The harsh realities of physician burnout have been shown on this blog and elsewhere for months, but what is actually being done industry-wide to reduce its prevalence and insulate the harmful effects?

"One possible reaction to physician dissatisfaction is a shrug of one's shoulders," wrote Health Affairs contributors Francis J. Crosson and Lawrence Casalino earlier this month. "Most physicians are well paid, compared to most Americans, and are highly respected. We suggest, however, that improving physician practice satisfaction should be important for both patients and policymakers."

Crosson and Casalino make a compelling case for why everyone should care about physician satisfaction, even going as far as to propose two primary strategies for improving doctors' working conditions, including:

• Empowering physicians so they feel a greater sense of influence
• Creating financial stability so physicians can afford initiatives that will improve care quality

These efforts should be appealing to physicians, but ultimately they may not be sufficient, particularly at a time when pressure—generated by healthcare reform—is only mounting on them, not subsiding.

Take, for example, the list of 10 healthcare reform strategies compiled by the Commonwealth Fund Commission on a High Performance Health System. All but three of the action points require direct involvement of physicians.

If you're a doctor, reading that list should leave you with a mixed bag of emotions. Put yourself in the perspective of a physician. Your natural instinct is to make every effort to help your patients, even if it's to your own detriment.

But even doctors accustomed to overnight shifts and 60-hour work weeks reach a point at which they can no longer continue at such a breakneck pace. The environment around doctors needs to change in order to reduce the likelihood of pervasive burnout, which eventually translates to lower quality care for patients.

Strategies for combating physician dissatisfaction

While the two-pronged approach laid out earlier by Crosson and Casalino is a start, a realistic effort to improve working conditions for physicians needs to be even more extensive.

The Organizational Culture Survey, conducted by Physician Wellness Services last month, provides some insights into the cultural elements that doctors say they want, including:

1) Transparent, respectful communication
2) Support for doctors who commit errors or mistakes
3) A patient-centered care environment.

As practices work to integrate these physician satisfaction strategies into their workflows, they should understand that hiring medical scribes goes hand-in-hand with each of them. Looking at the Organizational Culture Survey again, here is how scribes meet each standard, respectively:

1) In taking away secondary administrative responsibilities from doctors, scribes allow them to communicate more often—and more effectively—with patients.
2) If doctors themselves aren't filling out patient charts, and well-trained scribes are doing so instead, the likelihood of errors falls considerably.
3) Similarly to how scribes improve communication flows, they help physicians devote more of their time directly to patients so that accurate diagnoses and treatments, as well as improved patient satisfaction, will become commonplace.

As Heather Punke notes in a review of the survey in Becker's Hospital Review, "If organizations focus on improving these three cultural aspects, their physicians are likely to be more satisfied in their jobs and the overall culture of a hospital or health system—and less likely to leave."

And if turnover rates among doctors fall, patients aren't the only party who will benefit. Scribes, brought on to help doctors, take on their roles specifically so that they can learn about the medical field firsthand. They want to be able to form long-term, professional relationships with the doctors they serve, and that's not possible if physicians are entering and exiting in a revolving door fashion.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

"Patient engagement" is a term that has taken on even greater importance in the wake of healthcare reform efforts, which reward a patient-centered approach and accountable care.

In the view of Farzad Mostashari, the national coordinator for health IT, improved patient engagement efforts will help providers find "lost patients"—those who require follow-up care from providers, but rarely receive it.

"I'm sure if we did what marketers have been doing for more than a decade now—altering the message, figuring out how to couch it—we could iteratively drive up higher and higher the ability to re-engage patients who have been lost," he told Healthcare IT News.

So how do we get to this point?

Mostashari is in support of greater automation and population-based care. Others have spoken out about the benefits of remote monitoring and other new IT tools that make it easier for patients to become more active participants in their own care.

Whichever path providers choose to reinforce patient engagement, they should always be cognizant of the fact that for many patients, losing face-to-face time with their doctor isn't negotiable.

In an interview with Health IT Security, Dr. Susan Woods from Oregon Health and Science University said, "Engagement is a two-way street, so it's not just the patient that needs to engage with us."  Doctors need to adjust their workflows to account for whichever type of interactions patients prefer.

This could mean using remote monitoring, which widens the physical space between physicians and patients, or it could mean hiring medical scribes, who help eliminate the gap that forms between the two parties when a doctor is too focused on simultaneously treating a patient and filling out paperwork.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Although they are intended to treat emergencies only, ERs often turn into a "safety net" for patients who, for a number of reasons, cannot access a primary care physician. However, as long as ER overuse is controlled, ERs will remain a valuable linchpin in the healthcare system.

That's why the increased rate of ER closures is concerning, according to Atlantic contributor Jason Silverstein, who asks in a recent story, "What happens when the safety net moves farther and farther away from the people it's supposed to catch?"

He cites studies that have shown vulnerable populations–minorities and the uninsured–suffer most when ERs close. Silverstein assigns a share of the blame at the high costs of ER care. Typically, those who use emergency rooms are more likely to be uninsured or reliant upon government insurance programs.

Not only are the costs of ER care high, they could be up to three times as much as previously thought. A study in the Annals of Emergency Medicine suggests that emergency department costs represent about 5 to 6 percent of total healthcare spending in the United States, or up to $151 billion. The figure commonly cited by the Agency for Healthcare Research and Quality is just shy of $50 billion, or about 2 percent of total healthcare spending.

Despite their findings, researchers cautioned that this simply reinforces how important ERs are to patients.

"Rather than minimize the issue of cost, we should recognize the economic and strategic importance of the ED within the healthcare system and demonstrate that costs are commensurate with value," according to the researchers, led by Brown University's Michael Lee.

As ERs fight to rein in costs and stay open, improved workflow efficiency will become even more important, which is why emergency department scribes are so valuable.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

As the percentage of U.S. doctors using electronic medical records soars over the 90 percent mark, those practices that have still yet to make the transition are facing mounting evidence that paper records simply do not meet the demands of 21st century healthcare.

An infographic compiled by Quest Diagnostics Care 360 last month serves as the closing argument in favor of electronic medical documentation, as it lists the time, financial, environmental and health benefits of EMRs.

Here are just some of the information from the infographic:

• Physicians accumulate 975 pages of paperwork each week when electronic records aren't used.
• The operating margins of practices in their fifth year using EMRs are 10.1 percent higher than those of practices that have just made the transition.
• Primary care physicians who do not use medical scribes are only able to spend 30 to 40 hours per week treating patients directly, because of burdensome administrative responsibilities.

As clear as these benefits may be, medical practices must also understand that EMRs are not "plug and play"—complementary operational adjustments must also be made.

"Anyone who deploys technology without reengineering workflows, redefining job duties, readdressing policies, revisiting best practices and refining business arrangements could find that the cost exceeds the Meaningful Use incentive funds and that the technology will fall far short of delivering Meaningful Value," Rebecca Armato wrote in an InformationWeek Healthcare column earlier this year.

In some cases, technology, such as pagers and email, might even detract from doctors' abilities to treat patients. But if medical scribes are part of these reengineering of workflows that Armato alludes to, time can be saved, not wasted, when medical documentation responsibilities are completed.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

The most recent national patient safety assessment conducted by the Leapfrog Group led the organization's CEO to tell Healthcare IT News that she was "disappointed" in the results, which showed hospitals had made only "incremental" progress in reducing medical errors that harm patients.

Healthcare providers could learn from the patient safety infrastructures built by the 780 hospitals that Leapfrog awarded an "A" grade, as well as hospitals in Maine, Massachusetts, Minnesota, Virginia and Illinois, which were ranked highest in the nation.

"Safety is a 24/7, 365-day effort," Leapfrog president and CEO Leah Binder said in a statement. "This update of grades and accompanying change in state rankings should serve as a reminder that we are on an ongoing journey. Patient safety shouldn't be merely a concern; it should be a priority. Everyone, including consumers, hospitals, patients, families of patients, unions and employers, has a role in improving safety in American hospitals."

Concern has been expressed by some, including Healthcare Finance News contributor Dr. Bob Wachter, that the end of the "Golden Era of Patient Safety" roughly coincided with the dawn of the last decade. At the time we reported on his comments, we said that medical scribes would play a critical role in ensuring patient safety in the future, because they free doctors to devote more of their time to patients, thus lowering the possibility they commit a mistake during treatment.

A strong team of well-trained medical scribes is a benefit to any practice actively working to improve patient safety.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

At first glance, CMS' recent rundown of meaningful use disbursements for electronic medical record adoption seem to reflect steady adoption rates—75 percent of eligible hospitals have earned financial incentives, as have 40 percent of all eligible medical professionals.

Expand the scope of analysis to include all health IT tools, though, and those figures become somewhat diluted.

The Ponemon Institute released a study this week that showed how a variety of inefficient internal communication tools produce about $1 million in annual losses for the average U.S. hospital, in addition to about 45 minutes of wasted time per day, per doctor. Respondents mentioned several technological deficiencies, including:

• Pagers (52 percent)
• Inconsistent Wi-Fi (39 percent)
• Email (38 percent)
• Lack of text messaging (36 percent).

"Outmoded technologies also contribute significantly to increased patient discharge times, which average about 101 minutes," said the Institute's Larry Ponemon. "This time could be cut significantly through the use of smartphones and secure text messaging, but these technologies remain, for the most part, unused in hospitals because of the restrictive nature of security policies and challenging regulatory compliance requirements."

For now, technology–both new and old–should be viewed as a supplementary component in healthcare workflows. Healthcare professionals still need to find ways to optimize health IT in a way that improves efficiency and lowers costs.

As the party tasked with managing electronic medical records, medical scribes understand technologically advanced systems. Although their tasks are all administrative in nature, medical scribes play a critical role in improving workflows.

Much of the 45 minutes doctors lose daily are immediately gained back when practices transition medical documentation responsibilities to medical scribes.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

The Triple Aim of improving healthcare delivery models is a concept developed by former CMS administrator Donald Berwick, who called on the industry to simultaneously work toward:

• Improving patient outcomes
• Bettering the patient experience
• Lowering costs.

The regular and effective use of medical scribes will help practices meet these three goals, but let's focus on the patient experience component, specifically the role of trust between doctors and patients in strengthening these bonds.

In a column for Becker's Hospital Review, Kristin Baird shares some examples of her research regarding the reasons patients may say they were dissatisfied with the ways they were treated. Often, it's something as simple as a nurse leaving behind an IV wrapper that causes a patient to feel that the treatment environment was dirty or that they weren't being cared for properly.

"Many of the issues that are uncovered through qualitative patient encounters have nothing to do with what clinicians might typically view as 'care' — they have to do with issues related to trust," she wrote. "Healthcare organizations are only as strong as their weakest link and often don't know what these weak links are. They are the people, processes and environmental issues that diminish trust."

One of the easiest, most direct ways for doctors to build trust with patients is to show empathy and take a genuine interest in their care. If patients don't feel they are being treated this way, then practices aren't fulfilling the "patient experience" component of the Triple Aim.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Several years removed from the widespread introduction of electronic medical records (EMR) into the medical community, practices are still coming to terms with how these systems should best be managed.

The subsequent rise of the use of medical scribes as a best practice has helped smooth the transitional period away from paper records, but there are still questions about EMRs looming on the horizon.

What have been the effects of minimal physician input in designing EMRs?

Even though electronic medical records are entering their "third generation," there's little doubt that the earliest iterations of EMRs could have benefited from trial-and-error on the part of physicians. Part of the frustration stemming from practices adopting EMRs is that the initial stages of EMR adoption required some degree of workflow interruption.

"As opposed to them being 'Luddites' resisting the IT modernists, clinicians are largely pragmatic," Dr. Scot Silverstein, assistant professor of healthcare informatics at Drexel University, told Pennsylvania newspaper The Morning Call last week. "They are resisting the IT hyper-enthusiasts, who often lack clinical expertise, accountability, and true caring about possible downsides."

Since medical scribes' sole responsibility is to manage medical charts and records, they have a thorough understanding of both the clinical and technical aspects of EMRs, making them best equipped to overcome whatever design flaws may still exists in these systems.

Is patient privacy in jeopardy?

Also of concern to medical scribes should be the new HIPAA rules that just came into effect in March. Practices have until September to adhere to the new compliance measures, which, among other requirements, now prevents doctors from disclosing certain medical conditions to a patient's insurer if the patient makes such a request.

"The reality is, our ability to exchange electronic information is already well beyond our ability to control it," John Leipold, CEO of EMR vendor Valley Hope Technology, told the Wall Street Journal last week.

Electronic medical information holds a significant amount of promise for the medical industry, but it's the responsibility of medical scribes to help ensure that patient privacy is maintained.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Ask a patient in an ER whether they're experiencing an urgent medical emergency and 95 percent of them will say that they are. A look at the actual statistics, however, shows that the number of patients actually experiencing a true medical emergency is closer to about 50 percent.

This week, the Washington Post analyzed ER overuse in the United States, citing statistics from the Mount Sinai School of Medicine to show the disparity between how patients view their need for emergency care and the reality. The Post notes that ER trips climbed from 67 million annually in 1996 to 119 million in 2008.

It's difficult to assign blame to patients, many of whom seek ER care simply because they are unable to access their primary care physician at the time. Maybe they require after-hours care, or perhaps the wait time to get an appointment with their doctor is too long.

Whatever the reason, ERs must prepare for excessive patient volume by using emergency department scribes who can fulfill administrative responsibilities on the behalf of doctors, who are then able to see more patients.

What will be the role of patient education?

Using emergency department scribes helps reduce ER inefficiency, but ultimately, more needs to be done to educate patients on the hazards of ER overuse. Truven Health Analytics found that 70 percent of ER patients who are covered by employer-sponsored insurance do not need emergency care.

"Inappropriate use of emergency department services has become a major source of healthcare system waste," Truven's John Azzolini said in a statement. "Conventional wisdom has previously suggested that this issue was confined to the Medicaid, Medicare and uninsured populations, but our new research shows that the privately insured population's use of the ER is avoidable approximately three quarters of the time."

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

As a sophomore at Boston University, Ashvin Singh's experiences in healthcare environments could not have prepared him for what he witnessed in the aftermath of the Boston Marathon bombings last month.

Singh's day began just as he had expected – working as a medical scribe and member of the Red Cross Medical Record team to help runners who were experiencing exhaustion, dehydration, cramps and other ailments that come with running 26.2 miles on that crisp April morning. His specific role was to record information about those being treated and act as a conduit between the different treatment areas within the tent.

That all changed after Singh heard the explosions.

"I stopped, looked around, sort of scanned the room and it looked like a movie," he said, describing the flood of injured patients who appeared just minutes later. "I couldn't believe it happened. Then I went back to work, there were people to take care of."

In any other environment, medical scribes wouldn't actively treat patients, but these were no ordinary circumstances. While still fulfilling his scribe duties, Singh helped transfer patients throughout the tent.

Reflecting upon the experience to New Jersey's Independent Press, Singh said that despite the trauma he witnessed, the experience strengthened his resolve to become a doctor. Other volunteers who were thrust into action that day, like Dr. Sushrut Jangi, have also shared their experiences, recounting the horrors of the day.

No amount of training can truly prepare medical professionals for something like the Boston Marathon bombings, when mass casualties are a possibility. But having previously seen trauma firsthand, many of the medical professionals on-hand that morning were able rely on their instincts and training to become the heroes of the day.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

One glance at the headlines of some of the most prominent news outlets in the country should paint a clear picture of the where the mindset of the middle class resides these days, and how little it's improved since the recession began nearly five years ago.

The Atlantic asked in the fall of 2011 "Can The Middle Class Be Saved?" while NPR just declared in March that "'American Winter' Families Struggle To Survive Fall From Middle Class." Last week, the New York Times detailed a survey that found that 59 percent of Americans are worried about falling out of their economic class, in a piece appropriately titled "Optimism Dims For The Middle Class."

Given this consensus, it may be surprising that middle class jobs in the healthcare industry haven't followed suit until just recently. As the Wall Street Journal summarized in an article last week, sweeping changes within the industry have pushed practices to reduce the number of semi-skilled workers they employ, in favor of more workers in the highest- and lowest-skilled positions.

"This is a phenomenon that has been going on economywide," Georgetown University's Anthony Carnevale told the Journal. "The entry-level requirement has gone up across the board. Healthcare has been especially fast."

While this trend is a disturbing one for economists, who prefer to see more balance, it does reveal the increasing importance that practices are placing on scribes, as well as the immense value they provide.

Scribes in 21st century healthcare environments

The maintenance of patient charts and records has always been a critical aspect of practice workflows. Those responsible for keeping files accurate fall into the lower-skilled positions mentioned by the Journal. While their responsibilities have increased on the whole, due to a surge in electronic medical records, certain positions within this classification are expected to wane in the coming years as others increase in popularity.

"The shift to electronic medical records, meanwhile, has eliminated many traditional jobs maintaining patient records but has created a wealth of new opportunities for those with coding skills," according to the Journal.

The Journal doesn't delve much deeper than that, but figures from the Bureau of Labor Statistics (BLS) show that many recordkeeping positions haven't been "eliminated" by practices and hospitals, but rather, they've evolved.

And considerably so.

Drawing on figures from 2010, the BLS predicts that the role of medical transcriptions, who convert audio recordings of appointments into written records, will be reduced in the coming decade, as only 6 percent growth of the field is anticipated.

The outlook is more optimistic for what the BLS calls "medical records and health information technicians," who maintain the accuracy of medical records on behalf of doctors. Jobs in this field are expected to climb by 21 percent by 2020. Based on the BLS' description of the role of these workers, much of their time is spent in offices working behind computer screens, where they provide oversight and support services to physicians as needed.

What these professionals do not do is work in appointment rooms alongside doctors, as medical scribes do. Physicians still maintain records themselves, while simultaneously treating patients.

A better option for practices that are especially concerned about keeping accurate patient records is to hire medical scribes as part of a documentation support staff. They provide the day-to-day assistance doctors need to ensure accurate patient files, leaving technicians to manage the technical aspects of documentation and physicians themselves to treat patients.

In doing so, job responsibilities are more clearly delineated, leading to better, more efficient patient care.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

If you just started a new job and were only spending eight minutes per day training on each task that you were eventually expected to complete after the onboarding process was complete, how effective do you think you would be in your role?

Not very, most likely, but as a new study in the Journal of General Internal Medicine, this has become the reality for medical interns today.

The part of medical students' residencies that are most valuable – direct interaction with patients – only takes up 12 percent of their time, compared with the 40 percent of their workdays that go toward computer use. This translates to about eight minutes of direct interaction with each patient per day.

"It's not an easy problem to solve," said study author Dr. Leonard Feldman from Johns Hopkins Hospital. "All of us think that interns spend too much time behind the computer. Maybe that's time well spent because of all the important information found there, but I think we can do better."

And Feldman is exactly correct.

There is no reason that students in training shouldn't be able to fulfill their administrative responsibilities while simultaneously observing doctors and learning best practices firsthand. In ER settings in particular, the accelerated pace of patient care and the high stakes that come with treating serious conditions makes it even more important that doctors have prior exposure to such an atmosphere.

While emergency room scribes are not involved directly in the clinical aspects of patient care, unlike those completing their residency requirements, they do work alongside doctors as they interact with patients, which provides them with valuable experience they will need later in their careers.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Terms like "ROI" and "competitive advantage" are not likely to be the first ones that spring to mind when one thinks about the challenges facing the healthcare industry today. These are business-oriented terms that have always been present in higher level, corner office healthcare conversations, but they've seeped into the mainstream after years of practices adopting mission-critical electronic medical records.

The costs of EMR adoption are quite high, even when they're offset by financial incentives provided by the government's meaningful use program. If practices don't see a return on their sizable investments – in the form of streamlined workflows and improved patient outcomes – they'll begin to question the long-term value of EMRs.

There are other barriers to ROI too – compliance and legal issues, as well as possible technical hang-ups and staff training problems – but costs will always remain a chief consideration of providers.

Another related financial challenge, as EHR Intelligence points out in an article from earlier this month, is that the first wave of records systems – years old at this point – are becoming defunct because of rapid innovation by vendors, which have heard the complaints of the doctors and scribes who have used their systems. These changes have produced a second and third generation of more robust, intuitive records systems.

"The first-genners [of EMRs] were literally home-built in so many way," Dr. Todd Rothenhaus, vice president and CMO at Athenahealth, told EHR Intelligence. "These were guys who had to install servers under their desks and their data is sitting literally in a closet somewhere in their medical practice."

If you work in one of these facilities that is considering replacing its EMR system, the mere thought probably causes you to flash back to the first time you were introduced to an electronic records system. Yes, it will be easier for you and your staff this time. Transitioning from one electronic system to another is less of a challenge than moving from a paper records system to an electronic one.

But that doesn't mean the process will be entirely smooth, especially when costs are factored in.

What are the staffing costs associated with EMR systems?

A new report by Billian's has found that the staffing costs of hospitals maintaining their EMRs, which includes in-house maintenance providers, medical coders and programmers, can climb to nearly 7 percent of total salary expenses.

That's a significant percentage of the budget, but it's one that some believe can be justified.

"While spending 6.5 percent of general-service salaries on medical records might seem like a lot, the quality of the documentation process has the direct potential to both impact revenue and the rate of medical errors," Dr. Adam Powell, president of a healthcare consulting firm, told Healthcare Finance News earlier this month.

Controlling EMR operating costs with scribes

Practices already spend enough on electronic medical records, whether they're replacing an old system or functioning day-to-day with an existing one. Why should they have to spend more on staff who can maintain them?

Doctors need to be compensated – and rewarded handsomely – for the extraordinary work they perform with patients. It's not in their best interests, or the financial interests of their employers, that they be paid for primarily completing administrative tasks, like medical documentation.

On the other hand, the use of medical scribes is in the best interest of all parties:

• Scribes gain entry to the medical field early on in their careers
• Patients are provided higher quality care because doctors are only focused on their outcomes
• Doctors are relieved of burdensome, stressful responsibilities
• Practices do not have to compensate medical scribes at the same level as they would doctors.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

By the time doctors are fully invested in their careers of 60-hour work weeks, they've already spent years in a stress-inducing crucible that only allows the resilient to survive.

They've built up their resumes and worked as medical scribes while juggling undergraduate work. They've counted down the hours until "Match Day," dreaming of an envelope delivering the news they've waited to year, but fearing that their sterling GPAs wouldn't be high enough. They've completed residencies at some of the world's most renowned medical facilities.

And through it all, they never show a grimace, never utter a complaint.

But that doesn't mean the stress is nonexistent. Stressors only compound when doctors enter the field full-time, and for many – even the most battle-tested physicians – their breaking point is closer than many are comfortable admitting.

"Despite ample evidence that depression, suicide, and substance abuse disorders are more prevalent among physicians than the general population, the mental health of physicians consistently receives low priority," according to a recent Medscape story about physician burnout.

The causes of physician burnout have been well-documented in recent years, but it's always impactful to see them listed together and to get a full sense of the challenges facing those on the front lines of keeping Americans healthy. These causes include:

• Cultural shifts in care delivery (i.e. collaborative and accountable care)
• New IT tools (i.e. electronic medical records)
• Erosion of any degree of work-life balance
• Excessive workload
• Mounting administrative and compliance responsibilities (i.e. HIPAA)
• Loss of autonomy.

How can practices mitigate these stressors for physicians and, in turn, improve the quality of patient care? Orlando-based Florida Hospital has launched Physician Support Services, an initiative with the goal of addressing physician stress through counseling, coaching, community-building events and retreats.

Whether practices and hospitals take this approach or simply remove some responsibilities from doctors through the use of medical scribes, the problem is pervasive, and facilities need to at least acknowledge that fact.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Years before founding CNN and becoming one of the foremost American media authorities, Ted Turner was simply another college student who disappointed his father with the choices he made as an undergrad – especially choosing to major in Classics.

It's one prominent example, but how much correlation is there between an undergraduate degree and future career prospects?

In a blog post for the New York Times' "The Choice" blog this week, Haverford College dean of academic affairs Philip Bean tackled the topic that always vexes college-bound students – "Which major is most practical for my future job prospects?"

The piece is far-ranging, but the most relevant takeaway, for the purposes of this blog, is that there are always multiple paths to a career. Bean uses the example of the most recent medical school admissions data from the Association of American Medical Colleges, which shows that more accepted students had prior academic experience in the humanities (50 percent) than those with biological science degrees (42 percent).

"This is not to say that pre-med students should reflexively sign up to major in English or Anthropology, but it also suggests that pre-med students should also not, as many do, assume that majoring in the natural sciences paves the way to medical school," according to the Times.

What does pave the way to medical school for applicants is a proven ability to think quickly and communicate effectively in a fast-paced healthcare environment. Medical scribes, often pre-med students, are able to serve alongside and form professional relationships with doctors years before they've committed to their own careers in the medical field.

It's this real-world experience – observing a patient interacting with a doctor and documenting the appointment in a medical record – that either gives scribes the knowledge they need to continue down the path to medical school or to realize early on that they are better suited for another line of work.

After all, the transition away from a career in medicine is far easier when a student only has an undergraduate degree in hand than when they've already been accepted to medical school.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Even the son of Ben Bernanke – one of the foremost voices on financial policy in the United States – cannot escape the crushing weight of student loan debt. Bernanke said last year that his son could leave medical school with $400,000 in loans.

While that figure is somewhat higher than the average medical school graduate's debt of $170,000 – according to a new report by the Association of American Medical Colleges (AAMC) – it's not difficult to understand why students are increasingly choosing the more lucrative path of specialization instead of primary care.

Perhaps in part because of this disparity in earning potential, the margin separating prospective specialists from those planning to enter primary care has grown to a 2-to-1 margin. This is one of the reasons that the United States currently faces an estimated shortage of 130,000 primary care physicians by 2025, according to the AAMC.

Something of a perfect storm will continue to develop over the next decade, as the twofold pressures of fewer primary care physicians and more insured patients – 32 million, under the Affordable Care Act – converge.

Given this shortage of primary care physicians, practices need to find ways to improve efficiency and see more patients. To accomplish this goal, without rushing through appointments and sacrificing the quality of care at the altar of efficiency, practices turn to medical scribes. In managing patient medical charts and records, these scribes – often pre-med students – are able to remove some of the administrative burdens of doctors, allowing them to focus solely on patients.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

"Patients can't always know what is and what is not a true emergency. Is that pounding headache a migraine or portent of a stroke? Is that pain in the arm a pulled muscle or a symptom of a heart attack? Is the bad stomach pain a case of indigestion or appendicitis?"

It's for these reasons – listed in a must-read piece published by the New York Times' "Well" blog – that patients will rush to the emergency room without much hesitation, especially if they are unable to quickly get an appointment with their primary care provider.

The Times lays out the case that ER overuse leads to higher costs of care, doctor burnout, long wait times and reduced patient outcomes, which is particularly true among those ERs that do not have emergency department scribes on staff.

While some physicians have tried to alleviate the problem by keeping their clinics open outside of normal business hours – like the Ohio doctor we profiled in February – ER overuse is so rampant that emergency rooms may need to accept the reality that patients will continue to use their services to the point of excess.

And in fact, with the Affordable Care Act poised to provide healthcare to previously uninsured Americans, it will soon become even more difficult to get an appointment with primary care physicians, which will push even more patients to ERs.

To address mounting patient volume and reduce workflow inefficiencies, ERs use emergency department scribes, who free doctors from administrative work by filling out medical charts and records.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Who's to blame for the lion's share of health IT errors? Is it electronic medical documentation vendors and systems, many of which are still not yet perfectly refined, only a few years removed from the HITECH Act? Or is it the physicians who use them, overburdened as they juggle their administrative and clinical responsibilities?

In its assessment of 171 health IT errors committed by 36 hospitals in the last year, the ECRI Institute assigns nearly equal blame to each – 56 percent of errors can be traced back solely to the systems themselves, while 46 percent are attributable to humans' interactions with these platforms.

The ECRI Institute's Karen Zimmer said that the volume of errors in the study is particularly concerning because there are likely to be many more mistakes that weren't ever reported, many of which could cause real harm to patients.

"If we're seeing this much under a voluntary reporting program, we know this is just the tip of the iceberg," she told HealthLeaders Media earlier this month. "We know these events are very much underreported."

Of all the reported errors, more than half involved a flaw with a medication management system, but 17 percent were caused by a clinical documentation system. How many of these errors could have been avoided entirely if practices had medical scribes on staff? It's difficult to say, although it's clear that practices do need some sort of support structures, including scribes, as health IT systems become more entrenched in their workflows.

The value of medical scribes and third-party IT support

In describing the rise of "help desks" designed to prevent physicians from making these mistakes, EHR Intelligence spoke with several practices across the country that have struggled in some form or fashion using health IT.

"Our first EHR was not very user friendly, and customer service was really lacking," Dr. Waseem Khan, of Florida-based Cancer Care, told the source. "We just couldn't get answers. We were at the point of hiring a consultant just to help us navigate the EHR. It was really anxiety-ridden. I think we had one or two days of support from our vendor, and then we were on our own, so that was really difficult."

In his work as CIO of the Cancer Treatment Centers of America in Illinois, Chad Eckes has seen these impediments firsthand among his own physicians. Fortunately, he's also seen the benefits of customer service provided by help desks, which walk physicians through whichever problems they might experience with documentation systems.

In fast-paced clinical environments in which expedient treatment is a necessity, there isn't time for doctors to become, as Eckes says, a "human ping-pong ball" – bounced around from one EHR vendor's customer service representative to another, without being offered much in the way of immediate, substantive help.

However, practices can gain this sort of support in-house simply by hiring medical scribes, who become the sole keepers of patient charts and records. Because they understand the nuances of electronic medical records systems, due to their constant use of them, they are less likely to encounter difficulties as often as physicians would. Furthermore, because scribes use these systems everyday, they can help ease the learning curve for physicians who may have less familiarity with them.

Electronic medical records are supposed to streamline workflows, not impede them. They're supposed to make patient care easier, not potentially jeopardize their health. And with the right support structures in place, including medical scribes, these benefits are well within reach.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Who's to blame for the lion's share of health IT errors? Is it electronic medical documentation vendors and systems, many of which are still not yet perfectly refined, only a few years removed from the HITECH Act? Or is it the physicians who use them, overburdened as they juggle their administrative and clinical responsibilities?

In its assessment of 171 health IT errors committed by 36 hospitals in the last year, the ECRI Institute assigns nearly equal blame to each – 56 percent of errors can be traced back solely to the systems themselves, while 46 percent are attributable to humans' interactions with these platforms.

The ECRI Institute's Karen Zimmer said that the volume of errors in the study is particularly concerning because there are likely to be many more mistakes that weren't ever reported, many of which could cause real harm to patients.

"If we're seeing this much under a voluntary reporting program, we know this is just the tip of the iceberg," she told HealthLeaders Media earlier this month. "We know these events are very much underreported."

Of all the reported errors, more than half involved a flaw with a medication management system, but 17 percent were caused by a clinical documentation system. How many of these errors could have been avoided entirely if practices had medical scribes on staff? It's difficult to say, although it's clear that practices do need some sort of support structures, including scribes, as health IT systems become more entrenched in their workflows.

The value of medical scribes and third-party IT support

In describing the rise of "help desks" designed to prevent physicians from making these mistakes, EHR Intelligence spoke with several practices across the country that have struggled in some form or fashion using health IT.

"Our first EHR was not very user friendly, and customer service was really lacking," Dr. Waseem Khan, of Florida-based Cancer Care, told the source. "We just couldn't get answers. We were at the point of hiring a consultant just to help us navigate the EHR. It was really anxiety-ridden. I think we had one or two days of support from our vendor, and then we were on our own, so that was really difficult."

In his work as CIO of the Cancer Treatment Centers of America in Illinois, Chad Eckes has seen these impediments firsthand among his own physicians. Fortunately, he's also seen the benefits of customer service provided by help desks, which walk physicians through whichever problems they might experience with documentation systems.

In fast-paced clinical environments in which expedient treatment is a necessity, there isn't time for doctors to become, as Eckes says, a "human ping-pong ball" – bounced around from one EHR vendor's customer service representative to another, without being offered much in the way of immediate, substantive help.

However, practices can gain this sort of support in-house simply by hiring medical scribes, who become the sole keepers of patient charts and records. Because they understand the nuances of electronic medical records systems, due to their constant use of them, they are less likely to encounter difficulties as often as physicians would. Furthermore, because scribes use these systems everyday, they can help ease the learning curve for physicians who may have less familiarity with them.

Electronic medical records are supposed to streamline workflows, not impede them. They're supposed to make patient care easier, not potentially jeopardize their health. And with the right support structures in place, including medical scribes, these benefits are well within reach.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.

Dennis Manners had been a fixture in the emergency room of Louisville, Kentucky's University Hospital for two years. Doctors saw him 337 times in less than two years, many times to provide treatment for conditions that didn't require emergency care.

Manners, like many other ER "super-utilizers" across the country, had battled a host of other problems during that time period, including alcohol abuse.

"Back in the day, we'd say, 'Treat 'em and street 'em'," Dr. LaQuandra Nesbitt, the director of the Louisville Metro Department of Public Health and Wellness, told The Courier-Journal. "But now, hospitals are realizing the need to deal with these [social] issues."

To better serve patients like Manners, University Hospital recently instituted the Population Health Management Complex Case Program. To qualify for the program, patients need to have been to the ER five or more times in a three-month period, with medical charges exceeding $500,000. Manners met those requirements, having been responsible for $626,143 in charges in two years.

"Obviously, in the ER we have a lot of people who have a real emergency," said Dr. Adam Whiteside, who previously treated Manners. "It does stress the system."

The problem is not unique to Louisville. In Cincinnati, the Health Collaborative has been studying the impacts of its own "super-utilizers" and how hospitals can best alter their behaviors. According to the Cincinnati Business Courier, the problem is particularly vexing in Cincinnati, where 1,000 ER visits can be attributed to 14 patients.

To combat this trend, ERs across the country have turned to emergency room scribes to improve efficiency of their processes. ERs facing crowding issues know that scribes take administrative tasks away from doctors, freeing them to care for more patients.

As the premier provider of scribe services across the United States, Elite Medical Scribes is known for our optimized training, comprehensive quality assurance program and superior 24/7 customer service. Our commitment to the highest quality programs is reinforced by the industry leading client satisfaction and a retention rate of 100 percent.