A role gaining popularity in the ever growing electronic healthcare industry is the medical scribe. Scribes perform the data entry in the EHR so that the doctor can focus on the patient. They’re clerical in nature, don’t communicate directly with patients, and don’t perform clinical procedures or administer medications. We’ll examine the pros and cons of using medical scribes in today’s dynamic healthcare field.
These positions are very competitive to obtain, which ensures that only strong candidates are selected. They’re typically filled by pre-med students pursuing a career in healthcare, often during a gap year, as the idea of real provider-patient interactions appeals to many. Observing providers as they diagnose and treat patients is an invaluable real-world learning opportunity that can’t be paralleled in a classroom.
Refocus attention on the patient: Scribes manage the majority of the data entry for the physician, affording the provider the freedom to listen attentively and focus on the patient’s needs. In one example, “An American Journal of Emergency Medicine study found that emergency physicians spent 43% of their time entering data into a computer, compared to only 28% of their time spent talking to patients
Real-time documentation: While the physician examines the patient, a scribe can enter all relevant findings in real-time. The result is more comprehensive and accurate documentation with fewer incomplete notes for the physician to circle back to at the end of the day.
Reduced Visit Durations: By minimizing the physician-computer interaction during the actual patient encounter, the time required to document a patient visit is significantly shortened. This leads to decreased patient wait times and ultimately, increased patient and physician satisfaction.
Increased Revenues: Along those lines, practices stand to see potential long-term revenue improvement on two fronts:
- They can schedule a higher volume of daily appointments since patient visits are shortened, while maintaining high levels of accuracy and face-to-face interactions
- From a billing aspect, claims submissions should be more efficient since the documentation is completed in a quicker and more accurate fashion. This is especially important with the ICD-10 cutover less than 2 months out, but also very beneficial for incentivized programs.
Provide adaptability for incentive programs: Practices and physicians are constantly challenged with new regulations, and it is imperative that proper documentation accompanies each visit. Scribes can alleviate some of the stresses by expediting the documentation process for initiatives such as Meaningful Use or PCMH, and capturing the added details required by the move to ICD-10.
Provider Responsibility: Regardless of how a visit is documented, the provider is liable for their notes, and is required to review all scribed documents for accuracy before signing off.
Loss of alerts and decision support functions: Providers will not see the alerts and decision support prompts if they are not personally navigating through the EHR.
Initial Investment: Scribes may increase revenue over time, however the initial investment shouldn’t be overlooked. The additional compensation is an obvious consideration to account for, but using scribes also requires a workflow overhaul which may disrupt daily throughput (as any workflow change might).
Learning Curves: Other costs to consider are the associated learning curves. Scribes require training in multiple areas – the application, HIPAA, medical terminology, etc. – and the adjustment periods between the providers and scribes could hinder workflow efficiency. Practices must factor all of this, including the high turnover rate of pre-med students heading off to medical school, in their evaluation process.
Big Data: The need for structured, reportable data is greater now than ever before as pay-for-performance initiatives that leverage EHR reports are taking off. Moving forward, it’s not only important that a patient visit gets documented, it’s also important how it gets documented. As part of the initial onboarding, organizations must train their scribes to document in the appropriate fashion to ensure their providers get the full credit for each patient encounter
Patient Comfort Level: Patients may not be comfortable with other non-clinical personnel in the exam room, which could lead to them being less open about relevant healthcare information. Sensitive or embarrassing conversations necessary for accurate diagnosis and treatment may be omitted in certain scenarios.
There are definitely lots of discussion points when considering medical scribes. The cost/revenue analysis will differ at each practice. Patient and physician satisfaction are likely to improve, but at the cost of alert and decision support functions.
Our recommendation before even considering medical scribes is to assess your EHR and note module to ensure they are optimally configured for your providers’ use and for all requirements (e.g. ICD-10, Meaningful Use, P4P initiatives). We are all familiar with the additional work required of providers to document and order within the EHR, but often these efforts can be greatly reduced by streamlining the EHR’s configuration, especially the note forms, for ease of use. At the same time, an optimization can improve the documentation and data required for ICD-10, Meaningful Use, and other initiatives. Under pressure to first implement EHRs and then to conform to Meaningful Use, many organizations have not had the time to perform such an assessment. Once your EHR, especially the notes, is optimized, you may find that fewer providers actually require a scribe. For additional information and an example of an assessment, you can check out Galen’s complimentary Assessment & Gap Analysis for ICD-10.
Whatever decision you ultimately make, we always encourage our clients to define metrics and implement a pilot group before proceeding. Determine what is important to your organization. Maybe the focus is increased revenue, provider productivity, staff and patient satisfaction, accurate and timely documentation, or a combination of the above. Either way, goals need to be established and measured to be able to track success. Piloting a program on a small scale prior to enterprise-wide implementation could prove very insightful. Changes in a practice are always difficult, so it’s important to research and obtain the necessary information ahead of any decision making. For more information on medical scribes, EHR assessment & optimization, or Galen’s implementation methodology, feel free to contact us.