As electronic health records are adopted by more and more practices, it’s becoming evident that they have created an increased workload. Using a scribe may be key to increasing your office’s productivity.
The introduction of electronic health records (EHR) has brought about two often-voiced concerns from the physician. One is that they are cumbersome and impact negatively on physician productivity. The other is the structure means a doctor’s time and attention is split between the patient and the computer, to the detriment of the former.
One way to address both of these is to add a position to the practice known as a scribe. These are unlicensed individuals, usually with a medical background, who do the necessary data entry and management under the supervision of a physician or independent practitioner.
“What the scribe does is give back to doctors time lost to pointing, clicking, and typing,” says Kevin Brady, president of Physician Angels, Inc., a provider of virtual scribe services. “It makes no sense to have your $300 an hour doctor doing $15 an hour data entry work. The scribe frees up the doctor to focus on the patient, see more patients, and still get home at a decent hour.”
More Patient/Doctor Interaction
The scribe also impacts on the patient-doctor interaction and may help increase patient satisfaction scores. Before, the doctor had to spend a certain amount of time with their back to the patient while working with the computer. Scribes give providers an opportunity to maintain eye contact and lessens patient concerns about the doctor treating the computer instead of the patient.
Generally, the scribe is a person who has at least some knowledge of medical terminology. Most practices use a medical assistant (MA) or registered nurse (RN) for the position. A practice considering a scribe will need to make sure they understand the latest requirements for scribes in order for that encounter to be acceptable under the Centers for Medicare and Medicaid Services’ Meaningful Use rules. Although some organizations train and certify medical scribes, there are no widely accepted criteria for scribe training and employment requirements.
One way to utilize scribes is as an employee with that as their only function within the practice. They can interact remotely using video and/or audio conferencing from another room in the practice’s offices or at some central location.
Another way is to use staff already on board and working with the physicians. In this model, the scribe is often an MA or RN who sets up the room, gathers initial information such as vital signs, reason for the visit, and medication lists before the patient sees the physician. They then stay in the room during the visit and enter data as needed.
“In many cases, the practice won’t need to employ additional people,” says Jeffrey Daigrepont, senior vicepresident of the Coker Group in Alpharetta, Ga. “It is often repurposing a person already in the office. Most were probably already involved in note taking to a certain extent even before the EHR was implemented.” A third model seen in the U.S. uses a scribe that is employed by a third party. The scribes can work from anywhere in the world.
“The virtual or remote scribe is in a HIPAA-secure facility with an audio connection allowing them to monitor the interaction and ask questions as needed,” Brady explains. “They are logged in to the EHR under their own unique identifier and chart the encounter in real time.”
The scribe is not a transcriptionist taking down everything the doctor says. Instead, he or she listens carefully to the conversation the provider is having with the patient and populates the chart based on what is being said. This means the doctor vocalizes information that may have just been written down on paper notes before. This can help impart to the patient additional information on his or her condition and what the provider feels are important aspects of care.
The way that works best for a given practice will differ. The more repetitious the interventions are, the more a scribe can do to populate the charts from templates. The personality of the individual physician may also have an impact, as it requires a certain amount of trust in the abilities of the scribe and some relinquishment of control.
At the end of the visit, the doctor will need to look over the information entered into the electronic records and add anything that is needed. After confirming that all is in order, the physician can then sign the record and go on to the next patient.
“The doctor remains responsible for the note whether or not they entered it directly,” Daigrepont says. “I would not suggest that the scribe be given the authority to do the capturing for reimbursement. The provider really needs to be the one determining the level an encounter should be billed to avoid unwanted liabilities if there is an audit.”
In the end, the motivations of the physicians are largely based on two things. One is seeing more patients. Some studies suggest the average specialist can schedule as many as seven additional patients a day.
“Some just don’t want to work until 7 or 8 every night,” Brady says. “This is a quality of life issue so the provider can see their family and not spend their entire life at the office.”
— Ullman, RN, MHA, is an Indiana-based freelance writer with
nearly 30 years of experience. He wrote about making the move
from a private practice into a group setting in the February issue.