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Healthcare Practice Strategies - Summer 2015 - Documentation Overload: Can a Medical Scribe Improve Your Efficiency?

Aug 16, 2015

It was meant to be a time-saver, but Electronic Health Records (EHRs) have created some unintended consequences. Physicians are finding themselves overloaded with documentation and clerical responsibilities — and pulled away from actual patient care.

In the end, providers are finding that they make for very expensive typists. As a result, many are increasingly turning to medical scribes — trained medical information managers who follow a physician throughout the workday and chart patient encounters. In fact, a 2014 Technology Survey conducted by Physicians Practice magazine noted that one out of every five practices surveyed that was using an EHR is also using a scribe.

In addition to making patient visits run more efficiently, scribes can sometimes even add to the bottom line. A 2013 report published in ClinicoEconomics and Outcomes Research evaluated four cardiologists in an outpatient clinic over 65 clinical hours and found that they were able to see 81 additional patients when using scribes.

Thinking Medically (Instead of Clerically)

By handling data management tasks for physicians, medical scribes free physicians to think medically instead of clerically. This allows providers to:

  • Increase patient contact time
  • Give more thought to complex cases
  • Better manage patient flow
  • Increase productivity to see more patients

In practice, here's how a hypothetical scribe/physician/patient interaction might look:

As Dr. B. speaks with the established patient in Exam 1, his note-taking "shadow" taps into a laptop, updating the patient's electronic chart. Dr. B. loses eye contact with his patient only to attend to a lingering wound. His scribe sets down the important points in the medical record, noting the lab tests and medications ordered. Next, the scribe prints out a copy of the summary sheet as well as wound-care instructions for the patient to take home. Then, as Dr. B. writes up the prescription, checks and signs the chart and says goodbye to his patient, the scribe is off to Exam 2 for the next encounter.

How Do Patients Feel?

On most measures, patients seem to like the scribe concept. It frees up their doctors to focus more exclusively on them. Yet, the idea has its detractors. Critics say that having medical scribes in the exam room intrudes on the doctor-patient relationship. The presence of another person in the exam room, they say, may cause patients to be less forthcoming about their medical concerns — which could ultimately impact their diagnosis and treatment.

On the workflow side, physicians' verification and authentication of the scribed documentation adds another step to the patient exam process. In addition, inexperienced scribes may make errors as they learn the medical terminology and technology, further slowing down the overall workflow.

To be sure, a medical scribe isn't right for every practice. But most doctors report that their scribes make them more productive and their patients happy. In fact, a 2013 study by the National Library of Medicine indicates that scribes improve both productivity and patient care.

Who's a Candidate?

The answer depends on whether you are looking for a note-taker or something more.

Nonclinical staff person — If what you have in mind is just plain scribing, you might train a current staff member to take on the role. Or, consider looking outside the practice for a pre-med student or medical/nursing student. If you hire from outside the practice, figure on a starting salary roughly comparable to that of an entry- or mid-level office worker in your area.

MA or CMA — On the other hand, if you'd like your medical scribe to do more than just document — for example, provide patient education — a Medical Assistant might be a good choice. In certain specialty practices, Certified Medical Assistants who have completed extra education and training may be the best choice.

Staffing company — Companies such as ScribeAmerica and PhysAssist can help with recruiting and staffing. They provide trained, vetted scribes to hospitals and medical practices at a cost in the $20-$25/hour range, according to staffing provider eScribe.

Follow Some Best Practices

If you choose to hire a medical scribe, follow these three best practices for a greater chance of success:

  1. Establish clear goals. Set specific goals such as increased revenue, enhanced patient satisfaction, im-proved timeliness of documentation, etc. Practice management consultants typically recommend using objective metrics, such as relative value units per hour or shift, number of patients seen per hour, clinical versus administrative time, average charge per billable visit, and patient satisfaction survey results.
  2. Stay engaged. Although using a scribe will free you from many clerical duties, you'll still need to be involved with patient information. Your review and authentication of the scribe's documentation ensures that your patients' records are accurate and complete. Consider implementing a performance improvement process to ensure that the scribe is not acting outside of his or her job description, authentication is occurring as required, and no orders are being acted on before they are authenticated.
  3. Follow up. Evaluate the effectiveness of using a scribe by measuring the practice's overall improvement in efficiency and productivity — and making adjustments as needed. In the end, bringing on a medical scribe may be the answer for providers struggling to balance the demands of documentation and coding with the very real desire to interact meaningfully with their patients. 

Scribe Signature Requirements

According to The Joint Commission, a medical scribe is an unlicensed person hired to enter information into the Electronic Health Record or chart at the direction of a physician or practitioner. Specific signature requirements for scribes include the following:

  • The practitioner must authenticate the entry by signing, dating and recording the time. Here, a physician signature stamp is not permitted — the physician must actually sign or authenticate through the clinical information system.
  • Authentication cannot be delegated to another practitioner, and the authentication must take place before the physician and scribe leave the patient care area.
  • The role and signature of the scribe must be clearly identifiable and distinguishable from that of the practitioner or other staff. Example: "Scribed for Dr. X by Jane Scribe" with the date and time of the entry.
  • If the scribe is allowed to enter orders into the medical record, those orders cannot be acted on until authenticated by the practitioner who provided the orders scribed.

Healthcare Practice Strategies - Summer 2015

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