How medical scribe training has evolved

When DeAnn Champion, MD, began working with medical scribes at Chattanooga, Tenn.-based CHI Memorial Hospital, training for those positions was much different than it is today.

Scribe training at the hospital 11 or 12 years ago, when the hospital got a grant to implement a scribe program, consisted mostly of one-on-one training with the physicians telling the scribes what was important. "There was no formal training material or required classes, and this process only lasted for about a year [before] the program was disbanded, says Dr. Champion, an emergency room physician and co-chair of emergency medicine at CHI Memorial.

Eight or nine years ago, Chattanooga Emergency Medicine, the emergency medicine group contracted with CHI Memorial, restarted the scribe program with the help of e-Scribe, an arm of their billing company. The program was managed internally by CEM for years. Trainees were given materials to study for vocabulary tests and other tests they had to pass to show proficiency, recalls Dr. Champion. She says trainees shadowed a physician with another scribe, and eventually became a regular scribe for the physician.  

Due to the need for more standardization of practice and training oversight, CEM formally contracted with ScribeAmerica two years ago. ScribeAmerica is the nation's largest medical scribe vendor, serving more than 1,700 hospitals and health systems across all 50 states.

Medical scribes assist physicians with clerical and nonclinical duties, such as transcribing physicians' encounters with patients and providing physicians with information from the EHR. The need for medical scribes has increased over the past decade as more healthcare organizations invest in EHRs and physicians take on additional clerical tasks. The number of U.S. medical scribes is projected to reach more than 100,000 by 2020, about five times what it is today, according to an article from Jeffrey Gold, MD, professor of medicine and director of simulation at Portland-based Oregon Health and Science University. He attributes this growth to "the need to untether the doctor from the EHR."

Medical scribes are typically trained either through programs provided by vendors or directly by the physician.

ScribeAmerica hires and trains scribes for the specific department or practice in which the vendor is working. Craig Newman, chief strategy officer of ScribeAmerica, noted that's different from the origins of how scribe programs originated 10 years ago or more.

"Most physicians and executives thought about medical scribes only in the emergency department setting. We realized in order to truly serve partners, we had to custom design and train the scribes to each care setting, EMR and provider workflow," he says.

ScribeAmerica sends in a project leader, essentially a senior consultant or master scribe, to the department or practice site. This project leader then shadows a physician to understand their workflow, their process and their documentation style, among other things, according to Mr. Newman. The project leader also receives the physician's top 50 diagnosis codes, and ScribeAmerica builds a scribe blueprint around that information, which it uses to train and hire its scribe force.

"The training is cross-functional, online classroom and clinical shadow shifts, which is then supplemented on an ongoing basis based on provider or department need," says Mr. Newman.

Depending on the program, ScribeAmerica scribes go through approximately 120 hours of training. This training includes various topics, such as medical terminology and HIPAA compliance. The training may also include idiosyncrasies important to an individual department. For instance, one ScribeAmerica training program focused on Hierarchical Condition Category coding and Medicare Access and CHIP Reauthorization Act strategies.

Mr. Newman notes that the traditional role of medical scribes in the emergency department was focused around documentation, physician satisfaction and overall flow but the role has changed since then.

"As the market has evolved, the term 'scribe' has become truly a misnomer. At their core, scribes are a low-cost integrated labor support that can assist practices, departments and facilities with their ancillary and clerical tasks. The overall goal is to help providers and care team members work top-of-license, delivering better quality of care to their patients," says Mr. Newman. Mr. Newman says the need for medical scribes may accelerate as organizations move toward value-based care.


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