The next time you visit a local emergency department or doctor’s office, there may be an extra person in the room diligently typing away while the doctor conducts an examination.

Medical scribes, as they are called, are there to fill in electronic health records, and doctors are calling them an answer to their prayers.

Scribes are considered one of the fastest-growing professions in the medical industry. Their use is an outgrowth of the federal government’s requirements for hospitals and doctors’ offices to move away from paper records to electronic health records, which were supposed to revolutionize the medical industry’s ability to share information with patients and among physicians.

The American Recovery and Reinvestment Act of 2009 authorized the Centers for Medicare and Medicaid Services to award financial incentives to doctors who switched to electronic medical records. The program is now at the stage where doctors can face financial penalties if they haven’t switched from paper to electronic records.

According to the American College of Medical Scribe Specialists, there are about 20,000 scribes working in the United States and that number is expected to grow to about 100,000 by 2020, said Kristin Hagen, executive director. The Bureau of Labor Statistics doesn’t track medical scribes specifically. It projects that the population of what it calls “medical transcriptionists” was about 70,000 in 2014.

Toledo-area scribes

In Toledo, ProMedica uses scribes in both the Toledo and Flower hospital emergency departments and in some of its physicians’ offices. The University of Toledo Medical Center, the former Medical College of Ohio, also has scribes in the ER and physician offices. Mercy Health has a pilot program using scribes in three of its physician practices.

A group of ProMedica emergency room doctors found scribes so valuable that they started their own company, IScribe MD, five years ago, said Dr. Joseph Perkins, ER doctor at Toledo Hospital.

Before the scribes, “I felt that I was kind of married to the computer and it took a lot of the interpersonal relations that we have as physicians and patients. It took that away,” Dr. Perkins said.

Dr. Perkins, who is also one of the owners of IScribe MD, said the company contracts with ProMedica and provides about 80 scribes to the health-care company. There are about 50 who are shared by the Toledo and Flower hospital ER departments.

Brittany Norman, 24, who plans to become a physician’s assistant, has been working as a scribe for the past three years. She will graduate from Bowling Green State University in May with a degree in applied health science. Being a scribe is giving her a leg up before she attends school, she said.

“You get to learn what [the doctors] are thinking. You understand why they are ordering certain labs and radiology studies. It’s just incredible how much I’ve learned about medical decision-making and reasoning,” Ms. Norman said.

Like Ms. Norman, all scribes working in ProMedica ERs are college students planning to go into various medical fields. It’s not a requirement of the job to have a college degree or be on track in the medical field, but it’s helpful, Dr. Perkins said. The company provides four days of classroom training and then the scribes shadow another employee for a few days before they are on their own, Ms. Norman said.

She said her job is to listen, then to paint the entire picture of the patient’s stay in the ER “in paragraph form.” She interprets laboratory and radiology results in the record, she said.

Questions have been raised by some in the medical field about the growing use of scribes, who are unlicensed and not necessarily college educated, but who are entering medical data for physicians. To ensure the quality of the records, which will last for years, all scribes should be certified, said Ms. Hagen, whose organization offers the service for scribes.

“You can’t even be a nail tech without a certification,” she said.

However, Ms. Norman said she and the other ProMedica scribes are never used in any clinical capacity. They do not interact with patients, and doctors review everything entered into the record and must sign their name to it before it is an official record.

The beginning pay rate is minimum wage while in training, and then it averages about $10 per hour, ProMedica officials said. The average pay nationally is about $13 to $15 per hour, Ms. Hagen said.

How scribes help

The scribes in ProMedica ERs have boosted productivity and decreased time patients have to hang around waiting for treatment, Dr. Perkins said. The wait times after the first exam by a doctor have been reduced about 15 percent, and the number of patients treated by doctors during his or her shift in the ER have increased about 15 percent since the scribes came on board, ProMedica officials said.

“Instead of going back to my desk and documenting, I have the ability to see three, four, patients at a time because I don’t have to run back to my computer,” Dr. Perkins said.

Like Dr. Perkins, ProMedica cardiologist Dr. Adil Karamali said having a scribe in his office has saved time and increased the number of patients he can see each day.

Wait times for the patients in his office have been cut down from an hour to about 15 minutes, he said.

He’s had a scribe working in his office for about a year now. Before, he would jot down notes on a piece of paper while with patients because he was not comfortable with taking a laptop into the examination room and trying to fill out the electronic health record while talking to the patient. Then at the end of the day, Dr. Karamali would open the computer and use his notes to jog his memory about each patient.

“Sometimes I would be doing this at midnight at home,” Dr. Karamali said. Now he can just look over each record and approve each in minutes. There is no question that his records are more complete now, he said.

The scribes who assist doctors at UTMC are in a slightly different situation because they are already in medical school, therefore, they are not paid but receive clinical training, said Dr. Kris Brickman, chairman of the UT Department of Emergency Medicine.

The program started about eight years ago, first in the ER, and then gradually spread out to family medicine, neurology, and orthopaedics departments.

There are 100 first and second-year medical students both enrolled in the Scribe Program Preclinical elective course and who are members of the student organization called the Scribe Program. The students receive training to learn how to use the electronic health record system and then shadow other scribes before starting, Dr. Brickman said.

“It gives them the ability to break the ice and get a good clinical experience before they get into their required clinical rotations,” he said.

Those scribe positions are highly sought after and there is great competition among medical students to secure a spot, he said.

Since they are students, each scribe is only allowed to work a few hours per week in the ER unlike paid scribe who can work 40 hours per week. So overall, the program has not reduced wait times at UTMC’s emergency room, Dr. Brickman said.

“They are helpful. They take some of the responsibility for the EHR off the back of the attending [physician],” he said.

Contact Marlene Harris-Taylor at: mtaylor@theblade.com, 419-724-6091, or on Twitter @marlenetaylor48.

First Published March 20, 2016, 4:00 a.m.