Five Lessons for Working With a Scribe

 


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Documentation personnel can free up physicians during visits to “do what we do best.”

Fam Pract Manag. 2016 Jul-Aug;23(4):23-27.

Author disclosures: no relevant financial affiliations disclosed.

More than three-quarters of hospital- and office-based care is provided using electronic health records (EHRs), and significant government incentives (and penalties) are increasing that percentage.1,2 Incentives aside, most of us adopt EHRs to improve the efficiency, quality, and safety of our practices. Although standards like the Centers for Medicare & Medicaid Services' Meaningful Use program have accelerated adoption of important technology, they have also promoted complex systems with poor usability, even for technology-savvy clinicians.3 Many of us have struggled to give our full attention to patients when working with EHRs that require extensive scrolling, multiple clicks, and “checkbox documentation” that doesn't capture the true stories of our patients or the details of our reasoning. While awaiting better technology, more clinicians are considering scribes as a solution to these problems.

Medical scribes are trained clerical personnel who capture accurate and detailed documentation of clinical encounters in real time. They assist clinicians in gathering data and navigating medical records without making independent interpretations or judgments. Scribes are not licensed, although some are credentialed through the American College of Medical Scribe Specialists (ACMSS). That group estimates that there are currently 20,000 scribes working nationwide, and that number is expected to increase to 100,000 by 2020.4,5 Many physicians work with scribe service vendors (SSVs) that hire, train, and schedule scribes for medical practices. Some practices hire and train their own scribes.

As part of a pilot project, we matched scribes with six physicians in our medical group – a family physician, a subspecialist, two surgeons, and two cardiologists. One year later, based on high satisfaction and quality of life reported by the physicians, we decided to double that number. This article shares five lessons we learned from this project.

1. Working with scribes can increase visits and patient satisfaction

We implemented our scribe program to assist physicians who were struggling with our EHR (three members) and to determine whether scribes would enhance the productivity and efficiency of physicians who were average-to-proficient EHR users (three members). We created a dashboard that followed productivity, income, workflow, and patient satisfaction, and we evaluated provider satisfaction with a separate survey and interviews. The table “Pilot outcomes” shows that the physicians all experienced gains in these areas.

About the Authors

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Dr. Miller is a recent graduate of the Johns Hopkins general preventive medicine residency program in Baltimore and medical writer at HealthLoop, a patient engagement health information technology company in Mountain View, Calif....

Dr. Howley is a resident in the Department of Surgery at the Johns Hopkins University School of Medicine.

Dr. McGuire is director of education for Johns Hopkins Community Physicians.

The authors wish to thank Melissa Feld Helicke, Thomas Stewart, Ty Whitted, Ryan McGuire, Lisa DeGrouchy, Jenel Wyatt, Carl Morgan, Tiffani Freeman, and Caroline Lentz for their contributions to the project.

Author disclosures: no relevant financial affiliations disclosed.

 

References

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1. Charles D, Gabriel M, Furukawa MF. Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2013. ONC Data Brief, No. 16. Washington, DC: Office of the National Coordinator for Health Information Technology; May 2014....

2. Hsiao C, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013. NCHS Data Brief, No. 143. Washington, DC: National Center for Health Statistics; January 2014.

3. Mitchell J, Waldren SE. Making sense of meaningful use stage 2: second wave or tsunami? Fam Pract Manag. 2014;21(1):19-24. http://www.aafp.org/fpm/2014/0100/p19.html. Accessed May 3, 2016.

4. Campbell LL, Case D, Crocker JE, et al. Using medical scribes in a physician practice. J AHIMA. 2012;83(11):64-69.

5. Crosby J. Harried doctors hail the rise of the medical scribe. StarTribune. Oct. 20, 2014. http://strib.mn/28QdQyh. Accessed May 3, 2016.

6. Scribe Connect. Scribe service revenue calculator. http://www.scribeconnect.com/medical-scribe-roi-costs-profits.html. Accessed May 3, 2016.

7. PayScale.com. Medical scribe salary (United States). http://bit.ly/26PLLQK. Accessed May 3, 2016.

8. Arya R, Salovich DM, Ohman-Strickland P, Merlin MA. Impact of scribes on performance indicators in the emergency department. Acad Emerg Med. 2010;17(5):490-494.

9. Hull T, Taylor P, Turo E, Kramer J, Crocetti S, McGuire M. Implementation of a training and structured skills assessment program for medical assistants in a primary care setting. J Healthc Qual. 2013;35(4):50-60.

10. The Joint Commission. Use of unlicensed persons acting as scribes. http://bit.ly/1ufGuvC. Updated 2012. Accessed December 17, 2014.

11. Centers for Medicare & Medicaid Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program – Stage 2. Fed Reg. 2012;77(171):53968-54162. Codified at 42 CFR §412, 413, 495. http://1.usa.gov/1TtclWb. Accessed May 3, 2016.


 

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