In a recent New Yorker article, Atul Gawande, CEO of the Amazon, Berkshire, JP Morgan health initiative wrote about “Why Doctors Hate Their Computers.” He points to the soaring physician burnout rate and suicide rates that are nearly double (or triple for women physicians) the average population. The culprit, Gawande believes is the onset of complicated Electronic Health Records (EHRs), also known as Electronic Medical Records (EMRs) and his article vignettes how various physicians are approach the problem, including the use of scribes. In this article, we’ll take a look at how virtual scribes could be a solution to physician burnout and the current charting crisis.
How EMRs Are Killing Provider Productivity
Daya Shankar is the General Manager of ScribeEMR, one of a growing number of virtual scribe services such as M*Modal, iScribe and Physicians Angels. He says that the reason his company was started was because of the impact EMRs had on provider productivity. He explains,
We had a medical transcription company, which Nuance acquired in 2007 for $58 MM. Then, around 2016 some of our former medical transcription customers called us asking if we provided a medical scribing solution because they had installed an EMR system and their provider productivity had dipped some 32%, and in some cases even 50%. [italics mine]
Shankar adds, “We did intensive market research over a lengthy period and ScribeEMR was born.”
What we have found at ScribeEMR, in addition to what Gawande has described, was that for every hour of face time with a patient, a doctor spends an additional 2 hours completing clerical tasks. Many doctors wake up early to chart prior to clinic and also spend time after clinic charting and catching up with emails. It’s really overwhelming for them.
They found studies showing how EHR/EMR charting is related to “decreased physician productivity and revenue, negative patient-physician interactions and relationships, and widespread physician dissatisfaction.” They also found that physicians can lose out on reimbursement with insufficient charting.
What Is A Medical Scribe?
Medical scribes are trained to do the chart preparation and visit charting in the EMR providers. They take the burden of charting away from the provider and can return a doctor to an efficient workflow. Scribes can also help increase reimbursement, which will be discussed shortly. Of course, the physician must still review the chart and electronically sign the scribe’s documented encounter in the EMR.
The Problem With Using Scribes
One of the downfalls of a scribe strategy is that they are an added expense and HR overhead. Some practices recruit and hire pre-med students who are paid minimum wage. The main challenge with this route is that these smart, young students go away to academia after a year or two taking all of the knowledge with them, forcing the practice to start all over with finding, hiring and training a new scribe.
How ScribeEMR Makes Scribes Viable
By using a career scribe service like ScribeEMR, practices can avoid this type of costly turnover. For example, ScribeEMR, assigns a dedicated virtual scribe to each physician. If the scribe is unavailable for any reason (PTO/Sick Time), there is a secondary, or a backup scribe that is privy to the provider’s documentation routines. Each account has a team lead, so in any event that the primary or backup scribe are unavailable, the team lead can act as a tertiary scribe. With this structure, a practice never has to worry about scribe management.
ScribeEMR scribes are trained on all EMRs and are able to securely connect to physicians via laptops, tablets, or iPads via the secure VSee platform. They also function as virtual assistants by prepping labs, radiology/diagnostic testing orders, prescriptions, core measure reporting, patient letters, immunization requirements, and reminding doctors of notices and preventative items in a patient’s chart. Best of all, when it comes to cost, ScribeEMR scribes are market-friendly and significantly less costly than the medical student route.
Why Physicians LOVE Scribes
Shankar says offering scribe services is also a great recruitment tool for smaller, or more rural hospitals. “For many physicians it’s worth paying for a scribe out of their own pockets. Offering physicians a scribe is like offering a free chauffeur service as part of your compensation package.”
He adds, “Our physician customers are so grateful for their scribes that they frequently send scribes gifts, even to our scribes located in India!”
Why Scribes Should Do the Charting; Not a Physician
One reason that EMRs degrade physician productivity is that EMRS are heavily geared towards capturing details and requirements of a patient encounter more for insurance and billing purposes. With all of the insurance rules and regulatory requirements, EMRs lack physician/patient workflow and better serve the purpose for the medical coder’s use.
For the purposes of this article, a medical coder’s job is to take each medical chart and “translate” it into a coding level for maximum reimbursement. How physicians document their patient encounters is critical to what they get reimbursed for. A medical coder can only code by what is documented in the chart. As one doctor learned by shadowing a medical coder what gets captured in a medical chart is the “physician’s way of communicating the severity of the patient’s health and the amount of effort invested in the patient’s care. It is also a potential channel for documenting exams that were not performed.”
For example, a busy physician may complete a chart at coding level 2, while a professional scribe may be able to complete the same chart by documenting a more succinct encounter and added clinical specificity for a coding level 4. A coding level 4 equates to more reimbursement for the visit.
How Scribes Can Increase Reimbursement
Why can a scribe get a higher coding level than the physician? Well, there are several reasons. First, the physician is usually charting at the end of a long day. Providers are not big fans of charting, and typically document to the very minimum requirement. Many physicians chart quickly, trying to recall each visit and chart at a minimum so they can simply go home and have dinner and be with their families. Charting in this manner lends itself to occasionally forgetting to cue patients of some upcoming preventative tests, or procedures that are due – impacting patient care and are missed reimbursement opportunities.
On the other hand, scribes are specifically trained and focused on turning the patient encounter into a high-quality structured document. Shankar says that their scribes usually take 30 to 45 minutes to review patient charts before the visit, pulling up previous visits/tests/studies in the EMR. As mentioned previously, they are trained to prep and remind physicians of preventative screenings and chart details that a physician might otherwise overlook. Scribes save physicians time by preparing lab orders, diagnostic study orders, prescriptions, patient letters, etc., so a physician just needs to review the chart and send.
ScribeEMR scribes also work closely with ScribeEMR medical coders, and act as a bridge to providers to make the recommended documentation changes to improve chart specificity and compliance which positively impacts coding levels for optimized reimbursement.
As a 2017 Stanford study concludes, “scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction.”
ScribeEMR delivers an intuitive, lean scribe solution to enhance patient engagement, eliminate physician EMR data entry and proactively resolve clinical documentation challenges at the point of care. Using VSee, ScribeEMR scribes securely connect to physicians via laptops, tablets, or iPads via its managed peer-to-peer architecture, where media is streamed directly from endpoint to endpoint. All traffic is encrypted with FIPS 140-2 certified 256-bit Advanced Encryption Standard.
Physicians that use ScribeEMR can focus exclusively on their patients while key performance indicators like coding/denials, number of patients seen, optimized reimbursement and quality measures are tracked and dramatically improved. Visit scribeEMR.com
Or email firstname.lastname@example.org to get a live demo of how ScribeEMR turns a patient encounter into structured documentation.
Graphic courtesy of PLiXS