The case for virtual scribes

More and more physicians are employing medical scribes to decrease their clerical burden.

Using medical scribes has been shown to decrease physician documentation time, improve patient and physician satisfaction, decrease physician burnout and increase revenue. This all sounds great, however, there are some drawbacks to medical scribes:

• Cost
• Limited physical space for the additional person in the exam room
• The amount of time it takes to train the scribe on the specific Electronic Medical Record(EMR) and physician workflow, as well as training a new scribe if one leaves
• Coordinating physician and scribe hours, vacations, and calls can be difficult
• Patients might be uncomfortable with another person in the room

A virtual scribe will address many of these concerns.

While most people are familiar with a physical medical scribe, the virtual scribe is less understood and underutilized. A virtual scribe listens in real-time to the patient visit, or a portion of the visit, and enters information into the EMR as directed by the physician. The scribe is in a remote location using Health Insurance Portability and Accountability Act (HIPAA) compliant screensharing technology in order to navigate the EMR, enter orders, locate labs or studies, order prescriptions and add coding and billing information. The physician uses a desktop or portable device (mobile phone or tablet) to communicate with the scribe as documentation is entered into the native EMR.

Essentially, the virtual scribe can document anything that the physician or physical scribe can but with several advantages:

• Cost – Depending on the area of the country and the scribe’s qualifications, a physical scribe can earn between $26,000 and $46,000 per year, costing the employer between $31,000 and $55,000 per year. A virtual scribe costs about $1200/month or $14,400/year. While both physical and virtual scribes can be cost-effective if they allow the physician to see more patients and improve their coding and billing, the virtual scribe provides more options for the physician. Since scribes have been shown to free-up 1-2 hours each day for the physician, he or she can decide how to spend that time. He or she may decide to spend time with family, see more patients or spend more time with each patient. Since the cost of the virtual scribe is significantly less, the physician may not feel as much pressure to see more patients in order to cover the cost of the scribe. Instead, he or she can improve their work-life balance.

Virtual scribe companies can keep their costs low because scribes are only used when needed e.g., they do not have to listen to the entire patient visit but can be called upon only when needed. This allows the physician the time to engage with the patient, to talk about their families, to discuss preventive care – all while the scribe is completing the previous note or helping another provider.

• Training – The biggest complaint from physicians that use physical medical scribes is the amount of time it takes to incorporate them into the workflow and train them on the EMR. This is made more complicated when the scribe leaves and a new one needs to be trained. Many physical scribes are students that plan to pursue nursing or medical school and who are using the medical scribe position as a stepping stone for their future career plans. This makes inherent sense but it complicates the staffing of scribes. Most virtual scribe companies use a team approach where several scribes are familiar with the physician’s workflow and documentation preferences. As a result, if a scribe is sick or moves on to another job there is no disruption for the physician. The additional work is simply picked up by one of the other scribes. These same scribes will orient and train any new scribes who will be working with the physician.

• Physical Constraints – Exam rooms are already small and crowded especially in major cities. It is often not physically comfortable to have an additional person in the exam room. Also, some patients are reluctant to have someone other than a doctor or nurse being present during an exam. Both of these issues are solved by the virtual scribe. While the scribe is not physically present in the room, the patient will still need to be informed about them. If the patient is still not comfortable with the scribe, the physician will simply not use the scribe during that visit.

Virtual scribes are also well suited to practices in remote areas where it may be difficult to hire qualified physical scribes. In addition, practices that exist in areas where people vacation during specific times of year, like beach locations or ski towns, can also benefit from a virtual scribe due to the lower cost and the ability to be used as needed. Where these practices would otherwise find it difficult to justify a scribe, the virtual scribe makes it affordable and convenient for them.

• Scheduling Issues – When a physician has a 1:1 or 2:1 relationship with a scribe their schedules need to be coordinated. When the scribe takes a vacation or is sick, the physician is without assistance for that time period. Using a virtual scribe eliminates this concern. Also, if a physician sees patients in multiple locations it may be difficult for the scribe especially if covering more than one doctor. Using portable devices and a virtual scribe makes the changing of offices seamless.

In addition to addressing some of the concerns associated with physical scribes, virtual scribes also can provide additional benefits:

• EMR specialists – Many virtual scribes are familiar and comfortable with using multiple EMRs. This allows the scribe to make suggestions to providers about navigating the EMR and providing help with templates. In addition, new employees may benefit from using a scribe that is already familiar with the workings of the practice’s EMR. In this way, the scribe can assist the transition of the new physician.

• Flexible availability – Virtual scribes have the ability to be available when needed and can help other physicians when not needed. Also, most virtual scribe services offer an asynchronous dictation (not live) that physicians can access 24 hours a day in order to complete backlogged charts or add updates to any charts when data is received after hours.

The use of medical scribes is becoming more and more prevalent. While most physicians still use physical scribes, virtual scribes are an excellent alternative. Virtual scribes offer the benefits of reduced cost, increased flexibility, and the ability to reduce training time. A virtual scribe program can offer the physician the ability to increase revenue, improve work-life balance and decrease physician burnout. In a time when many physicians are overwhelmed by the clinical documentation tsunami, virtual scribes can be a valuable tool that frees providers from their clerical burdens and empowers them to experience the joy of practicing medicine again.

Bio for Andrea Caliri, M.D.:
Dr. Caliri is an OB/GYN who serves as MindLeaf’s medical consultant for the company’s medical scribing services. She is an industry thought leader on the topic of engaging physicians and medical practices in medical scribing solutions that help reduce their clinical documentation workload to increase physician satisfaction and practice revenue.

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