Why more providers are seeing value in medical scribes
"Medical scribes are EHR data managers that give back lost time to doctors," Physicians Angels President Kevin Brady said.
Physicians today spend about equal amounts of time seeing patients and completing computer tasks, a recent study published in Health Affairs revealed. The researchers analyzed data on doctors’ time allocation patterns in more than 31 million electronic health record (EHR) transactions between 2011 and 2014, recorded by 471 primary care doctors. They found that the doctors spent an average of 3.08 hours with patients and 3.17 hours on desktop medicine.
The study echoes the findings of previous reports. A study last year in the Annals of Internal Medicine found that physicians spend just under half their workday on EHR and clerical tasks and only 27% of their time with patients.
To reduce the administrative burden associated with EHRs and free up time for face time with patients, physicians are increasingly turning to medical scribes to perform data entry.
Numbers are growing
In 2014, about 15,000 medical scribes were employed in the U.S., and that number is expected to reach 100,000 by 2020, according to the American College of Medical Scribe Specialists (ACMSS). The total number of companies providing scribe services as of April 2015 was at least 22, according to the Journal of the American Medical Association.
Kevin Brady, president of Physicians Angels, a virtual scribe service, says market validation and willingness of healthcare organizations to adopt medical scribes has taken off in the past several years as EHRs has failed to deliver on their promise of greater productivity. “Even the fastest typing doctor will need 3 to 5 minutes to complete a simple chart,” Brady told Healthcare Dive in an email.
“How is this to be done when trying to see 20-30+ patients per clinic day? Doctors are patient care providers," he added. "Fundamentally, medical scribes are EHR data managers that give back lost time to doctors … and allow doctors to remain doctors and not become highly paid data entry clerks.”
Scribes help physicians by documenting the patient encounter and retrieving diagnostic results, nursing notes and other information that is recorded in the patient’s electronic record. “We’re taking on the burden of documentation, making doctors more efficient and happier with what they do and reducing physician burnout and turnover, Fabio Giraldo, southeast regional president for ScribeAmerica, told Healthcare Dive.
ScribeAmerica provides scribes to hospitals and physician practices. Giraldo argued studies have shown that unassisted providers experience a 30% lag in efficiency compared with doctors who use scribes. That difference can translate into dollars for a hospital starting with increased productivity in the emergency room, which can reduce overall length of stay and length without being seen rates, according to Giraldo.
Return on investment
Once a patient is admitted to the hospital, by accurately reflecting the care delivered, use of scribes can boost the case mix index.
“With accurate documentation, scribe programs have been able to increase the case mix index from 0.5 to 1.0 on average," Giraldo said. “One of our partners in Iowa say an increase in revenue of $130,000 per month just by a bump in the case mix index of 0.2.”
ScribeAmerica, the largest medical scribe vendor, has about 13,000 employees operating in all 50 states, as well as Canada and Australia. The company recently launched Telescribes, a HIPAA-compliant platform, to provide remote scribe in rural communities.
Yet while more hospitals and physicians are using scribes, the role is scantily regulated. The Centers for Medicare & Medicaid Services has a FAQ webpage on the use of medical scribes for data entry in EHR incentive programs, which doesn’t prohibit their use. But it has no official guidance on the subject.
The Joint Commission allows hospitals to use unlicensed scribes to enter patient information into the EHR so long as they adhere to applicable standards, such as information management, rights and responsibilities of the patient, as well as record and provision of care.
Education and training
Likewise, there are no standard education and training requirements for medical scribes. ScribeAmerica puts prospective scribes through a 120 program that includes equal parts general knowledge (e.g., HIPAA compliance, medical terminology and anatomy), specialty-specific instruction and in-person instruction with a master scribe and clinician.
Physicians Angels’ training ranges from one to four months and covers common disease conditions and medications, specialty-specific terminology, HIPAA, coding, best practices in managing an EHR, among other topics. “We do this so that when a doctor or group contracts with us, there is only 1-2 days of observation and learning before we begin to chart at 100% for a clinic,” Brady said.
While the ACMSS offers a certification process for medical scribes, it is voluntary. Giraldo did not provide a percentage, but said that a “good portion” of ScribeAmerica’s scribes are ACMSS-certified.