and has a history of COPD. I also have the knowledge to know when my knowledge is not enough and am backed not only the physicians but by two nurse practitioners. Today’s medical records require teamwork – intelligent teamwork!

    • Two great points Lisa! “I have the knowledge to know when my knowledge is not enough” and “intelligent teamwork!” Love it!

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