Scribes have been in general use since antiquity although the first use of a medical scribe is unknown.1 More recently, a 1974 article in the then relatively new Journal of the American College of Emergency Physicians, written by Dr Thomas Lynch of Decatur Memorial Hospital, discussed using a licensed practical nurse (LPN) as a scribe during busy times.2 One of the earliest medical scribe programs to receive national recognition was begun in 1995 at the emergency department (ED) of then-named Harris Methodist Hospital in Fort Worth, Texas.3 Harris Methodist won the USA Today/Rochester Institute of Technology Quality Cup, in part, because of the innovation and quality of its scribe program.
Anyone who has completed a patient's medical chart by hand (since the implementation of the Centers for Medicare and Medicaid Services [CMS] and Resource-Based Relative Value Scale [RBRVS] documentation criteria in 1995) knows that the process is cumbersome and time consuming. Hand-written charts frequently result in an incomplete record, especially related to meeting diagnosis and charge coding criteria. Those relying on the information contained in hand-written medical records to care for patients struggle with poor legibility and frequent errors of omission, which is particularly likely to occur in a busy and understaffed ED. It is not uncommon for the individual writing the hurried note to be unable to read his or her note later when asked to do so. Poor documentation, including the use of unorthodox abbreviations, exposes the patient and physician to the risks of error. As an example, a physician once wrote on a chart, “D-75 P-25 IM” (Demerol and Phenergan) as a shortcut measure and relied on the nurse to decipher the cryptic phrase.
Some of the first scribes brought into the ED for full-time coverage were introduced to address handwriting issues. They were tested for their command of medical vocabulary and good penmanship during the interview process. The 1974 article by Lynch discusses legible handwriting during busy times as a major benefit of the system.2 In the beginning, as the scribes worked to write what they were told or heard, this “real-time” documentation was in itself a great benefit. As scribe programs evolved, new and unforeseen benefits became apparent. Having the assistance of a scribe made the “poor penmanship” providers more efficient, able to see more patients in the course of a shift and less stressed while working. These benefits quickly won over even the more productive physicians. It turned out the quickest way to convince a physician that a scribe was a viable option was for him to see the transformation in his partners when they were working with a scribe.
The answer to the question of scribe demographics and qualifications depends on whom one asks, the geographic location of a program, and the expectations and intended use of the scribe. Even recently, many emergency physicians were still unfamiliar with the function of a medical scribe.4 Table ...