A medical scribe is a person, or paraprofessional, who specializes in charting physician-patient encounters in real time, such as during medical examinations. Depending on which area of practice the scribe works in, the position may also be called clinical scribe, ER scribe or ED scribe (in the emergency department), or just scribe (when the context is implicit). A scribe is trained in health information management and the use of health information technology to support it. A scribe can work on-site (at a hospital or clinic) or remotely from a HIPAA-secure facility. Medical scribes who work at an off-site location are known as virtual medical scribes and normally work in clinical settings.
A medical scribe's primary duties are to follow a physician through his or her work day and chart patient encounters in real-time using a medical office's electronic health record (EHR) and existing templates. Medical scribes also generate referral letters for physicians, manage and sort medical documents within the EHR system, and assist with e-prescribing. Medical scribes can be thought of as data care managers, enabling physicians, medical assistants, and nurses to focus on patient in-take and care during clinic hours. Medical scribes, by handling data management tasks for physicians in real-time, free the physician to increase patient contact time, give more thought to complex cases, better manage patient flow through the department, and increase productivity to see more patients.
The introduction of electronic health records has revolutionized the practice of medicine. However, the complexity of some systems has resulted in providers spending more time documenting the encounter instead of speaking with and examining the patient. A tool which was intended to elevate some problems of clinical documentation has caused many problems for the very people who were supposed to benefit from the technology - the providers. As a result, providers are experiencing burnout and dissatisfaction.  An increasing body of research has shown the use of medical scribes is associated with improved overall physician productivity, cost- and time-savings, and patient satisfaction. An in-depth study conducted by The Vancouver Clinic in Vancouver, WA from 2011-2012 found that medical scribes improved the quality of clinical documentation and allowed doctors to see extra patients, while noting the risks associated with scribe turnover and doctors' unfamiliarity with the scribe concept. Notably, research has recommended that healthcare providers employ medical scribes to reduce time spent performing data entry and other administrative tasks, which can increase physician fatigue and dissatisfaction.
The American Healthcare Documentation Professionals Group certifies Medical Scribes using the Certified Medical Scribe Professional (CMSP) and Apprentice Medical Scribe Professional (AMSP) designation. The CMSP and AMSP designations are respected by healthcare organizations and employers throughout the U.S. and internationally. In addition, the Center for Medicare and Medicaid Services (CMS) recognizes the CMSP/AMSP credential throughout the U.S. CMSP/AMSP scribes are supporting clinicians across the U.S. and internationally in all specialties and settings of care. Unlike other scribe certidications, the Medical Scribe Certification Exam (MSCE) directly links to on-the-job scenarios and realistic work situations, making it the most relevant certification available for Certified or Apprentice Medical Scribe Professionals.
There is distinction between a medical scribe and a Certified Medical Scribe Specialist or a Certified Medical Scribe Apprentice, appropriately certified and credentialed through the American College of Medical Scribe Specialists. CMS recognizes appropriately credentialed and certified professionals in Physician/CMSS or Physician/CMSA teams. Personnel entering CEHRT must be certified if not the licensed clinician themselves. CMSS scribes are assisting clinicians in meeting national iniatives and goals, in addition to innovating the healthcare system through full scope of clinical informatics/medical assistive skill sets. All physicians attesting for Meaningful Use, now Advancing Care Information through MACRA, must be certified for clinical documentation audit compliance. Physicians and Mid-Levels for Practice Administration: "CMS has asked that each clinician/provider/practice retain a copy of the Specialist crosswalk and certification documentation in their files just as they would retain documentation outlining their individual approach and method, as well as staffing protocols for audit purposes.”
An ER scribe works in the emergency department (ED) of a hospital. Their duties may include overseeing the documentation of each patient's visit to the ED and acting as the physician's personal assistant. A scribe might work with one physician per shift or might be shared between multiple providers, depending on the agency.
A prospective scribe is required to learn a large and extensive amount of medical terminology, as well as become familiar with human anatomy. Each program has their own training regimen and some are more structured than others. For example, some programs require that all new scribes take an official graded course prior to working. Other programs allow the scribe to start in the ED immediately, but only under supervision that is sometimes referred to as bedside training.
The first scribe programs were based in Reno, Nevada. Subsequently, in 1995, Dr. Elliott Trotter, M.D., a physician practicing in Fort Worth, Texas, discovered the Nevada program and decided to start a program at Harris Methodist Hospital. Dr. John Geesbreght, an ER physician at Harris Methodist Hospital, with approval from Texas Christian University (TCU) administration, recruited four pre-med TCU students to establish what is now PhysAssist Scribes, the oldest medical scribe company in The United States.
Medical scribe programs quickly expanded to other cities. Some of these programs have retained the original program paradigm; others have elected to create their own from scratch. Technology advances have seen the introduction of "portable tablets" within some hospitals, reducing the risk of transcription errors.
There are some programs that have expanded beyond the original model and its core subjects considerably, including more pertinent and up-to-date information. A few programs have included more advanced training topics and utilize standardized tests to certify preparedness to work in a particular clinical environment.
Physicians attesting to CMS Meaningful Use, now Advancing Care Information through MACRA, must utilize appropriately credentialed and certified Certified Medical Scribe Specialists (CMSS) for clinical documentation audit compliance. Healthcare, through MACRA, has shifted to outpatient specialties, known as preventive care, reducing admissions to the ED or Hospital.
For each patient seen in the ED, a scribe will:
- Accompany the physician into the exam room
- Document the history of the patient's present illness
- Document the Review-of-Systems (ROS) and physical examination
- Enter vital signs and keep track of lab values
- Look up pertinent past medical records
- Keep track of and enter the results of imaging studies
- Prioritize the physician's time by bringing critical lab results to his/her attention
- Type progress notes
- Enter the patient's discharge plan and any prescriptions
Scribe positions are often filled by college students pursuing careers in medicine, with some organizations providing assistance with college fees. Many of those college undergraduates plan to attend medical school to earn their MD or DO degrees. A smaller number plan on becoming a physician assistant (PA). Pre-health students benefit from the experience they gain working in the emergency department. These students are also able to build relationships with medical practitioners who are usually willing to write letters of recommendation for professional school applications on the students' behalf. Some scribe organizations have opted to not hire college students pursuing medical careers, due to the subsequent high rate of attrition. Also, due to this relationship between the doctor, scribe and professional school applications, some scribe programs limit the positions to seniors of undergraduate programs.
Centers for Medicare and Medicaid Services
All individuals entering electronic information must be certified. The Centers for Medicare and Medicaid recognized certified and credentialed medical scribe teams for physicians, and mid-levels secondarily, for improving America's healthcare system, through the either the American Healthcare Documentation Professionals Group, Inc. or the American College of Medical Scribe Specialists. Physician/Scribe teams are innovating and transforming healthcare together. "CMS has asked that each clinician/provider/practice retain a copy of the Specialist crosswalk and certification documentation in their files just as they would retain documentation outlining their individual approach and method, as well as staffing protocols for audit purposes.” American Medical Scribe Specialists fulfills the clinical documentation and regulatory compliance of CEHRT (Certified Electronic Health Records Technology) through Meaningful Use, now Advancing Care Information from MACRA. Learn more: theacmss.org/for-macra.
Innovating Healthcare across the Specialties - Clinical Certified Medical Scribes
Across the clinical medicine disciplines, physicians are innovating care models and specialties through Certified Scribes that enable clinical informatics/medical assisting across the specialties. CityMD is one such Urgent Care innovating the preventive side of healthcare for patient population and health (https://theacmss.org/citymdclinicalpartner/.
Commission on Accreditation of Allied Health Education Programs (CAAHEP.org/MSSRB)
The Commission on Accreditation accredits certificate to hybrid-degree programs for aspiring Medical Scribes. Curriculum is proposed and is anticipated release for accredited institutions January 19, 2017. Prospective schools may inquire to begin application process. View proposed standards, guidelines, and current and proposed curriculum at CAAHEP.org/MSSRB.
Joint Commission guidelines
The Joint Commission released guidelines for the use of medical scribes July 2012. The Joint Commission's guidelines explained: "A scribe is an unlicensed person hired to enter information into the EHR or chart at the direction of a physician or practitioner (Licensed Independent Practitioner, Advanced Practice Registered Nurse or Physician Assistant). It is the Joint Commission’s stand that the scribe does not and may not act independently but can document the previously determined physician’s or practitioner’s dictation and/or activities. Scribes also assist the practitioners listed above in navigating the EMR and in locating information such as test results and lab results. They can support work flow and documentation for medical record coding. Scribes are used most frequently, but not exclusively, in emergency departments where they accompany the physician or practitioner and record information into the medical record, with the goal of allowing the physician or practitioner to spend more time with the patient and have accurate documentation. Scribes are sometimes used in other areas of the hospital or ambulatory facility. They can be employed by the healthcare organization, the physician or practitioner or be a contracted service." The American Health Information Management Association also published guidance in its November 2012 edition of Journal of AHIMA for physicians on the use of medical scribes, echoing and elaborating on The Joint Commission's guidance by explaining that "a scribe can be found in multiple settings including physician practices, hospitals, emergency departments, long-term care facilities, long-term acute care hospitals, public health clinics, and ambulatory care centers. They can be employed by a healthcare organization, physician, licensed independent practitioner, or work as a contracted service.".
There is distinction between unlicensed and uncertified. As such, credentialing and certification has been in effect through American College of Medical Scribe Specialists since 2011. CMS recognized appropriately credentialed and Certified Medical Scribe Specialists (CMSS) meeting regulatory requirements for physicians, and mid-levels. In the outpatient settings, innovating healthcare, innovative Physician/CMSS teams are imperative to improving healthcare, building a patient-centric healthcare system. "CMS has asked that each clinician/provider/practice retain a copy of the Specialist crosswalk and certification documentation in their files just as they would retain documentation outlining their individual approach and method, as well as staffing protocols for audit purposes.” American Medical Scribe Specialists fulfils the clinical documentation and regulatory compliance of CEHRT (Certified Electronic Health Records Technology) through Meaningful Use, now Advancing Care Information from MACRA. Learn more: theacmss.org/for-macra.
Major scribe companies all over the world
Currently there are a number of scribe providers in the United States and in India. With the medical scribe position so prevalent in the American medical community, several companies have formed since the position's genesis to provide a gateway through which people (generally pursuing a career in the health industry) can apply for and work at designated hospitals with which the companies have formed relationships. It is becoming a very established industry as physicians appreciate the help of the scribes and the scribes gain experience as well as invaluable connections from working alongside physicians and other health professionals for their future endeavors such as medical school. In India, the company named as S10 health care (physicians angels) a medical scribe organization where they providing scribing for the physicians with the help of internet. Scribe America is one of the Nation's largest scribe programs, present in all 50 states with over 15,000 employees. Training for ED scribes through Scribe America involves Virtual Classroom Training, a series of 7 educational settings online through a scribe trainer, and floor training, an in hospital experience working with an experienced scribe. Certification requires an initial examination on medical terminology, and a final examination that encompasses terminology and virtual training. Following the completion of floor training, a new scribe goes through a 3 month probational period, where charts are reviewed by a Quality Assurance Manager or Chief Scribe, and criticisms are made.
Training and Certification:
The American Healthcare Documentation Professionals Group, Inc. (AHDPG) launched the industry's first online medical scribe training program in 2011. The Medical Scribe Professional Training Program is designed for individuals new to healthcare or those looking to augment their knowledge in the areas of Medical Terminology and Anatomy & Physiology. In 2014, AHDPG launched their Medical Scribe Training for Practicing Allied Health Professionals (MAs, MTs, LVNs, Techs, Translators, etc.) due to industry feedback. This program is designed specifically for experienced allied health professionals and healthcare organizations looking to leverage their existing labor resources to take on the activities associated with the medical scribe. The American Medical Association (AMA) advocates and supports thsi concept of Team Documentation through their Steps Forward program.
In 2016, the American Healthcare Documentation Professionals Group, Inc. launched the Medical Scribe Certification Exam. The Medical Scribe Certification Exam (MSCE) directly links to on-the-job scenarios and realistic work situations, making it the most relevant certification available for medical scribe professionals. Certification as a medical scribe must be as inclusive and diverse as the profession itself. Built by industry experts, the CMSP/AMSP certifications are applicable across our diverse industry, employer types, settings of care, and specialties. No matter the focus of your organization there is a universal set of skills necessary to effectively practice as a Certified Medical Scribe Professional.
The American College of Medical Scribe Specialists (ACMSS) is the nation’s only nonprofit professional society representing more than 18,000 Medical Scribes in over 1,800 medical institutions. ACMSS partners with academic institutions, non-profit partners, and medical scribe corporations to offer both education-to-certification and employment-to-certification pathways. Accredited academic programs may innovate minimum certificate to hybrid degree (i.e., associates, bachelors, and graduate residency programs) through the Commission on Accreditation of Allied Health Education Programs (CAAHEP.org/mssrb). Applications underway through CAAHEP to offer prospective schools proposed curriculum 2017, with anticipated release 1/19/17. View proposed curriculum: http://caahep.org/documents/file/Webiste%20Curriculum%20Proposed(1).pdf.
Certified Medical Scribe Specialists (CMSS) are in high demand, enabling physicians high-level clinical informatics/medical assistive personnel, onsite, at the point of care. Certified Medical Scribe Apprentice are certified scribes assisting workflow and non-clinical skill sets. ACMSS advances the needs of the medical scribe industry through certification, public advocacy, secure innovative systems design, individualized and customized consulting, and continuing education for improved care coordination and patient-centric care toward wellness. ACMSS is available for public speaking engagements and customized consulting serving healthcare. Esteemed Physician/CMSS teams are in high-demand innovating healthcare, meeting clinical documentation compliance.
ACMSS meets the needs across the healthcare enterprise, meeting clinical documentation compliance requirements with CMS.
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As of May 7, 2017, the above links are inactive.