When in New York last year, just before Christmas, we were walking from our hotel in Chelsea south to visit the site of the World Trade Centre terrorist attack. It was a cold day, particularly by New York standards, and the wind whistled up from the financial district, chilling our fingers and noses to the point of pain. As we continued down the Avenue of the Americas, I commented that people driving by must know that we are Canadians. Over the entire two mile walk, in the late morning of a weekday, we saw no more that a dozen or so pedestrians. As we neared Ground Zero, we were all starting to feel the effect of the windchill and, seizing an opportunity, we ducked into a car dealership to warm up.
These were no ordinary cars. Even a rube like me could see that right away. A couple of them had grille ornaments that I didn’t recognize. One looked like a trident. Turns out it is the Masserati symbol, reputed to have been designed by one of the seven Maserati brothers, Mario, based on a statue of Neptune at Bologna’s Piazza Maggiore. It was first used on the Maserati Tipo26 in, you guessed it, 1926. Store that away for your next round of Trivial Pursuit.
After a few minutes of feigning interest and ability to buy one of these beautiful luxury sports cars, we were ready to be on our way. I got one of the kids to snap my picture next to a Porsche. The woman greeting customers asked if she could help us with anything. I said “No. We just wanted to look at your cars. They are amazing” then added “If I ever lose my mind and sell the house, I will be back to buy one.” She smiled knowingly, like she was the keeper of some arcane and vaguely amusing knowledge nugget.
The knowledge was probably this: the car I hinted I might buy if I were insane sells for over $700,000. Even if I could magically transport my house to downtown Toronto and sell it at a vastly inflated price, it still would not pay for the car. What she probably did NOT realize is this: even if I had $700,000 to spare, I would never buy one of these cars. The concept of owning a car that expensive is ridiculous and obscene. Even more so if you consider what would happen to it on New Brunswick roads. Plus, I’m not sure you could weld a trailer hitch onto it, so how would I pull my pop-up camper?
Which brings me to my topic for the day: things that might be nice for EMR users, but which are not going to happen in this lifetime. At least not in New Brunswick.
Critics of EMR technology often raise the issue of how the computer gets in the way of normal conversation. Communication is more than words. Eye contact, body English, along with pitch, tone, rate of speech and cadence all contribute to effective communication. It’s difficult to carry on a normal conversation while simultaneously typing notes. Some are better than others at doing it, but there is always some loss of nuance when computers are interposed between humans.
There must be a solution.
There is. It’s called a “scribe.”
Now, I thought scribes were only found in the Bible, working hand-in-hand with Pharisees, maybe keeping track of accounts receivable for usurious money-lenders. Or perhaps in a medieval monastery, copying religious tomes by candlelight, with a quill pen.
Apparently I am behind the times.
Scribes are basically transcriptionists, who accompany doctors as they assess patients. Armed with an iPad or laptop, they laboriously transcribe a record of each patient encounter, which then can be pasted into the EMR. In the United States there are estimated to be in the neighborhood of 10,000 scribes assisting physicians in a variety of clinical settings. The cost is $20 to $25 per hour, usually paid for by the doctor. It’s claimed that cost is offset by greater efficiency, and patients are said to appreciate the undivided attention.
Will we see scribes popping up in doctor’s offices in New Brunswick? Not likely. At least, not in the office of any family doctor I know, where office overhead already runs in the range of 30 to 40 percent, and where the Department of Health may at any time try to impose another cap on Medicare billings. Most people I know don’t even hire an office nurse anymore.
The one place where we may see scribes might be in the Emergency Department. There, cost would be borne by the health care corporation, and there is already a demonstrated willingness to add Nurse Practitioners and Physician Assistants to the traditional doctor/nurse combo. Judging by the number of people who visit the E.R. and the typical time they wait to be seen, anything that would help to move things along would be a bonus.
For more information about how scribes have been deployed in the U.S., check out this article, recently reprinted by the Globe and Mail:
How sweet it is!