Medical scribes: Five critical success factors

Physicans have stressful jobs. They work long hours in an environment that is fast-paced and demanding.

Caring for the sick can be both rewarding and exhausting. In addition to the care of patients, physicians have had to face more challenges in recent years. These include the increasing usage of Electronic Medical Records(EMRs), government regulations including the Affordable Care Act (ACA) and the Medicare Access and CHP Reauthorizarion Act (MACRA), declining revenue and decreasing physician and patient satisfaction. Many doctors feel that the cause of a great deal of their struggle is the increasing amount of required documentation which has been exasperated by the EMR.

The pressures of doctoring are on the rise and the resultant physician burnout is a real problem. Up to 50% of physicians are not happy with their chosen career and would not recommend the medical field to their children. More than 50% of physicians report significant burnout which is increasing at a greater rate than other professions. A great deal of this burnout is due to decreasing patient time and increasing documentation time. Physicians currently spend 50% of their time documenting and only 27% of their day with direct patient care. This creates a situation where both the patient and the doctor are dissatisfied.

A medical scribe is an excellent solution to improve patient and physician satisfaction by allowing the clinician to focus on the patient and spend less time on documention. A scribe is a non-clinical individual who listens to the patient visit and navigates the EMR for the physician. The scribe can type progress notes, histories and physicals, and plans as directed by the doctor. The scribe can also enter orders, make referrals and pull-up any labs or radiographic studies. The “clicking” of boxes in the EMR is very time-consuming for doctors and the scribe is able to do this as well. This allows the physician to spend focused time with the patient while not having to worry about the documentation. The scribe will complete the note by the end of the day and the physician only has to review the record. There are essentially three kinds of scribes:

• Physical Scribe – the scribe is an individual who accompanies the physician into the exam room
• Virtual Scribe – providers connect in real-time with remote scribes using screen-sharing technology on a computer screen present in the exam room
• Dictation Service – the physician wil dictate into a device e.g., an iPhone and the elements of the patient visit will be transcribed into the appropriate fields of the EMR.

Studies have shown that using a scribe can increase the number of patients seen per hour by as much as 59%. Physicians using a scribe also experience a fourfold increase in time directly spent with patients and can also increase the Relative Value Units (RVUs)/hour by more than 15%. Overall, scribes provide a benefit to the patient, to the physicians’ well-being and to the revenue of the practice.

Five critical success factors for a medical scribe program

Here are five critical success factors to consider when developing a new medical scribe Initiative:

1. Practice and Scribe Goals – The physicians need to identify what they hope to improve by using a scribe. Every practice is different and different types of scribes are helpful in different areas. Things to consider are: increasing revenue, improving provider and patient satisfaction, improving chart completion time, and improving office morale. The physicians need to be able to discuss their changing needs with the scribe and/or scribe provider on a regular basis. Certain goals can be assessed using questionnaires before and after utilizing a scribe.
2. Defining the Specific Role/Responsibilities of the Scribe – It is important to keep open communication with the scribe so that everyone involved in patient care understands their role. Every provider has a different workflow. It takes some time for the provider and the scribe to fit into their roles. Some doctors might want the scribe to only work on certain areas in the EMR; other doctors might expect the scribe to transcribe the visit verbatim. Roles and expectations might change. Regular check-ins with each other are imperative for a successful collaboration and they should be scheduled at regular intervals such as monthly.
3. Patient Awareness – It is necessary for the physician to introduce the use of a scribe to the patient. While a patient might not be comfortable with a physical or virtual scribe, the physician is usually able to put the patient at ease. The physician should present the scribe as an aide to the patient’s care that permits the doctor to focus more on patient care and less on documentation.
4. Evaluation of Scribe Program/Feedback –The medical practice needs to be able to monitor the success of the scribe program in relation to the goals that were identified. This can be measured by looking at RVUs, Return on Investment(ROI), patients seen per day, percentage of complete records at the end of the day, comparison of patient vs. documentation time, patient and physician satisfaction. If some of the issues are not being met, it is important to take some time to work with the scribe and make any necessary changes.
5. Patience! –The introduction and training of a scribe does take some time. A motivated practitioner who is open to change will take the time to work with the scribe in order to commence a positive partnership. Scribes should be familiar with medical terminology and, ideally, be career-focused American College of Medical Scribe Specialists (ACMSS) certified vs. premed students who may leave in a year. The more feedback that the scribe and physician can provide each other, the better the relationship will be. Along these same lines, it is ideal if the practice has several available scribes that are familiar with the doctors and workflow. So if a scribe is sick or on vacation, there is another scribe who can seamlessly take over.

Medical Scribes provide a much needed solution to the present stressors of being a doctor. As scribes navigate the EMR, physicians can spend more time with their patients. A practice that has a well-run scribe program will attract and retain high quality physicians.

Practices and executives who are considering the use of medical scribes need to be aware of the critical success factors as well as the different types of scribes. A total scribe solution company who is able to provide physical scribes, virtual scribes and dictation services is desirable because they can address the scribing needs and preferences of all providers in your organization. Engaging all the physicians in your medical scribe program will reduce their clinical documentation hours, help prevent MD burnout and enable them to spend more time on patient care so they can experience the joy of practicing medicine again.

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