TeamConnect May 2016

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How Medical Scribes Connect Technology with Humanity by Kasaan Hammon, May 1, 2016

As technology continues to become a bigger and bigger part of modern patient care,providers and other experts struggle with the question, “Does health informationtechnology dehumanize healthcare?” With HIPAA compliance at the forefront ofadministrators’ and providers’ minds, the balance between meeting requirements andmeeting patient needs is at the heart of the matter. While technology strives to makehealthcare more efficient, providers themselves strive to maintain the humanity in patientcare.

The term “technology” was coined in 1829 by Jacob Bigelow, a physician atMassachusetts General Hospital who became an expert in botany while seeking toprocure better medicines for his patients. Concerns about technology’s impact onhumanity date back almost as far. When the stethoscope was introduced in the 1800’s,some doctors resisted its use because they felt it removed the intimacy of placing an earto the patient’s chest. Those same concerns about care becoming more impersonal areechoed now as the introduction of EHR systems into the exam room shift a doctor’sfocus from the patient to the computer screen.

Cultural analyst Sherry Turkle boils down the purpose of technology: “To take somethingcomplex and promise something simpler.” But she cautions that what we do with ourtechnology defines who we are. Turkle examines the power of social media platformslike Facebook and Twitter to “force the feeling that someone is listening to us” in a worldwhere we are “connected” in the technological sense and yet may feel more separate

and alone than ever.1 In field experiments, researchers found that people who hadconversations in the absence of mobile devices reported higher levels of empatheticconcern, while those conversing in the presence of a device reported lower levels ofempathy.2 In another study, mobile devices have negative effects on closeness,connection, and conversation quality, especially notable when individuals are engagingin personally meaningful topics.3

The translation of this effect to the doctor­patient setting is predictable as electronicdevices enter the care setting. Patients’ desire for emotional connection, reassurance,and a healing touch from their caregivers as they communicate their health concerns iswell documented and longstanding.4 When medical experts were asked by the WallStreet Journal to name the biggest factors to improving patient care, they agreed: eyecontact, empathetic listening, and communication. Dr. Alex Lickerman, an internist whohas taught medical students at University of Chicago, states, “Making the patient feelthey have been heard may be one of the most important elements of doctoring. It’s notthe actual time or lack of time people are complaining about – it’s how that time felt.”5The simple moments of direct attention, one­one­one eye contact, and touch are the keyingredients in a patient’s perception of a quality interaction.

Electronic health records demand communication time from the physician, and beinglegal documents, their need for attention can trump the patient's need. Researchers areasking what the impact is on patient satisfaction, and even the likelihood of malpracticecomplaints, when a doctor’s time is spent documenting and patients no longer feelheard when they seek medical advice. On average, a doctor will spend only 7­12minutes with a patient and ask only 50% of all questions they have.6 Health columnistRoni Rabin writes, “By all accounts, short visits take a toll on the doctor­patientrelationship. There is less of a dialogue between patient and doctor, increasing the oddspatients will leave the office frustrated.”

But more listening and communication means even more to recall and more todocument, hence the dilemma of where doctors’ time is spent. Dr. James Bailey wrote inthe AMA’s Journal of Ethics, “The danger is that developers, lawmakers, researchers,and quality organizations, in their zeal to demonstrate “meaningful use” of healthinformation technology (HIT), might establish design requirements for systems thatmandate such extensive documentation at every visit that it eats up the already limitedtime doctors have to actually care for patients. The most common concerns about HIThave little to do with the technology itself, but everything to do with implementation.”7

Numerous studies have found that hospitals and clinics that bring on scribe servicesalong with EHR implementation have been able to meet HIPAA guidelines while alsoimproving patient satisfaction, doctor satisfaction, and efficiency in operations. Becausescribes assume the tedious but essential task of properly and thoroughly documentingthe patient visit, they free up physicians to spend more time focused directly on thepatients. As Dr. Carol Cassella said in the Wall Street Journal panel, “Stop facing thecomputer. Look at your patients while you talk to them. Listen for more time than youtalk. Body language can say more than words, but you'll miss it if you aren't looking.”5

Medical scribes, by making EHR documentation somewhat invisible and separate fromthe doctor­patient interaction, help ensure that documentation supports the purpose ofthe visit rather than becoming the centerpiece of it. While the fear may be that thetechnology will separate the doctor from the patient, when you add medical scribes tothe equation, the doctor­patient interaction can actually be improved. Documentation is

improved by use of the scribe, while the doctor has time to look, listen, communicate,and best serve the patient’s needs, thereby bridging the technology­humanity gap.

(1) Sherry Turkle, “Connected, but Alone?”, www.ted.com (February 2012); (2) Misra, Cheng, Genevie, & Yuan,“The iPhone Effect,” http://eab.sagepub.com (Sage, July 1, 2014); (3) Andrew Przybylski and Netta Weinstein, “CanYou Connect with Me Now?”, http:// http://spr.sagepub.com/ (Sage, July 19, 2012); (4) Bailey JE. Asklepios: Ancienthero of medical caring (Ann Intern Med. 1996); and Wensing, Jung, Mainz, Olesen, Grol: A systematic review of theliterature on patient priorities for general practice care (Soc Sci Med. 1998); (5) The Experts: “How to ImproveDoctor­Patient Communication” (Wall Street Journal, April 12, 2013); (6) https://www.physiciancognition.com; (7)James e. Bailey, M.D, “Does Health Information Technology Dehumanize Health Care?” (AMA Journal of Ethics,March 2011)

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Erich's Message: The Human Element

I’ve had the opportunity to travel todifferent countries and experience variouscultures over the years. The food,languages and customs are alwaysdifferent and fascinating to learn about.But there are some things that are sharedin every culture and by all of humanity:smiles are always pleasant and welcome;a friendly laugh breaks down barriers;sharing food creates memories and buildstrust; helping hands engender gratitude.

The medical environment is oftentimes a reflection of many world cultures. When youwork with your provider, you may meet patients who speak little to no English, who donot share the same cultural set of ideas as you, and who may be very confused orfearful about their present situation. As part of the greater healthcare team, we are thereto bring the patients healing and relief from their symptoms and pain.

As a medical scribe, your friendly smile can go a long way to making a patient feelwelcome, at ease and cared for no matter what language they speak or which culturethey come from. The work you do allows the provider to focus more closely on thepatient and removes the physical barriers of technology from the patient­providerinteraction.

You may not realize it or feel it every time you walk into a patient’s room, but you arebringing a foundational piece of medicine with you every time: The Human Element. Youare part of a larger Team that removes the barriers of technology and provides theessential Human Element to over 600 patients in 18 medical facilities every day. TheScribeConnect Team that you are part of is not duplicated anywhere else in the scribe

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industry. Our people and our culture cannot be matched in fulfilling our purpose ­ toprovide meaningful assistance to our providers that is caring, efficient and accurate.Thank you for your compassion and dedication to your ScribeConnect Teammates,providers, patients, and the greater medical team you work with every day.

Erich Rempel CEO ScribeConnect

Quality of the Month: Humanity

"A pair of kidneys will never come to thephysician for diagnosis and treatment.They will be contained within an anxious,fearful, wondering person, asking puzzledquestions about an obscure future,weighed down by the responsibilities of aloved family, and with a job to be held, andwith bills to be paid."

­Dr. Philip Tumulty of Johns Hopkins

SC Spotlight: Elizabeth Rios Scribe, Long Beach, CA

Elizabeth has been a scribe with ScribeConnect sinceAugust 2015. She is known for being a good team playerand her willingness to help others.

Elizabeth’s favorite thing about working forScribeConnect is that she has the opportunity to workwith amazing doctors and nurses that allow her to gainknowledge about the OB/GYN specialty. She tells us, “Myexperiences as a scribe have cemented my desire tobecome a physician.”

Elizabeth enjoys working at an OB/GYN clinic becauseshe gets to see patients frequently, especially pregnantpatients. “The best part about my job is the patientinteractions and when we have the pleasure of meetingthe babies after delivery. It is also rewarding to be able towork in a community similar to the one I grew up in.”

Elizabeth graduated from Cal State Fullerton andcompleted the Post­Baccalaureate Program at UCISchool of Medicine. She is currently studying for theMCAT and planning on applying to medical school in2017.

Some of her interests include photography, painting,cooking, reading, and spending time with her husband,family and friends. What else might you find Elizabethdoing on a day off? She loves to go ATV riding!

SC Spotlight: Jazmin Bennett Scribe, Long Beach, CA

Jazmin has been a scribe with ScribeConnect sinceNovember 2014. Jazmin is known for her sweet, bubblypersonality and her great communication andorganization skills.

Jazmin loves being a part of a company that invests in itsworkers, as she describes it, “ScribeConnect trains usvery well, provides continuing education, and encouragesus to maintain healthy, balanced lifestyles through theWellness program.” Her favorite part of her job is buildingrelationships with both the OB/GYN team as well aspatients. “I love being able to follow patients from theirfirst positive pregnancy test all the way through their 6­week postpartum visit. It is always a fun bonus when theybring in the cute newborns.”

Jazmin grew up as an Air Force brat, went to anInternational School in Europe for 8th and 9th grades,and moved around to many schools over the years. Shegraduated from Azusa Pacific University with a B.S. inBiology. Though she graduated pre­med, she hasdecided she wants to become a Nurse Practitioner/Midwife, and she is taking prerequisite courses andplanning to apply for a Master’s in Nursing.

Jazmin loves anything Disney related, Harry Potter,giraffes, hanging out at the beach, and maintaining longdistance friendships across the country and globe.

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VIDEO A Doctor's Touch

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What are you reading? Send us your recommendations, and we may include them in anupcoming "Brain Food."

Got any news? Send us news, photos, updates, interesting reads or items youwant to share with TeamConnect: kasaan@scribeconnect.com.

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