Scribes Fill Documentation Gaps
In a busy emergency department (ED), the use of medical scribes is alleviating the pains of the ever-changing relationship between the physician and the computer. More robust documentation and increased physician satisfaction are driving scribe initiatives beyond the ED and into other specialties and initiatives.
When Jim McManus enters the 18-bed ED at Seton Medical Center in Daly City, Calif., he's ready to document patients' conditions but he's not a physician. An aspiring medical student, McManus is part of a growing force in the physician's toolbox: a medical scribe.
While a physician takes care of approximately 20 patients per shift in Seton's ED, McManus is assigned to one of 12 physicians. During patient encounters, McManus inputs patient information into an EMR template as the physician interacts and engages with the patient. When not seeing patients, he assists with such tasks as generating patient reports and tracking down x-rays and interpretations.
Following the physician from room to room throughout the day and listening to conversations with patients, along with the use of medical terminology, offers McManus a unique style of training as he preps himself to apply to medical school. In addition to aiding his personal goals, McManus believes his role in the ED helps the organization at large.
"Scribes add a certain level of accountability to an organization as someone trained in medical terminology whose sole purpose is to create the best patient chart they can," says McManus. "They add another pair of eyes and ears to the ED."
"Being a scribe gives young people an audition for what their future career might look like," says Robert C. Reiser, MD, associate professor of clinical emergency medicine, medical director for the scribe program at University of Virginia (UVA) Health System in Charlottesville. "It gives them an up close and personal view."
Twice a year in the spring and fall, the academic teaching facility, which admits 50,000 patients annually, takes 120 hours to train scribes on medical terminology, the mechanics of an ED and how to make sure a patient record is as complete as the encounter. Reiser says that the medical scribe program at UVA expects a commitment of three years.
UVA currently employs 10 full-time and 70 part-time employees with a retention rate of 95 percent. Using primarily undergraduate pre-med students, Reiser notes that the field is highly competitive due to this specialized experience. More than 80 percent in the UVA program go to medical school when they graduate, he adds.
UVA employs 70 part-time scribes for its high-acuity ED. However, Jason Ruben, MD, scribe program director at CEP America, an ED management and staffing company, suggests that to run a 50,000-volume ED, an organization needs 20 to 25 scribes because most work part-time. Scribes keep busy with their undergraduate work, taking exams and preparing to apply for medical school, Ruben says. "Scribes typically don't work full-time. It isn't cost effective for departments to hire all full-time scribes as they cost significantly more than per diem scribes."
The profession has seen considerable growth in recent years, Ruben says. CEP America, based in Emeryville, Calif., trains scribes for EDs that contract its services. The increasing trend towards electronic documentation and reporting in an EMR has led to the projection of significant growth in medical scribes, Ruben says. In 2008, the company employed 66 scribes; it currently employs more than 300, with projections for the end of 2012 of approximately 450, according to Ruben.
Aside from that improved efficiency, a huge benefit lies in workplace satisfaction, says Reiser. "It's great for residents to see patients without the frustration of the voluminous documentation for the encounter," he says.
James Bonner, PhD, medical director of the department of emergency medicine at Underwood-Memorial Hospital in Woodbury, N.J., echoes this sentiment. Going live with an EMR in 2005, the 305-bed nonprofit hospital employed five scribes in 2007 to cover physicians throughout the day. "It's a huge physician satisfier," says Bonner. "There is workflow improvement when a physician doesn't have to chart out a patient's past physical history."
Seeing patients, ordering tests, obtaining results and documenting care can cause delays, according to Bonner. "Our scribe program has enhanced the ability to move the patients through the emergency department," he says.
The scribe initiative at Legacy Emanuel Medical Center (LEMC) in Portland, Ore., is a huge hit among physicians. Robert J. Vissers, MD, quality chair and director of emergency services, says the 51 providers that use medical scribes personally pay for the program. He says they are willing to do so because the scribes give physicians an opportunity for accurate reimbursement. Inadequate documentation can result in nonpayment for certain services, leaving money on the table. For example, it's easier to train the scribes how to appropriately document pulse oximetry than the physicians, he says. And, ED physicians have been able to leave up to two hours earlier than before LEMC added scribes six years ago because their documentation is done so much faster.
"It's ironic that an EMR requires human interaction between the physician and the machine," adds Reiser. "EMRs have made scribes more valuable rather than less valuable. It's going be interesting to watch the rest of the medical world deal with scribes."
Sarah Esquibel, COO, master scribe at ScribeAmerica, a scribe service company for hospitals, says that although the role of the medical scribe has gone largely unchanged in the past decade, expect to see more of them in different specialties. For example, UVA uses scribes in its sports medicine and ear, throat and nose clinics, says Reiser, and the nursing program would like a scribe program to call its own.
Vissers also plans to test using scribes in research and quality improvement initiatives. For example, they can document how many times a physician washes his or her hands, and provide accurate timestamps for quality metrics in the care of stroke, heart attack and pneumonia patients.
The practice of using medical scribes is a vital element in many organizations and presents new opportunities each day for physicians and scribes alike. "There's always something to learn," concludes McManus.
When Jim McManus enters the 18-bed ED at Seton Medical Center in Daly City, Calif., he's ready to document patients' conditions but he's not a physician. An aspiring medical student, McManus is part of a growing force in the physician's toolbox: a medical scribe.
While a physician takes care of approximately 20 patients per shift in Seton's ED, McManus is assigned to one of 12 physicians. During patient encounters, McManus inputs patient information into an EMR template as the physician interacts and engages with the patient. When not seeing patients, he assists with such tasks as generating patient reports and tracking down x-rays and interpretations.
Following the physician from room to room throughout the day and listening to conversations with patients, along with the use of medical terminology, offers McManus a unique style of training as he preps himself to apply to medical school. In addition to aiding his personal goals, McManus believes his role in the ED helps the organization at large.
"Scribes add a certain level of accountability to an organization as someone trained in medical terminology whose sole purpose is to create the best patient chart they can," says McManus. "They add another pair of eyes and ears to the ED."
Who are scribes?
McManus has been working for the 357-bed nonprofit hospital in Northern San Mateo County, Calif., for three and a half years. The time spent as a scribe is invaluable as it offers an opportunity equal parts educational and professional networking."Being a scribe gives young people an audition for what their future career might look like," says Robert C. Reiser, MD, associate professor of clinical emergency medicine, medical director for the scribe program at University of Virginia (UVA) Health System in Charlottesville. "It gives them an up close and personal view."
Twice a year in the spring and fall, the academic teaching facility, which admits 50,000 patients annually, takes 120 hours to train scribes on medical terminology, the mechanics of an ED and how to make sure a patient record is as complete as the encounter. Reiser says that the medical scribe program at UVA expects a commitment of three years.
UVA currently employs 10 full-time and 70 part-time employees with a retention rate of 95 percent. Using primarily undergraduate pre-med students, Reiser notes that the field is highly competitive due to this specialized experience. More than 80 percent in the UVA program go to medical school when they graduate, he adds.
UVA employs 70 part-time scribes for its high-acuity ED. However, Jason Ruben, MD, scribe program director at CEP America, an ED management and staffing company, suggests that to run a 50,000-volume ED, an organization needs 20 to 25 scribes because most work part-time. Scribes keep busy with their undergraduate work, taking exams and preparing to apply for medical school, Ruben says. "Scribes typically don't work full-time. It isn't cost effective for departments to hire all full-time scribes as they cost significantly more than per diem scribes."
The profession has seen considerable growth in recent years, Ruben says. CEP America, based in Emeryville, Calif., trains scribes for EDs that contract its services. The increasing trend towards electronic documentation and reporting in an EMR has led to the projection of significant growth in medical scribes, Ruben says. In 2008, the company employed 66 scribes; it currently employs more than 300, with projections for the end of 2012 of approximately 450, according to Ruben.
Happy faces, happy places
New scribes make approximately $10 an hour at CEP America, according to Ruben. Thus, the real cost to a facility is paying their wages. "While wages vary with experience, a scribe program is generally at least revenue neutral within a year, and typically increases a department's revenue after a year," he says, adding that using scribes to handle patient reports can decrease throughput times by 10 to 12 minutes.Aside from that improved efficiency, a huge benefit lies in workplace satisfaction, says Reiser. "It's great for residents to see patients without the frustration of the voluminous documentation for the encounter," he says.
James Bonner, PhD, medical director of the department of emergency medicine at Underwood-Memorial Hospital in Woodbury, N.J., echoes this sentiment. Going live with an EMR in 2005, the 305-bed nonprofit hospital employed five scribes in 2007 to cover physicians throughout the day. "It's a huge physician satisfier," says Bonner. "There is workflow improvement when a physician doesn't have to chart out a patient's past physical history."
Seeing patients, ordering tests, obtaining results and documenting care can cause delays, according to Bonner. "Our scribe program has enhanced the ability to move the patients through the emergency department," he says.
The scribe initiative at Legacy Emanuel Medical Center (LEMC) in Portland, Ore., is a huge hit among physicians. Robert J. Vissers, MD, quality chair and director of emergency services, says the 51 providers that use medical scribes personally pay for the program. He says they are willing to do so because the scribes give physicians an opportunity for accurate reimbursement. Inadequate documentation can result in nonpayment for certain services, leaving money on the table. For example, it's easier to train the scribes how to appropriately document pulse oximetry than the physicians, he says. And, ED physicians have been able to leave up to two hours earlier than before LEMC added scribes six years ago because their documentation is done so much faster.
EHRs and beyond the ED
With so many organizations going through an EHR implementation, there's plenty for physicians to be skeptical about concerning the technology's impact on their workflow. According to Vissers, when you switch to an EMR format, productivity is going to drop by at least 40 percent initially. Using scribes helped LEMC successfully overcome the challenges of the switch because physicians were able to focus on care rather than a computer, he says. "Some physicians don't want to type and document and scribes allow them to take care of patients at the bedside and make complex decisions.""It's ironic that an EMR requires human interaction between the physician and the machine," adds Reiser. "EMRs have made scribes more valuable rather than less valuable. It's going be interesting to watch the rest of the medical world deal with scribes."
Sarah Esquibel, COO, master scribe at ScribeAmerica, a scribe service company for hospitals, says that although the role of the medical scribe has gone largely unchanged in the past decade, expect to see more of them in different specialties. For example, UVA uses scribes in its sports medicine and ear, throat and nose clinics, says Reiser, and the nursing program would like a scribe program to call its own.
Vissers also plans to test using scribes in research and quality improvement initiatives. For example, they can document how many times a physician washes his or her hands, and provide accurate timestamps for quality metrics in the care of stroke, heart attack and pneumonia patients.
The practice of using medical scribes is a vital element in many organizations and presents new opportunities each day for physicians and scribes alike. "There's always something to learn," concludes McManus.