Got scribes? Study says they could make ED testing more exact
Querying a health information exchange can lead to significant reductions in laboratory tests and radiology exams, according to a new study of more than 2,000 emergency department visits in three western New York hospitals.
The study was published in the Journal of the American Medical Informatics Association, conducted by the Brookings Institution and supported by HealtheLink, the Buffalo, N.Y.-based health information exchange.
It began in late March and ran through late May in 2014. It divided ED patients into two groups, one composed of 737 patients whose ED physicians had scribes who queried clinically relevant information on each patient. Members of a second, control group of 1,275 patients were seen by ED physicians whose prior records were not queried through the exchange.
According to the study results, usage of the HIE was associated with a 52% reduction in the expected total number of laboratory tests and a 36% reduction in radiology examinations ordered per patient at the ED.
The study's secondary result proved the efficacy of using scribes.
According to the study's principal researcher, Brookings fellow Niam Yaraghi, scribes were used to ensure 100% of the patients in the study cohort would have queries run through the exchange.
“If we had asked the doctors to do it themselves, they wouldn't do it,” Yaraghi said. “The HIE access rate is about 6% to 7% of the patient encounters. Physicians don't have the time to do it.”
“The mere existence of them (scribes) point to the user unfriendliness of our EHR systems,” Yaraghi said. “Without the scribes, there are seven clicks that (a physician) has to make to go and find patient information. And also he (or she) has to type in the name and the identifiers of the patient to find it. But if they could just push a button, based on the patient identification information, the query could be automatically run and the information could be loaded on the screen with one button.”
Physicians say they like to use scribes because doctors find EHRs slow and clunky to use, interfering with their interactions with patients. Those complaints have only increased in the years since EHRs have come into broad use.
The costs of scribes range from $10 to $20 an hour, according to a 2011 white paper by the American College of Emergency Physicians. The ACEP paper estimated, based on interviews with scribe service providers, that 1,000 hospitals and 400 physician groups are using them. The ACEP study found a return on investment greater than 100%.
The study was published in the Journal of the American Medical Informatics Association, conducted by the Brookings Institution and supported by HealtheLink, the Buffalo, N.Y.-based health information exchange.
It began in late March and ran through late May in 2014. It divided ED patients into two groups, one composed of 737 patients whose ED physicians had scribes who queried clinically relevant information on each patient. Members of a second, control group of 1,275 patients were seen by ED physicians whose prior records were not queried through the exchange.
According to the study results, usage of the HIE was associated with a 52% reduction in the expected total number of laboratory tests and a 36% reduction in radiology examinations ordered per patient at the ED.
The study's secondary result proved the efficacy of using scribes.
According to the study's principal researcher, Brookings fellow Niam Yaraghi, scribes were used to ensure 100% of the patients in the study cohort would have queries run through the exchange.
“If we had asked the doctors to do it themselves, they wouldn't do it,” Yaraghi said. “The HIE access rate is about 6% to 7% of the patient encounters. Physicians don't have the time to do it.”
“The mere existence of them (scribes) point to the user unfriendliness of our EHR systems,” Yaraghi said. “Without the scribes, there are seven clicks that (a physician) has to make to go and find patient information. And also he (or she) has to type in the name and the identifiers of the patient to find it. But if they could just push a button, based on the patient identification information, the query could be automatically run and the information could be loaded on the screen with one button.”
Physicians say they like to use scribes because doctors find EHRs slow and clunky to use, interfering with their interactions with patients. Those complaints have only increased in the years since EHRs have come into broad use.
The costs of scribes range from $10 to $20 an hour, according to a 2011 white paper by the American College of Emergency Physicians. The ACEP paper estimated, based on interviews with scribe service providers, that 1,000 hospitals and 400 physician groups are using them. The ACEP study found a return on investment greater than 100%.