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Time is something physicians see slipping away. From minutes to focus on patient care, to special moments with family, the demands of documentation and EHRs are eating up that precious commodity. Capturing and entering data rather than focusing on patients can also be a hindrance to the quality of care. And while electronic health records (EHR) were supposed to help with documentation, the fact is they have increased the workload for doctors greatly and decreased efficiency. One current solution making its way into West Tennessee is the use of medical scribes. Scribes can provide many benefits to the practice of medicine, ultimately impacting the overall quality of healthcare delivery.
The Joint Commission defines a medical scribe as an unlicensed individual hired to enter information into the EHR or chart at the direction of the physician or licensed independent practitioner. A scribe can be found in multiple settings including physician practices, hospitals, emergency departments; long-term care facilities, long-term acute care hospitals, public health clinics and ambulatory care centers. They can be employed by a healthcare organization, physician, licensed independent practitioner or work as a contracted service. A scribe can work onsite at a hospital or clinic or from a remote HIPAA-secure facility. While scribes can handle many of the documentation duties associated with patient care, a physician must still review the documentation and sign off on it after the patient visit because their medical license and tax ID are associated with the record.
Scribes accompany the provider to the exam room and enter information in real time, using individually assigned security rights to access the EHR. The use of a scribe allows the provider to spend more time with the patient while ensuring accurate documentation. The scribe may not act independently but documents the physician’s or licensed independent practitioner’s dictation and activities. Scribes can also assist in navigating the EHR and locating information such as test and lab results. They can support workflow and documentation for medical record coding.
“In 2004, the scribe industry didn’t exist but since then it has grown due to increased EHR mandates. ICD-10 benchmarks have also increased the need for scribes. The scribe model has migrated to 48 states and the concept really started taking off in larger metro areas initially, mainly due to the number of viable candidates to fill the need from area colleges and medical schools,” said Justin Wilson, director of Communications and Business Strategy for ScribeAmerica, the largest provider of scribes in America. “Many scribes are college students majoring in a science or pre-med. The experience a scribe gains can be invaluable in the application process to medical school as well as providing excellent exposure to the practice of medicine and the terminology.”
While the concept is slowly seeping into West Tennessee, demand is great across the country for medical scribes. The American College of Medical Scribe Specialists estimates that the number of scribes will be 100,000 by 2020. The group is also working to develop national standards for the currently unlicensed profession. Scribes usually have some background in the medical field such as a pre-medical student or a certified medical assistant. About a third are certified and that is voluntary. The only professional body for scribes is The American College of Scribe Specialists which was created in 2010 by the founders of ScribeAmerica.
There are several reasons scribes can be an important addition to healthcare: increased efficiency and productivity for physicians; improved quality of doctor –patient visits, patient satisfaction and value care; alleviation of EHR struggles; and streamlining the billing cycle. Research has shown that using medical scribes has a number of benefits. According to a report in the Annals of Family Medicine, physicians report an increase in not only job satisfaction but also in time saved on chart review. Physicians who work with scribes average an additional patient per hour and scribe produced documentation is typically so thorough that a higher level of visit, diagnostic and procedural coding can be achieved, which results in more revenue.
Provider efficiency and productivity can increase with the use of scribes as well. The documentation completed by scribes is often available more quickly for review. As a result, documentation by a scribe can be more detailed and more comprehensive. When the provider is verbally summarizing decisions and plans, the scribe is able to capture the details of the encounter in the provider’s words and do so in real time.
Scribes have typically been found in emergency rooms where the work environment is focused on speed, productivity and throughput. They are moving into the outpatient office thanks to federal incentives to digitize medical records. The American Recovery and Reinvestment Act authorized the Centers for Medicare and Medicaid Services to award incentive payments worth ten of thousands of dollars to doctors who switch to electronic medical records. The Recovery Act program is now at the stage where it penalizes a physician in terms of reimbursement rate if they have not gone digital. And the Affordable Care Act’s emphasis on health outcomes and the value of medical services encourages the collection and tracking of patient data.
ScribeAmerica, which is the nation’s largest scribe staffing agency, has seen the number of hospitals utilizing their services grow to over 600 over a ten-year period. It is estimated that the top four national companies employ about 4,700 scribes with another 1000 scribes for startups and regional players. “We are anticipating growth in hospital and outpatient areas and expect it will become our largest line of services surpassing emergency departments in the next few years,” said Wilson.
“We started providing scribes to the Emergency Department of Jackson Madison County Hospital in October. While the ED had not had scribes before, some of the doctors had used them. They are actually referred to as physician extenders,” said Catherine Bailey, project leader for ScribeAmerica.
An option that many facilities in rural areas employee is outsourcing scribing duties to a virtual scribing company in which case the scribe documents the patient encounter from a remote or offsite location by utilizing a secure phone, internet connection or video application. “There are several scenarios for telescribing. One is the transcript model that has same day turnaround,” said Wilson. “A second option is a live scribe that utilizes a HIPAA secure line, telephone, tablet or video. This option can work very well in a rural setting where there are variable hours as well as there may be a shortage of qualified scribes.”
By utilizing a scribe, program physicians can increase their reimbursements, leave on time, avoid cash disruption with ICD-10, improve job satisfaction and overall quality of life, while delivering more efficient patient care directly at the bedside, not behind a computer.
Photo Notes: Headshot of Justin Wilson, Catherine Bailey
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