Medical scribes offer hospitals and health systems a low-cost method to bolster productivity and boost physician efficiency and morale, particularly after an EHR implementation.
With the advent of electronic health records in patient care, healthcare organizations have been looking for a way to help physicians combat the deluge of mandates, while still maintaining a high level of efficiency.
One fast-growing position designed to remedy this situation is the medical scribe. A medical scribe's primary duty is to document a physician's encounter with a patient in the electronic health record system. Scribes enter information about a patient's history, the physical exam, the physician's assessment, notes on decision making and discharge and after care instructions.
Scribes can also help physicians with the transition to ICD-10, identifying quality measures and specific CPT codes for the providers and assist with follow up care.
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"After you have that initial encounter, scribes are really patient advocates and patient flow assistants for the physician, but on the patient's behalf," says Michael Murphy, MD, CEO of Aventura, FL-based ScribeAmerica.
"As the physician and provider is being pulled in many different directions, [scribes] are there coordinating all the different labs and tests for 15 to 20 different active patients that the physician or provider may have."
Scribes are typically medical students or college students looking to get into med school, although Murphy says physician assistants and nurse practitioners may also be scribes.
Scott Donner, MD, FACP, the Medical Director of Emergency Care Consultants, an organization that supplies scribes to various hospitals in the St. Paul MN area, says that the position is a good starting point for young people wanting to experience the workflow of a hospital.
"The vast majority of them have a defined plan that they will be trained in med school or PA school, and they use this for experience as well as an opportunity to learn medical terminology and it's great experience to watch physicians take care of patients, so it has a lot of downstream affects in terms of their education," said Donner.
Using scribes gives healthcare organizations a cost-effective way not only to help physicians with patient care, but to help with physician morale and productivity.
Andy Mulvey, MD, FACEP, the Regional Medical Director at EmCare North in Horsham, PA, has been working with scribes for five years in the emergency department. He saw the benefits of scribes even before the rise of EHR systems. Now that scribes are a big part of his emergency department, Mulvey says he sees a stark difference in physician productivity.
"Before you used scribes, physicians used to get out of shifts late and would fall behind on charting, and would be challenged to see as many patients," said Mulvey. "With scribes, you see more patients, you work more efficiently, and make sure that your charting is nice and robust and accurate."
"We didn't go to medical school to sit at a computer and be a secretary," said Mulvey. "We want to provide high quality patient care. We want to be in front of patients and families, spending time and communicating, so what we find with our docs is that the scribes help put them back in front of the patients. If you eliminate some of the time you have to spend in front of the computer, it helps you see more patients."
"This is one of those rare things that really will make your physicians appreciate what you are doing," said Mulvey. "This is a service you can provide to physicians that will help retain them and make them happy while you are driving up their productivity."
Mulvey says his organization saw a 25 to 30% reduction in productivity after its EHR system was implemented. With physicians being an expensive and limited resource, scribes can be a low-cost solution to help strengthen efficiency.
While scribes are becoming an accepted part of the medical team in most places, there can be initial reticence in some quarters. Mulvey has observed that some physicians have had some issues giving up documentation control to another person.
Pushback has been the exception in Murphy's experience. "We have a very large supporting base and people understand that they want to provide better care and have happy physicians," said Murphy. "95% of the time we have no resistance."
While the position pays relatively little—the national average hourly rate for a medical scribe is $12.92 per hour, according to PayScale.com—and turnover is high, the position has the potential to be more than just a stepping stone, says Murphy.
"There [are] career EMTs, paramedics, medical assistants and all these different things," said Murphy. "People are becoming more aware of the medical scribe profession, and enjoy working with providers in that intimate kind of sending, and I think it will become a long term career path."
The need for scribes appears ripe for growth as more regulations come online. "As ICD-10 comes and there more requirements in terms of documentation and reimbursement, I think they have a very bright future," says Donner.