Clearly, the Holy Grail of patient encounter documenting is to allow the doctor to be 100% focused on doctoring. If practicing to highest level of licensure is a prime directive, then a doctor who has to hunt-and-peck scribe is stepping backwards, and doctoring less. Whether the problem is the system or more commonly the doctor, it's enough to block some physicians from adopting digital records.

The ultimate expression of customizing an EHR may not be a feature set of the software. It may be getting another intelligent human being at your side, more adaptable than any artificial intelligence system commercially available, who knows the system and can adapt to your practicing idiosyncrasies. A Jeeves to your Wooster, if you're familiar with that reference.

Then again, think of ultrasound techs.

Surely there's a way to redesign the machines, so that all those sliders and switches and lights and the trackball aren't necessary (well, maybe keep the trackball — it's fun). I've had ultrasounds done on me, and I was absolutely mesmerized by the symphony of movement of the tech's free hand over the controls. Complex — absolutely. Simplifiable — almost certainly. But the job gets done, often and casually.

Are doctors trained to a lesser level than ultrasound techs? Are the doctors who can't make the switch admitting to an IT defeat that apparently requires more repetition than an advanced post-graduate professional degree?

There's definitely a degree of “won't” as opposed to “can't” in some cases.

I don’t think the notion is all that off. In fact, I don’t think it is that unusual, even today.

Recently, during a visit to my children’s Ophthalmologist, the doc brought in a RN who sat in the corner with the paper chart writing down what the doc was dictating. I actually took noticed and commented on how I thought that was a clever idea.

A while back, I remember going in for an annual physical where two staff members (RN’s or MA’s, wasn’t sure) accompanied me to the exam room. Once inside, one took vitals, asked me the traditional questions and if I had any complaints, while the other wrote down the values and my responses to the questions.

The process was very efficient and fast. In fact, we’ve discussed it here at our practice and explored the idea of having two medical assistants room patients and take vitals. One performs the task, while the other documents the chart.

You definitely make a good argument to bring back a skill set that can help EMR naysayers overcome objections such as EMR’s are too difficult to manage, how it is faster to document on paper charts instead of the computer, or how EMR’s can slow doc’s down. With a Scribe, one can say to those naysayers, how about if you didn't have to touch the EMR to document the chart?