Pinnacle docs hope to make mark in growing medical-scribe industry
A doctor walks into the room of an ailing patient and sits down next to his bed.
She listens to the patient’s concerns, nodding, maintaining eye contact and performing hands-on examinations as needed.
Within a few minutes, the patient has a clear idea of the next steps in his treatment, and the doctor can move on to the next patient. Both are happy with the experience.
It’s a pretty picture, but, some medical professionals fear, an increasingly uncommon one as doctors spend less time facing patients and more time facing computers.
The culprit is electronic medical record programs. Digitalized systems have grown essential for streamlining work and reducing errors, but they also create more clerical work — cutting into patient facetime — for doctors who use them.
Enter medical scribes, a low-tech solution to the problems of a high-tech world.
These scribes, often college students, look up information, take down notes and do all the other tasks that have more to do with record-keeping than they do with making use of a medical license.
C2 Solutions Inc., a company started by two PinnacleHealth emergency room doctors, has offered these services in Pinnacle for about three years.
The concept was far from new when C2 Solutions entered the market, said Dr. Christian Caicedo, one of the company’s founders. But C2 hopes to make its mark by expanding the customizability of its scribes’ services and, eventually, the technology they use.
Rise of the scribe
More than 19,000 medical scribes work in over 1,900 institutions across the country, according to the American College of Medical Scribe Specialists, an industry trade group.
Demand for scribe services has grown in recent years, especially after federal laws required institutions to adopt electronic medical records to avoid penalties on Medicare and Medicaid reimbursement.
Caicedo and his business partner, C2 Solutions COO Dr. Craig Skurcenski, saw a need for scribe services locally as they practiced emergency medicine at PinnacleHealth. Doctors, they said, often felt overwhelmed catching up on electronic data entry at the end of already long shifts, and patients noticed when physicians spent more time looking at their computers than they did looking at them.
“I understood those pain points,” Caicedo said. “Having a low-cost solution was something that was very interesting to me.”
Several national scribe companies already operate locally, but Caicedo and Skurcenski wanted something they could customize to meet their peers’ needs.
They brought on their first five scribes — five students from Skurcenski’s alma mater, Messiah College — three years ago in Pinnacle’s emergency department. The company’s current roster includes aspiring medical students from Messiah, Lebanon Valley College, Penn State, HACC and other local institutions.
C2 Solutions, Inc.
Leaders: CEO Christian Caicedo, COO Craig Skurcenski, clinical operations manager Elizabeth Owen and business manager Robert Hollister
Number of scribes: 58
Cost of hiring scribes: Around $20 to $25 per hour, depending on type and volume of services
Most scribes throughout the country are undergraduate students who hope to go to go into medicine. Following doctors helps them learn medical terms and understand what’s ahead of them. As Caicedo put it, “they’ve already seen 300 abdominal pains” by the time they finish their one-and-a-half- to two-year stay.
“It’s just been a win-win for everyone,” including the doctors, the patients and the scribes, who are paid for their work, he said.
Still, the scribe industry has faced some criticism over the years for letting unlicensed students have a hand in the medical process, even in a limited data-entry role.
Scribes at C2 undergo more than 200 hours of extensive training and a strict vetting process before they are allowed to work independently, Caicedo said. Even then, they follow strict guidelines to prevent them from playing any role in direct patient care.
The process also involves a little bit of a learning curve for the doctors, who need to teach their individual workflows to the scribes — and then make sure those scribes are able to pass along that information to their successors after they leave the program.
That was the case at Pinnacle, where many of the physicians had never used a scribe before C2, said Elizabeth Owen, C2’s clinical operations manager.
Now, though, most of the system’s doctors are on board with the idea, Owen said. Three years after its start, C2 has 58 employees in Pinnacle who help not just emergency physicians but also surgeons, family doctors and other professionals in the Pinnacle system.
Owen credits much of that growth to word of mouth among doctors, like Dr. Mubashir Mumtaz, who appreciate the lighter administrative burden.
Mumtaz, a heart surgeon, said he struggled to keep up with medical records before he started working with scribes about six months ago.
After surgeries, when his head ached and his legs were tired from hours of standing, he used to have to clean up and then immediately do an operative note, talk to family, answer texts and emails and sign orders.
Now, a scribe helps him generate the operating note while he’s still in the operating room, meaning all he has to do is fill in any missing information when he breaks scrub. Scribes also help him when he works in his office, freeing him to make eye contact with patients as he explains his plans for their surgeries.
Dr. Jed Seitzinger, an osteopathic doctor who has worked in Pinnacle’s emergency room for 19 years, has also noticed the benefits.
His scribe follows him into exam rooms and records his interactions with patients, meaning he has to spend less time filling out charts. That means shorter wait times for patients, and less pressure on him.
“The stress that is felt working in the ER will always be there,” he said. “But decreasing it a small amount is a bonus.”
Eye toward innovation
The leaders at C2 already hope their ability to customize each scribe’s services to the needs of each doctor makes them stand out as innovators in the industry.
In addition to traditional scribe work like data entry, their employees, many of whom are digital natives, can also help doctors learn new record-keeping systems, Owen said. C2 can also help doctors find inefficiencies in their processes.
The company’s immediate goals include expanding beyond PinnacleHealth, something Caicedo hopes they can do in 2017.
But the company’s biggest opportunities for innovation, they believe, lie ahead.
“The future is technology,” Skurcenski said.
What if, Caicedo reflected, scribes could remotely watch doctors interact with patients via a Google Glass-type device? Or what if artificial intelligence software could listen to the interaction, letting a human scribe come back later to clean up the record?
C2’s founders believe these innovations could come to fruition in the company’s not-too-distant future.