One centers around privacy concerns, both legally and from a practice standpoint. “Patients might not tell the doctor in full disclosure certain personal things if there’s someone else in the room,” warned Union City, N.J. gastroenterologist Dr. Patrick Tempera, who uses scribes but doesn't let them join him in the exam room.

Then there is the law... and liability. According to the Health Information Technology for Economic and Clinical Health (HITECH) Act, unlicensed workers, such as scribes, can't enter orders into patient records – but they can put in "pending" orders subject to approval by a physician.


That can be risky and not everyone is comfortable with it. “We don’t have the same expertise as providers… there are so many drugs that sound the same but have one letter difference. It’s not within our scope of skill,” Lap-Heng Keung, a scribe at MetroSouth Hospital in Blue Island, Ill., told The Atlantic.

Not all scribe providers will let them enter such information. “Put yourself in the position of a 21-year-old pre-med student: here’s a doctor in the ER, you want a letter of recommendation so you can go to medical school — it’s a lot of pressure,” Cameron Cushman, a vice president at PhysAssist, told the magazine. “We [say]… ‘You’re going to be starstruck by these doctors, but you have to play your role and if you don’t, there will be consequences.’”

PhysAssist has lost 10 to 20 clients, he noted, because they place this restriction on their workers.

And Michigan surgeon, Dr. Richard Armstrong, who has been in practice 34 years, is more uncomfortable than that. He has a transcriptionist, but puts all the information into the EHR himself, just to make sure it's accurate, he told the magazine.

Whether your physicians enter the notes themselves or a scribe does it for them, the key is careful chart review, as all in the industry face the new challenges of increased data-gathering and ongoing efforts to boost productivity — not to mention the need to maintain work-life balance.

ENT Dr. Asfer Shariff, surgeon in Toledo, Ohio, and CMO of scribe service Physicians Angels, reported to Medscape's Business of Medicine that he now can check through 15-20 scribe-produced charts in 20 minutes — it had been taking him 2 hours a day to update that many in the EHR system. "I got my family back," he said.

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