Hate Dealing With an EHR? Use a Scribe and Profits Increase

Neil Chesanow

Disclosures

February 27, 2014

In This Article

Benefits of Using Scribes

Doctors who personally interact with the EHR during a patient visit tend to be minimally communicative with the patient.[6] However, with a scribe in the exam room (or sometimes sitting just outside), the doctor is not only free to verbalize the details of the patient's diagnosis and treatment more completely, the doctor must do this so that the scribe understands enough of what is being said to craft a proper note in the EHR while the doctor interacts with the patient in real time.

ScribeAmerica's Michael Murphy calls this a "narrative physical exam" and a "narrative assessment and treatment plan."

"Patients love this," he says. "Even though it's just bread-and-butter medicine, the physicians sound smarter, and patients love the physician's display of intellect. As a result, we've seen patient satisfaction scores go dramatically up."

How dramatically?

"We've had orthopedic surgeons consistently in the 20th percentile in patient satisfaction over 20 years of practice who suddenly leap to the 85th percentile because they do a narrative physical exam while working with a scribe," Murphy says. "Patients like that interaction, the doctors are happier, and they are able to focus on the patients even more."

Physician satisfaction scores, if anything, are even higher.[1,2]

"It's amazing when you see the difference between a dictated note and one that's generated by a computer," marvels William A. Rivell, MD, a family physician in North Augusta, South Carolina, who began using a scribe for the first time last September. "Even if you're using the templates, it just sounds terrible; whereas I can just tell the scribe what's going on, and it comes out much more fluid."

"Scribes create comprehensive, nuanced documentation that might improve reimbursement by allowing a physician to bill a higher level evaluation and management (E&M) code than he or she would have without this level of documentation," Toth explains.[4] "Many physicians gain a sense of security, knowing that their documentation was completed thoroughly and according to regulations and guidelines."

Ironically, this more comprehensive, nuanced documentation results from spending more time with patients and less time with the EHR.

Internist Joshua Brown, MD, lead physician at IMD Practice Management Group, an 8-doctor internal medicine group in Santa Fe, New Mexico, "was overworked and so behind in my dictations that I'd wake up at 4:30 or 5 AM just to catch up," he recalls.

That was 2 years ago. Brown had read about scribes back then, was intrigued, and thought, "Why don't I try a scribe for 10 hours a week and see how it goes."

It went so well that in the first week, he promoted the part-time scribe to a full-time position. Within 2 months, he had hired a second full-time scribe.

"It was very powerful in terms of improving the patient experience tremendously and improving my experience tremendously," he says.

Vascular surgeon Jeffrey Wang, MD, a member of Horizon Vascular Associates, a 5-doctor surgical group in Rockville, Maryland, tried using a scribe last September for the first time. Now his whole group uses scribes.

"The other doctors, who initially may not have been that interested, became very interested very quickly," he recalls. They realized that I was much more efficient. I was getting out on time. It made the office experience in general much better."

A 2013 report in the Annals of Family Medicine cited 5 innovations used in high-functioning primary care practices that lead to greater physician satisfaction and doctors who derive more "joy" from their jobs.[8] "Sharing clerical tasks with collaborative documentation (scribing)" was number 3 on the list.

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