How Medical Scribes Are Improving the Business and Practice of Medicine at the Point of Care

Dr. Kathleen Myers

Guest post Kathleen Myers, MD, FACEP, is an emergency physician and founder/chief medical officer of Essia Health.

A few years ago, JAMA published a drawing by a 7-year-old girl after a recent visit to the doctor. It showed the girl on the examination table. Her older sister was seated nearby in a chair, as was her mother, who was cradling her baby sister. The doctor sat staring at the computer, his back to everyone – including the patient. The picture was carefully drawn with beautiful colors and details, and you couldn’t miss the message: Technology is making us physicians less human.

This powerful picture paints the role of the medical scribe in re-humanizing healthcare: If a medical scribe had been there, the doctor would have been able to focus 100 percent on the little girl while the scribe entered the necessary documentation into the computer.

Medical scribes specialize in charting physician-patient encounters in real-time in the electronic health record (EHR) during medical exams, freeing physicians from the data entry burden. They are typically bright, tech-savvy college students or recent graduates interested in pursuing a career in medicine and other healthcare disciplines. Many of them go onto medical school and become physicians themselves, having gained invaluable experience and insights into real-world medicine through scribing.

When I first started using an EHR, I realized that I didn’t want to be the doctor depicted in that drawing. And I was sure other doctors felt likewise. So I started a medical scribe program in my emergency department physician group as a way to integrate EHRs while re-humanizing healthcare – helping physicians maintain a more personal relationship with their patients, helping hospital customers ensure high-quality care for their patients and helping create a meaningful place for people to work. It wasn’t long before I realized that the model I started to solve our needs internally had significant potential in the marketplace, so I turned our program into a company that could serve the medical scribe needs of other healthcare providers.

In the nearly 10 years I’ve personally been using a scribe, I have observed how they are improving the practice, as well as the business, of healthcare. And our customers have confirmed these benefits time and time again.

First, patient satisfaction increases when they receive a physician’s full and focused attention. In fact, studies show improvement of 40 percent to 45 percent in Press Ganey patient satisfaction scores to overall levels 90 percent and higher when scribes are used.

Second, by reducing their time on EHR documentation, scribes enable physicians to focus on delivering the highest quality care (vs. on data entry), work at the top of their license and achieve optimal work/life balance. Without scribes, documentation requirements typically mean longer work hours for physicians; for every 60 minutes of clinic time, physicians spend about 30 minutes charting, typically after hours on their personal time.

Third, scribes can have a positive impact on the bottom line at hospitals and specialty clinics by helping improve medical documentation quality, resulting in billing and coding processes that are more accurate and efficient. It is estimated that government and payers have driven increased documentation and coding requirements to capture three and a half times more data from each patient encounter. Using scribes has resulted in 14.8-17.1 percent increases in relative value units (RVUs) per hour, or 2.1-2.4 units per hour per physician, according to recent studies.

And finally, scribe programs can deliver positive return on investment, enabling physicians to see more patients in the same amount of time. Studies suggest scribe programs result in physicians seeing approximately 0.5 more patients per hour.

As hospitals and specialty clinics continue to make significant investments in information technology to meet the Affordable Care Act’s EHR adoption deadlines, documentation requirements will continue to increase. If physicians and care teams are to harness the potential of IT without losing the human touch in practicing medicine, they have to either learn to use computers and other technologies – or it’s essential that they find other ways to adapt, such as integrating medical scribes into their practice.

But what if providers determine they want to learn to use an EHR, or at least understand everything an EHR can do? Learning a new EHR system is a little like learning how to drive, and we offer medical scribes in the role of EHR driving instructors for doctors and hospitals. It’s unique, but we’ve expanded the role of medical scribes – with special EHR implementation training – to provide one-on-one support that can help physicians quickly gain comfort and confidence with EHR systems. One hospital we worked with had gone live with its EHR a full year previously, but the physicians were so frustrated with the system that they were taking their business to the competing hospital across town that was still on paper charts – and some were even physically throwing the computer monitors. Within a month, we were able to show the benefit of scribes working as EHR tutors to train the physicians on the optimal use of the EHR, increasing their efficiency and restoring their engagement with the hospital.

Medical scribes – whether they’re integrated into the patient exam or specially trained to ensure a smooth EHR transition – are one way to help make IT work and still keep the physician and care team focused on the patients’ needs.

Kathleen Myers, MD, FACEP, is an emergency physician and founder/chief medical officer of Essia Health, the premier provider of EMR implementation specialists and specially trained medical scribes.

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