Originally published February 2018
Medical scribes offer an innovative approach to the challenge of providing patient care while simultaneously documenting the care in the medical record. These individuals sit in on patient consultations and input information into the record for physicians. The intent is to reduce the time physicians spend documenting, allowing them to focus instead on delivering patient care.
Physicians who are considering introducing a scribe into their practice should plan for how they will continue to meet their legal and professional obligations including acting as an employer, delegating and supervising, documenting, and obtaining patient consent.
Well established in the U.S.,1 medical scribes have only recently been introduced to Canadian healthcare, leading physicians to wonder about the benefits and risks of using them.
Studies have shown benefits include increasing the productivity of busy specialists,2 and improving clinical satisfaction and patient-clinical interactions.3
From a medical-legal perspective, to date the CMPA has little experience with scribes; it is unaware of any regulatory authority (College) complaints and no civil actions have been brought.
“As we assess the role of medical scribes and the associated risks, we can use many of the lessons we’ve learned from other physician extenders, such as physician assistants,” says Dr. Todd Watkins, the CMPA’s Managing Director of Physician Services. “The most important message is that, when any new provider comes into the system, we need to continue to fulfill our role as physicians and meet the standards of care.”
Determine who is the scribe’s employer
When a hospital is proposing the use of medical scribes, or a physician is considering using one in their hospital practice, the first question is: who is the employer? For example, is the hiring of medical scribes a decision among a group of physicians, or are the medical scribes to be employees of the hospital where the physicians work?
The answer is important because employers have many broad obligations. They must ensure appropriate written agreements are in place to define the conditions of employment, determine minimum education and training, and determine potential business issues and liabilities. Physicians who hire a medical scribe must meet the obligations of an employer. The CMPA encourages physicians to get professional advice on such agreements and other obligations.
Delegate and supervise
Medical scribes are neither independent nor regulated professionals. This means physicians who delegate the task of clinical documentation to scribes are responsible for ensuring it is appropriate to delegate the task to that individual. They are also responsible for supervising scribes when they are carrying out the task.
Among other things, supervising physicians should ensure scribes are qualified and properly trained, and that they follow the physician’s professional and ethical obligations for record keeping.
Scribes must also adhere to their conditions of employment, including the clinic or hospital’s professional protocols, and to privacy legislation. As with all personnel who are privy to personal health information, medical scribes should sign a confidentiality agreement as a condition of their employment.
Medical scribes generally require monitoring and evaluation of their work, like any other staff member.
Establish clear rules for documentation
Supervising physicians are responsible for instructing the scribe on how to document properly, in accordance with the statutory and professional obligations of physicians. In addition to the legislative requirements for keeping records, Colleges have policies and guidelines for medical records, and physicians need to ensure scribes follow these.
While there is little specific guidance on using a scribe, it is generally expected that the record will clearly identify the medical scribe who made the original entry (i.e. provide the scribe’s name) and whether the physician reviewed the note.
Get patients’ consent
While the physician and scribe have appropriately prepared for delegating the task of documenting, physicians must also obtain patients’ consent before a medical scribe is allowed to sit in on a clinical encounter.
Physicians should introduce the scribe to patients and explain why the scribe is present. As well, physicians should make their patients aware that the scribe is bound by the same expectations of confidentiality that apply to the physician. If patients object to the scribe, physicians must honour their wishes and ask the scribe to leave.
The bottom line
The role of medical scribes in the Canadian healthcare system continues to evolve. Physicians who are thinking about using scribes in their practice should keep in mind they need to continue to fulfill their role as physicians and meet the standards of care. They should consider the following:
- Clarify who is responsible for meeting the obligations of the scribe’s employer, and for delegating tasks and supervising the scribe.
- Ensure the scribe adheres to the conditions of employment, and to the professional and legal expectations for record keeping that apply to physicians.
- Be sure to obtain patient consent for a scribe to sit in on a patient consultation.
- American College of Medical Scribes [Internet]. Montville (US): American College of Medical Scribes; [cited 2018 Jan 4]. Available from: https://theacmss.org/about-us/
- Bank AJ, Gage RM. Annual impact of scribes on physician productivity and revenue in a cardiology clinic. Clinicecon Outcomes Res [Internet]. 2015 Sep 30 [cited 2017 Dec 12];7: 489–495. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598196/ doi: 10.2147/CEOR.S89329
- Dubé K. Re: The use of medical scribes in healthcare settings: A systematic review and future directions. J Am Board Fam Med [Internet]. 2015 Oct [cited 2017 Dec 12];28(5):684-685. Available from: http://www.jabfm.org/content/28/5/684. doi: 10.3122/jabfm.2015.05.150184