Scribes can ease documentation burden -- for a price
■ A practical look at information technology issues and usage
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The increased demands on physicians to electronically document care for incentive and quality reporting purposes have left many feeling frustrated because of the extra time it takes to accomplish those tasks. Physicians now question if their face-to-face time with patients has been replaced with data entry.
Many are looking at ways to outsource that part of their job and are considering scribe services. Scribes have been associated with emergency care, but people familiar with the industry report that, in the past year, there has been an uptick in the number of office-based physicians interested in contracting scribe services or training programs.
A scribe takes notes during a clinical exam and enters them into the appropriate places in the electronic medical record, relieving the doctor of data-entry responsibilities.
"From our perspective, use of scribes is growing significantly as more and more physicians are being burdened with the documentation tasks they are being asked to carry out," said Peter Reilly, CEO of the American Healthcare Documentation Professionals Group, which provides training programs for health care documentation professionals.
There are several options for practices interested in hiring a scribe. However, one important thing for doctors to remember is that whether they enter the data or have a scribe do it, they are ultimately responsible for what gets into the record.
Physicians have to sign off on each entry and authenticate the record, which may leave some to question the advantages of adding another layer (the scribe) to the documentation process.
Among the scribe options:
Training an existing employee. Some hospitals and practices have opted to train existing staff, such as medical assistants or licensed practice nurses, to take on the role of a scribe.
The training could range from the person simply learning the new EMR system and assuming the documentation role to undergoing a formalized program.
Online programs are available as well as educational materials that students can learn on their own.
The advantages are that the person already has a medical background and probably is familiar with commonly used terminology.
The biggest disadvantage, said Michael Murphy, MD, CEO of Scribe America, which trains scribes, is that physicians will have to dedicate time to the development of the scribe program and the training of the employee. So although the employee may be motivated to learn and make the career move, the physician must be equally motivated, he said.
Dr. Murphy said that if a practice goes this route, the employee's new role as scribe should be his or her only role, rather than having the employee split his or her duties between the old and new roles. If the old role was essential, the practice will must hire someone to fill it. A scribe's job description could include other tasks, however.
Hire a scribe. One advantage to hiring a new employee is that the practice could mold him or her in the way it wants.
But hiring a scribe is probably a medical practice's most expensive option. Not only will the practice pay, on average, $20 per hour, it also must assume all liability for the employee in the event of a mistake, such as improper documentation that leads to wrong coding. The practice also would be responsible for paying for any employee benefits.
These issues also apply if a practice has trained an existing employee to become a scribe.
Contract with a scribe management company. Although the scribe will not actually be employed by the medical practice and will answer to someone outside the practice, there are some advantages to this approach.
"There is a shared liability with using a management company," Dr. Murphy said. If something goes wrong, the management firm would assume some of that responsibility.
Contracting with a scribe management company also will eliminate the time required to advertise, interview and train someone to fill the job. The management company would take on those responsibilities and send someone who is ready to jump into the role on day one.
The cost to the practice is about the same, an average of $20 per hour, but would include everything.
Contract with a "virtual" scribe. A limited but growing number of companies are offering scribe services from a virtual environment.
The services are conducted via a video or audio connection from the exam room to the scribe's virtual office.
Kevin Brady, spokesman for Physicians Angels, a physician-owned company that contracts with scribes overseas, says a major advantage is affordability. By outsourcing, Brady said, the service can be offered for nearly half the price -- about $10 per hour.
Johana Ojeda, information technology director for Medviks Telehealth, a virtual scribe company in Pearland, Texas, says another advantage is keeping the scribe outside of an already crowded exam room. The patient is told that the scribe is there, but that he or she does the job behind the scenes with no disruption to the flow of the exam.
One downside is that patients may not always feel comfortable knowing someone is watching from a webcam. Ojeda said that although it's uncommon, some patients are uncomfortable and ask the physician to turn the webcam off. She said physicians sometimes voluntarily shut off the monitors when discussing a sensitive issue with a patient.
Another factor for physicians to consider is what kind of relationship they want with their scribe. Some companies pair scribes with physicians they will work with every day, or at least for a shift; some don't. Physicians must decide whether they want a long-standing relationship, or are OK with having someone new each day.
The level of services expected from the scribe can help physicians determine who they want to fill the job and the background that would be most appropriate.
When they are not busy in the exam room, many scribes also are used to track down lab results, help patients set up appointments, or contribute to an improved practice work flow in some other way.