Scribe-assisted physicians say their productivity is back to normal after plummeting with connection to an EHR and have time to spare
One unintended consequence of the federal program to encourage hospitals and physicians to adopt and use electronic health record (EHRS) systems is the creation of a new category of healthcare worker. Today, a growing number of hospitals and medical groups are hiring medical scribes.
Medical scribes are trained individuals who document physician-patient encounters in real-time while a physician is examining the patient. Dark Daily was one of the first to call attention to this new healthcare profession. Medical scribes got their start several years ago working in emergency rooms (ER) to help increase ER physician productivity [See Dark Daily: Adoption of EMRs Creates Demand for New Healthcare Job of ‘Scribes’].
Now, thanks in part to $15.5 billion in federal funding under the American Recovery and Reinvestment Act of 2009, medical scribes are assisting physicians outside the ER. They can be found with doctors making hospital rounds and in medical practices, entering patient medical data into EHRs while physicians are examining or interacting with patients, noted a report published in Modern Healthcare.
Based on interviews with scribe service providers, a 2011 white paper on the use of medical scribes was published by the American College of Emergency Physicians (ACEP). In this paper, it was estimated that 1,000 hospitals and 400 physician groups were using scribes as of 2011.
One early concern about the use of medical scribes was that their presence would be disruptive to doctor-patient interactions. However, medical scribes have become valued collaborators. In settings where they are used, scribes are helping physicians make the transition from old-fashioned paper charts to electronic medical records (EHRs).
Scribes Helping Physicians Transition from Paper Charts to EHRs
Physicians complain EHRs are slow and clunky. Moreover, many physicians type slowly. These are among the reasons why scribes are being hired to enter data for them. Physicians estimate, in fact, that their productivity plummeted by as much as 30% after beginning the transition from old-fashioned paper charts to EHRs, noted an article published in the Los Angeles Times.
Michael Merry, M.D., an Internist/Pediatrician at FHN a group practice in Freeport, Illinois, who heads the group’s EHR implementation, told Modern Healthcare that when his group adopted an EHR last year, his patient visits dropped from 25 to 30 per day to 20 to 25.
Merry began using a scribe in January and stated that he is nearly back up to his pre-EHR productivity. Likewise, Oliver Jenkins, M.D., an otolaryngologist with Toledo Clinic, a multispecialty practice in Toledo, Ohio, said that his productivity dropped when his group connected to an EHR, but returned to 25 to 30 patients a day when he hired a scribe.
Both Merry and Jenkins use Physicians Angels, a scribe service based in Toledo. This company connects physicians at the bedside and in their offices to virtual scribes in India and throughout the United States using Voice over Internet Protocol (VIOP). “All you need is a data connection and anyplace in the world becomes home,” explained Jenkins.
Scribe-Assisted Physicians Report Return on Investment in Scribes
The ACEP white paper reported a 100% return on investment for employing scribes in the ER. It pointed out that emergency physicians spend approximately half of their time on indirect patient care activities, primarily charting and recordkeeping. “The economic benefit of a scribe program, therefore, comes in large part from freeing the physician from some of this indirect time burden and enabling him or her to see additional patients,” stated the authors of the white paper.
The Modern Healthcare article noted that “the jury is still out, however, on whether scribes can boost physician productivity enough to offset their cost in clinical realms outside EDs.” Medical scribes generally cost $10 to $20 per hour.
Some physicians who use scribes in a clinical setting, however, contend that the increased physician productivity afforded by scribes justifies the cost. That is the contention of the Vancouver Clinic in Vancouver, Washington. This multispecialty group practice has 194 physicians, 18 of whom use medical scribes.
Vancouver Clinic’s COO is Tom Sanchez. He told Modern Healthcare that the group pays its scribes—which are supplied by Portland, Oregon-based Scribes STAT, upwards of $20 per hour. Sanchez estimates that the return on investment is between 15% to 20%.
Marcia Sparling, M.D., a rheumatologist and one of the group’s two medical directors, said the scribes add one patient-contact hour to each physician’s workday. Moreover. even with that additional patient visit, scribe-assisted physicians managed to cut their workday by 1.3 hours. This was due to a reduction in doctor recordkeeping chores. An added bonus, she added, is, according to a patient survey, patients like having scribes around.
“There was some concern with providers that this would be disruptive to the doctor-patient relationship,” Sparling noted. But, “patients actually thought the scribe made the encounter better.” Nearly one-fourth of patients said it was better, and three-quarters said it was the same. Asked whether doctors listened better with a scribe, 32% said it was better.
Scribe Demand Increasing Faster Than Pool of Qualified Scribes
Michael Murphy, M.D., co-founder and CEO of Aventura, Florida-based ScribeAmerica, estimates that the top four national providers of medical scribes employ about 4,700 scribes, and another 1,000 scribes work for startups and regional services.
Murphy told Modern Healthcare that most scribes work at the 500 hospitals currently using scribes and most of them assist ER physicians. Murphy, however, predicts huge growth in scribe use in other medical settings in the near future. His service already has scribes assigned to 15 inpatient sites other than ERs. “We’re anticipating it will be our largest line of services and surpass the emergency departments in a couple of years,” he said.
Medical scribes are a relatively new concept, and there is limited number of people qualified to do this job, pointed out Scott Hagood, Vice President of Marketing for Fort Worth, Texas-based PhysAssist Scribes, in the Modern Healthcare story. His service now gets three or four times as many requests for medical scribes from clinic-based physicians than from ER doctors.
EHR vendors contend that the need for medical scribes is temporary because eventually EHR use will evolve in ways that will make scribes obsolete. Only time will tell whether or not scribes become a permanent fixture. But in the meantime, scribes are aiding physicians during a time of transition and dynamic change in the healthcare system. Since scribes will often be the individual preparing and transmitting laboratory test orders at the direction of their physicians, clinical laboratories and pathology groups may want to get to know the scribes assisting their client physicians.
– Patricia Kirk