EHR scribes cut physician documentation time in half, study says

AMA Wire
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The electronic health record (EHR) is well entrenched as a practice necessity, but it need not be the exasperating experience many physicians report. New research and a straightforward, easy-to-access training program both point the way to getting the most out of an EHR with the least disruption to care.

Research was conducted by dermatologists at Boston’s Brigham and Women’s Hospital, where the implementation of a new EHR provided an opportunity to test the effectiveness of medical scribes. The study results were published in Nov. as a research letter in JAMA Dermatology.

“Our scribe pilot program achieved significant documentation time savings and reduction of physician burnout factors. Dermatologists’ willingness to see additional patients with scribe support reflected enhanced physician efficiency, improved patient access, and increased clinical revenue,” say the research letter authors. “Scribes were well received by patients, with few refusals and unchanged overall patient satisfaction scores.”

Scribes, who were provided and trained by a third-party contractor, shadowed the dermatologists. Using dedicated laptops, the scribes documented patient-physician interactions and recorded orders—for example, pathology requisitions—medications, and diagnoses for the physician to approve.

The net increase in efficiency was striking, cutting physicians’ average time spent on EHR work in half. “Across 690 prescribe time-audited encounters, dermatologists averaged 6.1 minutes of clinical documentation per patient,” the study reports. “Across 695 post-scribe visits, physician documentation time significantly decreased, averaging 3.0 minutes per patient.”

Also notable was the financial result—the scribe service paid for itself. Comparing two three-month periods, “Overall, there was a 7.7 percent increase in revenue comparing each physician’s scribe-supported sessions to unsupported sessions,” say the researchers. That efficiency, “more than off-set the cost of the scribes.” In addition to the financial benefit, the scribe support resulted, for the physicians, in “freeing time for scholarly, leadership, teaching, or personal pursuits.”

The authors also note that scribe services are not the only type of documentation support, but the alternatives have fared especially well in situations other than principally face-to-face care. “Other solutions combatting physician documentation burdens, such as real-time dictation software or conventional transcription services, have been employed particularly successfully in diagnostic specialties, such as pathology and radiology, which have limited point-of-care patient interaction.”

EHR relief with a CME bonus

For physicians who want to learn how documentation support help can have a positive practice impact, the AMA has developed a CME and MOC learning module on team documentation. The free module provides an eight-step, solution-oriented program, as well as case studies, information on related Medicare payment issues and an online calculator to estimate scribe savings. Completion of the course provides 0.5 AMA PRA Category 1 Credit™.

The program is scalable—practices are actually encouraged to start small—allowing physicians and their teams to try it out and make adjustments early in adoption. Steps include creation of an in-house change team to implement the process, selection of the scribe—such as a medical assistant, nurse or former transcriptionist—and the decision for establishing the scribe’s scope of work. A scribe working as a clerical documentation assistant shadows the physician and works only on documentation. In an advanced team-based care model, a specially trained nurse or medical assistant gives EHR support while the physician is present, and provides services—such as health coaching or care coordination—at other times during the patient visit.

The module is part of the AMA’s STEPS Forward practice improvement strategies, which was created in response to the widely cited 2013 AMA and RAND Corporation study on factors affecting physician professional satisfaction and what could be done to improve it. That report gave high-profile attention to EHR burdens, including inefficiency and intrusion on face-to-face care as “prominent sources of professional dissatisfaction,” and that among physicians most negatively affected were those without access to scribes and other resources for data entry.

STEPS Forward comprises 50 practice improvement modules grouped into five areas—patient care, workflow and process, leading change, professional well-being, and technology and finance.  Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.

The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.

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The absolute truth is that scribes DO decrease my EHR input time. The absolute truth is that scribes who understand the nuance of my exam command a hefty pay scale. The absolute truth is that the accuracy of my EHR is less than my previously preprinted check off manually annotated patient record. The absolute truth is that my paper chart took less than half the time it takes for my scribes to enter the electronic record. The absolute truth is that the limited advantages of electronic records in my office care of patients is abolished by the disadvantages of redundant meaningless documentation, extended cost of scribes, software, hardware, IT maintenance and most importantly the inability to document nuance of changes in chronic disease progression, regression, treatment results etc. without prolonged dictation to scribe who may or may not get it. In addition the electronic record even with scribes provides a distinct barrier to physician patient interaction and communication. Electronic health records after 3 years has no real benefit to my care of patients and is clearly a financial burden. Trying to soft soap EHR by describing how scribes decrease my input time is missing the boat.
It is the height of absurdity to posit that scribes are a means to “efficiency” in healthcare by decreasing documentation time. The mere fact that one has to hire a “scribe” is anathema to the very goal of efficiency. Any EHR system that is so complex or intrusive into the natural and organic documentation directly from the clinician is inherently flawed and fundamentally an obstacle to efficiency. EHR’s are supposed to deliver solutions that allow the physicIan to document more clearly, thoroughly and reproducebaly without consuming more resources, not by requiring the creation of a third party that adds yet another layer of cost, and takes us backwards in time to the era of scribes and hyroglyohics. And to think that was the very thing doctors were once criticized for most: hyroglyphics. There is something very wrong with the state of technology in healthcare when we start espousing the virtues of adding another cost layer and interloper between the doctor their patient. Technology is supposed to work for us, NOT the other way around!
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