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

Neil Chesanow

Disclosures

February 27, 2014

In This Article

Scribes Who Are in the Office With You

Some 10-12 vendors offer scribe services, Murphy estimates. Most offer onsite scribes who are physical presences in the office and who shadow you in exam rooms. Once the scribe's role is explained to patients, few object, studies show.[1,2,3,9] On the contrary, patient satisfaction when a scribe is present usually goes up.

If you're doing a breast exam and the scribe is male, or a prostate exam and the scribe is female, the scribe remains outside the exam room. The doctor usually wears a lapel microphone to maintain communication with the scribe. The scribe typically has a laptop or tablet on which he or she enters notes or test data or scripts into the EHR as the physician details while conversing with the patient.

ScribeAmerica, begun in 2003, is the market leader in scribe services, Murphy, the CEO, claims. He figures that there are currently nearly 10,000 scribes in the United States. Of these, about 3600 work for ScribeAmerica. Sixty percent of ScribeAmerica's workforce is in preprofessional programs for aspiring physicians, nurse practitioners, physician assistants, and nurses; the rest hold 2- or 4-year college degrees and plan to scribe as a full-time career.

Cheryl Toth's calculations are based on a practice hiring its own scribe to join the staff, the cost for which in salary ($25 an hour) plus benefits came to $28.12 an hour.[4] The rate for ScribeAmerica scribes is $20-$23 per hour, depending on the contractual arrangement, total shifts, and other factors. Hiring your own scribe might well cost $25 an hour plus benefits, Murphy agrees. Scribe vendors generally charge less. "I don't feel the market could support that," he says.

Vendor-supplied scribes work for client practices, but they are employees of the vendor, which pays their salaries and benefits. Hourly rates are all-inclusive, although there may be an up-front fee if specialized training is involved.

About 70% of ScribeAmerica clients are EDs. EDs were early adopters of EHRs, Murphy says. Emergency physicians, for whom the pace of work is typically hectic, were the first to feel the pain. Their productivity plunged, as did patient satisfaction, and so EDs became early adopters of medical scribes.

The majority of studies on the cost/benefit ratio of scribes have been conducted by EDs. Those that have been published report dramatic improvements.[9,10]

The remaining 30% of ScribeAmerica clients are outpatient practices. "We have internal medicine, family practice, ob/gyn, orthopedics, hematology/oncology, pain, cardiology, spine surgery, ENT -- you name it," Murphy says.

Scribe vendors recruit, hire, and train scribes for client outpatient practices and hospitals. If one doctor in a multidoctor practice wants a scribe and the rest don't, no problem. It's not necessary for every doctor to buy into the concept. If other doctors change their minds later, as is common, Murphy says, additional scribes can be recruited on as-needed basis.

Scribes Who Work From a Remote Location

A relatively new concept is the virtual scribe, introduced by Physicians Angels, which began in 2007. Virtual scribes aren't physical presences in your office. They are in a remote location -- in this case, Chennai, India -- and you communicate with them via a microphone attached to your laptop or tablet.

If your EHR is cloud-based, as more and more are these days, issuing the credentials for secure access for a remote scribe is a simple matter. If your EHR is on a server in your office, a virtual private network (VPN) must be established. This is a bit more complicated. However, Physicians Angels has a networking expert work with your local tech support person to establish a secure link.

Once the link is established, the scribe is an invisible presence in the exam room as you speak with a patient, capturing your dictated notes, the patient's responses, test results, and so on, choosing likely CPT codes for your review, sending electronic scripts to the patient's pharmacy on your behalf, generating referral letters, and the like. If you don't want the scribe to hear what is said, simply mute the microphone.

The rate for Physicians Angels virtual scribes is $14 an hour. Scribes are part of a pool of scribes. You may not always get the same scribe, but you do get a scribe with the same training, which is extensive -- up to 3 months, although this is partly due to cross-cultural differences that must be bridged, in addition to learning clinical terminology, coding, HIPAA compliance, and all the rest.

Can scribes in India do as good a job as American scribes? Many people clearly think so. Indian firms are also doing billing and medical transcription for doctors in the United States.

Physicians Angels provides scribes to over 100 US sites with nearly 980 doctors, Shariff estimates. "Most of our work right now is in 3 major categories," he says, "ENT, orthopedics, and urgent care.

"We're starting to pick up a fair number of primary care, pediatrics, and rheumatology practices," he adds. "We’re getting 1 or 2 new requests on a daily basis."

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