High-tech 'scribes' help transfer medical records into electronic form

side note: This is a growing area, but for how long? Well, we have 100,000’s of doctors with millions of patients, so they’ll be busy for sometime. There is always added risk when you have someone working with your medial records, so it’s always recommended to go with a company that has been properly qualified. There is no reason to take short-cuts when handling patients’ sensitive data.

CHARLOTTESVILLE, Va. — Derek Leiner’s workplace is densely packed with the latest technology.

At the University of Virginia Medical Center’s emergency room, doctors have access to electrocardiogram machines and bedside ultrasounds and are just steps away from a CT scanner and MRI machine.

Yet Leiner’s job title harks back to the days of the pharaohs.

He’s a scribe.

“When I tell my friends I’m a scribe, they ask me if I use a quill,” says Leiner, 22, a University of Virginia graduate who plans to apply to medical school.

Instead of pens, scribes here use laptops as they trail doctors from bed to bed, taking detailed notes that will form part of each patient’s electronic medical record. Experts say the scribes’ peculiar role — with one foot in 2009 and one in 2000 B.C. — illustrates hospitals’ often bumpy transition from clipboards and closets of paper charts to digital records.

While most other businesses scrapped their paper files decades ago, hospitals have lagged. Several of the health reform proposals being considered in Congress would push the industry to convert to electronic records, says Ashish Jha of the Harvard School of Public Health.

“Most doctors and hospitals are in the olden days,” he says. “In the average physician’s practice, you are still going to see closets full of paper charts.”

A financial incentive to switch

Congress dedicated $30 billion of the economic stimulus package to help hospitals and doctors create electronic records, Jha says. That investment should save the country $10 billion over time, according to the Congressional Budget Office. Doctors and hospitals who convert to electronic records can receive bonus payments from Medicare and Medicaid beginning in 2011; those who aren’t using them by 2015 will face penalties.

Today, only 1.5% of hospitals have a “comprehensive” electronic health record, and 8% have a basic version, according to Jha’s March study in The New England Journal of Medicine. Most hospitals are intimidated by the cost, which can range from $20 million to $200 million.

And because there are no common standards for these records, doctors who do implement electronic charts may not be able to share them with a hospital across the street, he says.

At the University of Virginia, ER doctors enter orders on their computers and get text messages when lab results are ready, says Robert O’Connor, professor and chair of emergency medicine at U.Va. The ER’s $675,000 system also helps prevents mistakes, he says, by flagging patients’ allergies or alerting doctors to dangerous drug interactions.

The country could eliminate 200,000 drug mistakes and save $1 billion a year if doctors in all hospitals entered their orders on computers, according to a 2005 study in Health Affairs.

Hard to implement

Yet hospitals making the switch don’t have a clear blueprint to follow.

The University of Virginia’s approach appears to be unique, Jha says. Although he tracks how hospitals across the country are making the transition, he hasn’t heard of anyplace else using scribes.

At other hospitals, doctors often dictate their notes instead, relying on transcriptionists to enter patient information into a computer. Other doctors dictate their charts using voice-recognition software, Jha says.

At the Veterans Health Administration where Jha works, doctors use wireless computers on wheels as they make their rounds through the hallways.

O’Connor says scribes like Leiner have been “invaluable” since the ER’s transition to a “nearly 100% paperless” department last October, O’Connor says. Other hospital departments are still working toward an electronic record, he says.

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