It's late afternoon, and Dr. James Suen is striding rapidly through a maze of hospital corridors when a colleague approaches him with a request.
Vladimir Zharov, a cancer researcher, follows Suen into a parking deck on the University of Arkansas for Medical Sciences campus in Little Rock. In their wake, a member of the UAMS communications staff and a newspaper reporter hustle to keep up.
Suen is just out of surgery and looking for a quiet corner for an interview with a reporter, but he slows down to give Zharov his full attention. He promises to meet with Zharov in 45 minutes, then he's off again, the tails of his white medical coat flying as he leads the way into an adjoining building.
Suen, like many of his fellow physicians, is always on the clock. At 75, he is unfailingly polite and seemingly unruffled by the demands on his time.
He gives much of the credit for his efficiency to Jenny Badley, his longtime nurse and medical scribe. In her role as a scribe, Badley documents Suen's interactions with patients in UAMS' electronic medical records system. If she didn't do the time-consuming work, Suen said, he would have to.
"I'd have to cut back on seeing patients," he said. "Instead of 30 [patients per day], I'd probably see 20. The backlog would build up."
The patients who couldn't get into UAMS, whether to see Suen or some other physician, would seek treatment elsewhere or forgo treatment altogether. In either case, Suen said, the hospital will lose money.
"And if we lose money, we can't pay people and run the hospital," said Suen, chairman of the department of otolaryngology-head and neck surgery in the UAMS College of Medicine.
The national movement to replace doctors' handwritten or dictated notes with computerized records was intended to save money and make the health-care system more efficient. But some critics say the transition has come with significant unintended consequences. They contend that unwieldy computer programs are turning doctors into clerks, forcing them to spend more time entering and reviewing data online. In some cases, they say, the extra work compromises doctors' interactions with patients and leads to physician burnout.
Scribes are one solution to the problem, and national reports indicate that they are becoming more common. In Little Rock, medical scribing has been slow to take hold.
"There's increasing interest in outpatient settings, in doctors' offices," said Dr. J.D. Fuller, chief executive officer and co-founder of Medoptim, a Little Rock-based provider of medical scribes. "I think it's definitely catching on, but it's been kind of a slow process."
Fuller said the company has about 50 scribes in place. Most are in Little Rock, he said, but a few work at locations across Arkansas.
The company offers three options, Fuller said: Direct scribing, where the scribe accompanies the doctor into the exam room; remote monitoring, where the scribe is based in the doctor's clinic but sits in a separate room and listens in on examinations via a microphone; and tele-scribing, where the scribe can be based anywhere in the state and listen to the examination over a secure communications network.
Remote monitoring is the most popular choice for Medoptim's clients, Fuller said. A general surgeon with a focus in laparoscopic bariatric surgery, he uses remote monitoring in his own practice.
"It's more comfortable for the patient," Fuller said. "Patients often don't want another person in the room during examinations."
Most of the scribes employed by Medoptim are young adults who are either college students or recent graduates, Fuller said. Typically, they are computer savvy and interested in pursuing careers in health care, he said.
Training begins with an online course taken during the hiring process, Fuller said, and continues with a 40-hour class and 40 hours of on-the-job training during which newcomers are mentored by experienced scribes. New scribes are taught to use multiple electronic medical record software programs as well as terminology specific to the fields of the doctors they'll be working with, Fuller said.
Medoptim's scribes typically earn $10 to $12 an hour, he said. Pay at those levels leads to some turnover, but Fuller said it's not enough to jeopardize the company's ability to provide physicians with reliable scribing services.
Other members of Little Rock's medical community said the use of scribes remains limited.
Greg Campbell, chief executive officer of Little Rock Diagnostic Clinic, said only one of the approximately 40 physicians at the practice uses a scribe. He said most of the clinic's doctors, or their nurses, log patient information.
"It really comes down to practice style and preference," Campbell said.
Dr. Eddie Phillips, chief medical officer at Baptist Health, said some emergency room doctors and hospitalists -- two types of physicians who typically see large numbers of patients each day -- use scribes at Baptist Health. Outside of those fields, scribes aren't common at Baptist Health, he said.
At CHI St. Vincent in Little Rock, spokesman Chad Dillard said that hospital is evaluating the use of scribes but hasn't implemented a program.
Fuller said the relatively slow adoption of scribing in Arkansas could be attributed in part to the personality types who are drawn to medicine in the first place.
"Doctors are used to working very hard and fixing their own problems," Fuller said. "Change, even for the better, is difficult sometimes."
Confronted with time-consuming electronic record-keeping requirements that can extend their already long days, doctors are either seeing fewer patients or working harder, Fuller said.
"Most doctors aren't slowing down," he said. "They're working harder, and that's why so many doctors are burning out."
For his part, Suen is sold on the value of having a scribe.
He said the three hours each day that he typically devotes to electronic medical records can turn into six to eight hours when Badley, his scribe, is on vacation.
Equally problematic is the way the process of filling out complex digital records affects patient interactions, he said.
"With electronic medical records, they initially envisioned that if you were a patient, instead of me looking at you and talking to you, I'd be over here typing up [records] as we talked, and I'd be paying more attention to the typing," Suen said.
Shifting the doctor's focus to a computer screen can be upsetting for patients. That's especially true when they are confronting complex and potentially life-threatening diagnoses like the cancer patients that Suen treats, he and Badley agreed.
"Patients don't like it," Badley said.
Asked about the potential downside to using scribes, Suen noted that doctors typically bear the costs of their salaries.
"You have to pay the scribe, and you still have extra work to do, but they're worth it," he said.
A few minutes later, Suen was on the move again, hurrying to his meeting with Zharov.
SundayMonday Business on 12/24/2015