Dumb, computers are.
Amid the controlled chaos that defines an average afternoon in an urban emergency department, Dr. Marian Bednar, an emergency room physician in Dallas, entered the exam room of an older woman who had fallen while walking her dog. Like any doctor, she asked questions, conducted an exam and gave a diagnosis — in this case, a fractured hand — while also doing something many physicians in today’s computerized world are no longer free to do: She gave the patient her full attention.
Standing a few feet away, tapping quickly and quietly at a laptop computer cradled in the crook of her left arm, was Amanda Nieto, 27, Dr. Bednar’s scribe and constant shadow. While Ms. Nieto updated the patient’s electronic chart, Dr. Bednar spoke to the woman, losing eye contact only to focus on the injured hand.
“With a scribe, I can think medically instead of clerically,” said Dr. Bednar, 40, who works at Texas Health Presbyterian Hospital Dallas.
Without much fanfare or planning, scribes have entered the scene in hundreds of clinics and emergency rooms. Physicians who use them say they feel liberated from the constant note-taking that modern electronic health records systems demand. Indeed, many of those doctors say that scribes have helped restore joy in the practice of medicine, which has been transformed — for good and for bad — by digital record-keeping.
“Having the scribe has been life-changing,” said Dr. Jennifer Sewing, a family medicine practitioner in St. Louis, who used to spend late nights at her computer finishing electronic patient charts. Now, she can relax with her family or go to bed instead.
Dr. Michael Murphy, the chief executive of ScribeAmerica, a company based in Aventura, Fla., that supplies scribes to hospitals and medical practices, estimates that there are nearly 10,000 scribes working in hospitals and medical practices around the country, with demand rising quickly. At his company alone, the number of scribes deployed to clinics and emergency departments has risen to 3,500 from 1,000 in the past three years. Many of them are people like Ms. Nieto, who works for PhysAssist, a company based in Fort Worth. Training typically takes between 15 and 21 days, and is done by the companies themselves. She plans to enter a master’s program to become a physician assistant.
For decades, physicians pinned their hopes on computers to help them manage the overwhelming demands of office visits. Instead, electronic health records have become a disease in need of a cure, as physicians do their best to diagnose and treat patients while continuously feeding the data-hungry computer. Five years ago, only 10 percent of hospitals and doctors’ offices used electronic health records. But now the adoption rate is nearly 70 percent, thanks to tens of billions of dollars of federal incentive payments. And on the heels of electronic records has come the growing popularity of scribes.
Phi Beta Iota: IBM and NSA are both off the deep end in relation to human-centric computing. Neither appears to understand that thinking is a dynamic activity that is mostly human (not just the brain but eyes, ears, hands as both sensing and recording devices). The above article is a superior example — a heartening example — of how annoyingly ineffective a standard computer can be to a professional, and how adding another human to the mix enhances the value of the whole. Add to that holistic analytics, tools for thinking (instead of stupid tools working stupid data) and you get to some magic. We have never been serious about human-centric computing — IBM’s Watson, Google, Microsoft, Apple — all self-absorbed and still not ready to help create the world brain — a human-centric world brain.