Evolution Of Medical Transcription Into Scribing-2
Although the use of electronic medical records (EMRs) had been in existence since 1960s, not much attention was given to it until the passing of Health Insurance Portability and Accountability Act (HIPAA) in 1996. This act stressed upon more emphasis on high-level security and confidentiality while handling medical records and also prescribed penalties for those who did not follow these regulations. Many big organizations started to move towards EMRs to ensure compliance of HIPAA regulations. Since computers and Internet were getting much cheaper and becoming easily available with user-friendly technologies during the 2000s, American Federal Government started to think about implementing 100% EMR policy, and President Bush’s budget called for an industry-wide adoption of EMRs by 2014. This mandate was also supported by President Obama and incentives were suggested to practitioners who adopt EMRs and follow the concept of meaningful use by 2014. Beginning in 2015, penalties were implemented on practitioners who had not yet adopted EMRs.
Both the fear of penalties and the lure of incentives led physicians to rapidly adopt EMRs. Adoption of EMRs brought about a big change in medical transcription, as all the notes now needed to be typed directly into the EMR. For the doctors, it didn’t make their life easier, it made it worse by demanding much of their time before EMR. The doctors slowly got drawn into doing more data entry work than caring for patients. They were seeing lesser and lesser patients per day, incurring heavy financial losses and were getting burnt out due to much time spent on their computers. Many medical transcription companies sensed this change early on and made themselves available for training on EMRs and were ready to provide the transcription services via EMR. Doctors who were outsourcing their transcription work previously now once again started using the transcription services to work on EMR. Doctors began to choose EMRs which were far simpler to create notes, like having the option of typing the whole note into a single page in the EMR. They usually ignored the use of templates, drop down menus as it took more time and the end result was not up to their satisfaction. Yet another challenge was awaiting, which made the doctors rethink about the options of creating notes in EMR; the introduction of MACRA/MIPS.
The introduction of MACRA/MIPS, an advanced form of meaningful use, implemented from 2017, requires doctors to report quality measures and ensure proper use of EMR. Improper reporting or no reporting would lead to penalties and lesser payments from Medicare. To make the reporting easy, most of the EMRs started to incorporate technology to abstract information from the notes created by doctors. So doctors now face the challenge of creating notes keeping in mind the implementation of MACRA/MIPS measures. This once again demands much of the doctors’ time and reduces their ability to see more number of patients. Now medical transcription companies are gearing up to this new challenge and are rigorously training themselves to support the doctors.
How the transcriptionist turned into a scribe? When doctors were training medical students in their practice, they used the students to create notes on EMR while they cared for patients. This slowly developed into a regular practice. Both doctors and medical students found it mutually beneficial, the doctors having found a solution for their transcription needs and the students had an opportunity to learn more. What started as a learning experiment slowly became a part-time job opportunity for medical students and they began to be called scribes. Since the students had to leave and start their own practices, the doctors who had gotten used to having scribes now desperately needed scribes and they started looking at other healthcare-related staff, like nurses, medical assistants who can work as a scribe. Thus slowly and surely scribing became a true profession.