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Driving Dr. Daisy – Using Scribes to Drive Meaningful Use

In the movie Driving Miss Daisy, the lead character refuses to accept a driver despite her son’s insistance and her inability to purchase car insurance. She eventually relents, agreeing to have Hoke drive her everywhere. The rest is Oscar history.

Physician groups and hospitals are hiring “drivers” to deal with the impact of EMRs on their practice of medicine. Unlike Daisy, who resisted a driver, physicians are willingly hiring scribes to input data into EMR systems. Some blame the perceived disconnect between provider and patient when an electronic system is introduced – the hypothesis is that patients feel the physician is paying attention to the computer rather than their needs. Turns out patients actually have greater confidence when their information is entered directly into a system. Similar studies and surveys have linked patient confidence to providers’ use of technology. The larger reason for the growth in scribe use is because “new record-keeping systems, which are touted as a way to improve efficiency and quality, slow down” physicians so much that they hire others to input the data for them.

The largest scribe companies have doubled their employee base and provided greater than 6x the number of hours of coverage over the last few years. Some are even turing down more projects than they take. Is this a good thing? Other than providing gainful employment and invaluable exposure to pre-med students, I’m inclined to think this is a net negative development. EMR systems must better support physician workflow and minimize data entry burden.

Many systems expose physicians to additional fields and alerts that don’t exist in their current clinical workflow – does the patient require a translator and does he/she need transportation are two relatively simple examples. Other examples include questions typically answered by a clinical pharmacologist rather than a general practitioner – transferring this from a pharmacist to a physician introduces new workflow. Unless these additional fields have clinical value that physicians should be expected to answer and/or would impact medical decision making, they only serve to decrease productivity thereby negatively impacting technology adoption.

EMRs also introduce new data entry requirements with the keyboard as the only option. Voice recognition, tablet and digital pen technology have all advanced to the point where data entry shouldn’t disrupt the traditional physician-patient interaction.

Technology has slowly but steadily removed the need for transcriptionists – let’s not introduce scribes as the transcriptionists of the HITECH era.


Why Doctors Need Marketing Now More Than Ever

I just returned from the Diabetic Limb Salvage conference in Washington, DC. I could end this post on that note. If there ever was an example that screamed for marketing help, it’s a conference (or anything for that matter) that goes by the name of “Diabetic Limb Salvage.” But that’s actually not the entire point.

Physicians get a bad rap for a number of reasons often characterized generally as being more Dr. Evil than Patch Adams. A common explanation (not excuse) cited is that doctors walk out of med school with triple-digit debt – and that’s only from four years of study – forget that most go on to additional years of training at salaries not in-line with their level of expertise or responsibility. That would certainly challenge my disposition.

But it goes beyond simple salary implications. For the first time in history doctors are being forced to purchase and use electronic medical records (EMRs). You might think this is a good thing given the rest of the world stands in line for hours to buy the next “iThing” that Steve Jobs dreams up. But EMR technologies have not been designed the way Apple designs their products – that is to say, they have not been designed to serve the end user above all else. In addition, all specialties are at financial risk going forward, and the delta between them is shrinking. Finally, healthcare reform aims to provide benefits to nearly everyone, thereby guaranteeing an oversupply of patients for a chronically under-supplied pool of physicians. We need doctors, now more than ever.

Two things stood out to me at the DLS conference this week. First, doctors are “wicked smaht.” Yes, I always knew this having spent my career working with and/or designing products for their use. But if everyone could sit in a packed conference room watching a surgeon operate on a patient while simultaneously discussing (and debating) the merits of his approach before a panel of world-renown experts, you would get a new appreciation for just how much they really know. Secondly, doctors care very deeply about their profession and their patients. The winner of this year’s Georgetown Distinguished Achievement Award in Diabetic Limb Salvage went to Dr. Gary W. Gibbons. Dr. Gibbons was one of the more, shall we say, challenging physicians on the expert panel. Yet not five minutes later, while accepting the award, he gave an impassioned, emotional speech not about his career achievements (which are quite lengthy and impressive) but about their collective calling. He challenged everyone in the room to work together like never before on behalf of their profession, but more importantly on behalf of their patients. His conviction was as clear as the crystal award he held at the podium.

The themes of Dr. Gibbons’ speech and the dedication of those in attendance at the DLS conference should be part of the broader healthcare debate. See you at next year’s “Diabetic Limb Preservation” conference!

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