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A Vote In Favor Of Using Scribes

Posted on September 26, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Over the past few years, using scribes to complete medical documentation in EHRs has gotten mixed reviews. Some analyses have found that scribe services were too expensive to justify the investment, while others have concluded that the use of scribes can make a meaningful impact on revenue and improve physician productivity.

This month, a new paper has been published whose results fall into the plus column. The small study, which appears in JAMA Internal Medicine, looked at the use of scribes among 18 primary care physicians.

To conduct the study, researchers looked at physicians at two medical center facilities within an integrated healthcare system, gathering data between July 1, 2016 and June 30, 2017.

The research team assigned PCPs randomly to two groups, one with and the without scribes, for 3-month periods, switching physicians between the with and without groups every three months. At the end of each three-month period, the PCPs filled out a six-question survey which collected their perceptions of documentation burdens and visit interactions.

In addition to capturing PCP perceptions of scribe use, researchers also collected objective data, including time spent on EHR activity. They also surveyed patients of participating PCPs to gather data on the patients’ perceptions of visit quality.

When all was said and done, the research team found that scribed periods were associated with less self-reported after-hours EHR documentation work.

Researchers also found that when they used scribes, PCPs were more likely to report spending more than 75% of the visit interacting with the patient and less than 25% of the visit on the computer. In addition, physicians were more likely to finish their encounter documentation by the end of the next business day during scribed periods.

What’s more, 62.4% of patients said that scribes had a positive effect on the visits, while just 2.4% said they had a negative effect.

The researchers’ take away from all this was that the use of medical scribes could be one strategy for improving physician workflow and primary care visit quality.

As I noted previously, other research has drawn similar conclusions. For example, a study published in 2015 (which included the involvement of scribe provider ScribeAmerica) found that scribe use at the two hospitals was linked to an improved Case Mix Index which ultimately led to gains of about $12,000 per patient. Meanwhile, inpatient physicians were able to cut time spent the chart updates by about 10 minutes per patient on average.

Having been over arguments for and against scribe use, my personal conclusion is that working with them can be a worthwhile investment if doing so is a good fit for the physicians involved, but doesn’t work in all cases.

Ultimately, it seems that there’s too much variation between settings in which scribes could be used to make a single blanket statement about their benefits. I guess we won’t be drawing grand conclusions about scribe pros and cons anytime soon.

E-Patient Update: Clinicians Who Email Patients Have Stronger Patient Relationships

Posted on January 26, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I don’t know about you, but before I signed up with Kaiser Permanente – which relies heavily on doctor-to-patient messaging via a portal – it was almost unthinkable for a primary care clinician to share their email address with me. Maybe I was dealing with old-fashioned folks, but in every other respect, most of my PCPs have seemed modern enough.

Few physicians have been willing to talk with me on the phone, either, though nurses and clinical assistants typically passed along messages. Yes, I know that it’s almost impossible for doctors to chat with patients these days, but it doesn’t change that this set-up impedes communication somewhat. (I know – no solution is perfect.)

Given these experiences, I was quite interested to read about a new study looking at modes of communication between doctors and patients in the good old days before EHR implementation. The study, which appeared in the European Journal for Person Centered Healthcare, compared how PCPs used cellphones, email messages and texts, as well as how these communication styles affected patient satisfaction.

To conduct the study, researchers conducted a 16-question survey of 149 Mid-Atlantic primary care providers. The survey took place in the year before the practices rolled out EHRs offering the ability to send secure messages to patients.

In short, researchers found that PCPs who gave patients their email addresses were more likely to engage in ongoing email conversations. When providers did this, patients reported higher overall satisfaction than with providers who didn’t share their address. Cellphone use and text messaging didn’t have this effect.

According to the authors, the study suggests that when providers share their email addresses, it may point to a stronger relationship with the patient in question. OK, I get that. But I’d go further and say that when doctors give patients their email address it can create a stronger patient relationship than they had before.

Look, I’m aware that historically, physicians have been understandably reluctant to share contact information with patients. Many doctors are already being pushed to the edge by existing demands on their time. They had good reason to fear that they would be deluged with messages, spending time for which they wouldn’t be reimbursed and incurring potential medical malpractice liability in the process.

Over time, though, it’s become clear that PCPs haven’t gotten as many messages as they expected. Also, researchers have found that physician-patient email exchanges improve the quality of care they deliver. Not only that, in some cases email messaging between doctors and patients has helped chronically-ill patients manage their conditions more effectively.

Of course, no communication style is right for everyone, and obviously, that includes doctors. But it seems that in many cases, ongoing messaging between physicians and patients may well be worth the trouble.