Jared’s article was published first on LinkedIn: How We Fix Medical Documentation for Doctors.
It was a response to Jonathan Bush’s article: Electronic health records ‘inflict enormous pain’ on doctors. It’ll take more than stopwatches to learn why
Here’s Jared’s article in full:
How We Fix Medical Documentation for Doctors
September 12, 2016
My company buzzed last week about this article written by athenahealth’s CEO, Jonathan Bush. Mr. Bush admitted, for the entire industry, that they designed Electronic Health Records (EHRs) very poorly. EHRs lack the usability that many of us take for granted when using sites like Facebook, Amazon, and other modern software systems. Here’s an excellent TL;DR quote from the article:
“With limited authority and the best of intentions to oversee EHR certification and adoption, the Office of the National Coordinator for Health Information Technology continues to inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating.”
Though the mountains of administrative papers now live in electronic databases, the volume and difficulty of paperwork has only escalated. The advent of EHRs hides this fact. Casual onlookers might think technology has improved healthcare documentation, but it has not.”
Mr. Bush’s response in the article was to structure his design team’s bonus around creating features that decrease the amount of time doctors are spending in the EHR. The immediate fix to this problem, however, has nothing to do with making the EHR more usable for doctors.
What is a medical scribe?
It took eleven years for me to complete my training through undergrad, medical school and residency before I was able to practice medicine without an instructor or supervising physician over my shoulder. During that training, I realized that it took me an incredible amount of time to document every detail of the work I had done while seeing patients. Fortunately, I was an emergency medicine resident at the University of Virginia, where every EM resident is given a medical scribe: someone whose job it is to follow a doctor to every encounter and do the clicking, typing, and record keeping for them.
This just doesn’t make any sense
When it came time to find my first job out of residency, I knew I needed to work in a clinic that had scribes; so I joined the main hospital of a small health system in central Virginia with scribes. Later, I became the medical director for the ER in a smaller hospital that doesn’t. For the first time in my medical career, I had to do all of my own documentation.
It was incredibly frustrating to sit and type while the waiting room filled with sick patients who needed my attention. I was the rate limiting resource – as well as the most expensive and the most highly trained – but my time was being sucked up by medical documentation, preventing me from being a doctor for the patients who needed my help. The equivalent would be having airline pilots not just fly the plane, but also schedule the flight, assign the seats, and load and unload the bags. It just doesn’t make any sense.
Fixing the medical documentation problem
Yes, I needed the EHR to function better, to be more usable. But most importantly, I knew that doctors needed to spend their time treating patients, not working in the EHR. From experience, I knew that scribes were part of the solution. But these are not medieval scribes; they’re 21st century scribes using mobile technology and a HIPAA-secure cloud to work in the EHR. Scribes are the more fundamental solution to the medical documentation problem, and they are why I started my own company, iScribes.
iScribes has seen tremendous success, and is growing at Internet startup speed because it lets doctors work with patients instead of the EHR. Every month we document tens of thousands of patient encounters, saving doctors thousands of hours of medical documentation time. We’re also giving doctors their lives back. I know this because I get emails like:
“No more charts!! I can take my kids to school in the morning because I don’t have to get to the office an hour early to catch up on dictations.”
We will fix medical documentation for doctors because we must
At iScribes, we are not the only ones focused on this solution to the problem. The AMA training module Team Documentation, is all about “allowing doctors to spend more time with patients by sharing responsibilities with staff.” Indeed, we are at the beginning of a massive shift that will end when other professionals are doing nearly all medical documentation chores, while doctors focus on their patients.
The EHR software our country’s medical professionals use every day does need to add great user-centered design and usability to the security and compliance features they have focused on. But the more important and more immediate fix is for most medical documentation to be done by professionals other than the doctors, so that doctors can focus on patients, not the EHR.
Jared Pelo is an Emergency Medicine physician and the founder of Durham, NC based iScribes