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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.

EMR Systems Spawn Cottage Industry: Scribes

Posted on September 19, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

One of the limiting factors when it comes to EMR systems is that it requires some amount of training to use an EMR system. Doctors are in the habit of writing down notes, or dictating them into dictaphones for transcribing later. So the idea of an EMR system that requires typed input can easily face some resistance, just based on the process change it requires. And hence the rise of a new class of health IT worker – the scribe.

Having a scribe taking notes at hand would’ve seriously helped me like my doctor better at my last appointment. This was someone whom I was meeting on account of a referral – I didn’t already have an established relationship with the doctor. The doctor and an assistant spent about a third of their time figuring out how to enter my scans into the EMR system. I don’t know what was at fault – the newly acquired iPad or an EMR they didn’t know how to use. They were effusive with their apologies but I couldn’t help feeling that I got the short end of the stick when the doc rushed through the rest of my visit and quickly ushered me out. A competent scribe, well versed in their EMR of choice, might have really helped.

 There have been a slew of articles about the rise of scribes in health IT. They started sounding really promising to me, especially when I considered how one could tail a doctor on his/her rounds with patients, and gain some insight into the business of being a doctor from the ground up. I checked out a couple of companies (ScribeAmerica, EM Scribe Systems) that train medical scribes and source them out to ERs. EM Scribe Systems’ application form states that it requires a one or two year commitment, wants to know what your future med school plans are. The pay anywhere is between $8-$16/hour (scroll to the bottom of the page). The higher end of that range gets paid with scribe experience.

(Seriously? If medical transcription can be outsourced to India and Philippines, why set the bar so high for medical scribe jobs? Or alternatively, if the bar is so high, why not pay better?)

I guess the pre-med scribes are approaching it from a different aspect – the real payback for them comes from understanding the medical aspect. The EMR system is merely a tool to an end.