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Hi Scott and Dave and all,

I used Cerner and scribes with the excellent group Northwest Acute  
Care Specialists who staff the EDs of  the Legacy Health System  
(mothership: Emanuel Hospital and Emanuel Children's in Portland).

Cerner was initially challenging for me, my first experience in an  
electronic ED, but ultimately computerized physician order entry  
(CPOE) became comfortable, and ease of data retrieval was a godsend.  
CPOE is time intensive -- no individual order requires a great deal  
of time -- but with each order it really adds up over entire shift.  
This was facilitated by two things:
1) patient "caresets" created physicians, which is a list of orders  
pertinent to a chief complaint or diagnosis, so that you click on  
"abd pain" and have the list of orders ready for your check marks  
(meds, nursing orders, labs, etc).
2) the use of scribes --  college-aged students with medical career  
aspirations and solid science backgrounds, who follow you with  
portable "computers on wheels" and hang on your every word,  
completing 90+% of your electronic medical record (electronic T chart  
was the one chosen for its breadth and depth and flexibility within  
peds) while the patient is still in the ED.

Downsides to scribe program:
This is labor intensive in the recruiting and training phase. The  
scribe has to learn medical language, then pediatric specific  
language, as well as the electronic T chart. The latter was the  
easiest for this millennial generation group of "kids", and many  
became more facile with T system than the docs.
The scribes are in transition in their education/career, so training  
and bringing in new staff is an ongoing process.

To summarize:

Disadvantages to Cerner/CPOE
1) Time required for CPOE
2) When computers go down (unexpected failure or scheduled  
"downtime") -- back to painful paper in a staff fully accustomed to  
the efficiency of electronic, with resultant potential delays in care  
delivery.

Advantage to Cerner/CPOE
1) You don't have to waste time explaining to a secretary what test/ 
film you want. Just order it.
2) Physician errors (particularly drug dosing) caught by computer. I  
think this is huge.

Disadvantages to Scribes:
1) Cost, time, effort, training investment

Advantages to Scribes
1) Charting is done contemporaneous to care, more detailed and  
accurate, and you're home post-shift about an hour earlier.
2) Having a "personal assistant" at your side telling you the CXR is  
completed, the lab results are in, don't forget to call the primary,  
etc is actually quite......luxurious.....especially for any brain  
fatigued with multitasking at the end of a shift.
3) Well worth the investment, time, training, cost.
4) Gets your head out of the computer, allows you face time to talk  
with/teach patients and family
5) They're young, eager-to-learn folks, enthusiastic about their  
career path, who infuse energy in the workplace.

Hope my thoughts, opinions are helpful

Meta Carroll, MD
Children's Memorial Hospital
Northwest Community Hospital
Chicago

PS: I'm missin' my scribes, can you tell?


On Jan 30, 2009, at 8:25 AM, David Ernst wrote:

> Please leave replies online as interested in responses.  Thanks.
>
> Dave Ernst, MD
>
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List
> [mailto:[log in to unmask]] On Behalf Of Scott Freedman
> Sent: Friday, January 30, 2009 9:14 AM
> To: [log in to unmask]
> Subject: scribes in your ED
>
> We are evaluating many processes that could potentially positively  
> impact
> efficiency and throughput.  One I am keenly interested in is the  
> use of
> scribes. Is any department or group using  dedicated scribes and  
> what has
> been the experience?  We soon will be transitioning to Cerner EMR  
> and I am
> most interested to hear back from anyone who use scribes 1) with an  
> EMR such
> as Cerner and 2) with residents.
> Feel free to respond directly to me so as to not cloud the listserv  
> with
> such a specific topic/ question.
>
> Thank you!!
>
> -- 
> Scott H. Freedman, MD
> Medical Director, Pediatric Emergency Medicine
> MEP
> (240) 826-7017
>
> For more information, send mail to [log in to unmask] with  
> the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html
>
> For more information, send mail to [log in to unmask] with  
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                  http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html