Although electronic medical records (EMR) have enhanced the management of patient care, they have also burdened healthcare providers with tedious and time-consuming clerical tasks. This dilemma has led to providers spending less time with their patients and accumulating a stockpile of incomplete patient notes. These hindrances have caused providers to succumb to a poor work-life balance and experience physician burnout. It is obvious that the use of EMRs has become a double-edge sword, but which edge of the sword is sharper? This is a question that no longer needs to be answered, as medical scribes have proven to be a documentation solution for countless providers.
Evidence of Success
Medical scribes emerged as a means to help providers keep up with the high volume of patients in the emergency setting. However, studies have shown that the benefits of scribes extend far beyond the emergency room. In fact, a prospective study in a cardiology clinic found that scribes significantly improve patient interactions, physician productivity, and physician revenue. Four cardiologists shared a total of 65 clinic hours, each with their own scribe, and compared their results to 65 clinic hours without a scribe. Although the cost of four scribes for 65 hours reached $2,050, the four cardiologists were able to see 81 more patients and generate over $200,000 more in revenue over that time, for a profit of $191,000 and a yield of over 2000% on their investment of $2,050. A randomized controlled trial in a family medicine clinic revealed the direct impact of scribes on the physician. This study reported a significant increase in all aspects of physician satisfaction including their satisfaction with clinic, patient interaction time, documentation time, chart quality, and chart accuracy. Another study that took place in a urology practice reported similar results as the two previously mentioned studies.
Different Types of Documentation Specialists
Medical Scribes vs. Medical Transcriptionists
It is evident that medical scribes have made an undeniable impact in medicine. In fact, there has been a five-fold increase in their numbers within the past five years, growing from approximately 20,000 to over 100,000. A medical scribe is an unlicensed healthcare worker who documents patient-provider encounters in EMRs. The name of the position is often used interchangeably with medical transcriptionist. However, they are actually different. A medical transcriptionist documents the provider’s note from a prerecorded audio, while a medical scribe documents the note in real-time. There are also a variety of different types of medical scribes, including virtual/remote scribes, onsite dedicated scribes, and onsite cross-trained scribes. So, which one is best for an independent practice?
Virtual or Remote Scribes
A virtual or remote scribe documents patient notes from a remote location. In order for this to be possible, it is essential that the EMR has a cloud-based component that can be accessed remotely. The scribe can acquire information from the patient-provider encounter through a HIPAA-secured audio communication software such as Zoom. Zoom is widely used by many of the virtual scribe companies today.
In comparison to its alternatives, virtual scribing has the advantage of patient and provider privacy. This is the principal reason for a provider to opt for a virtual scribe. However, it is important to note that there have been no peer-reviewed studies to prove that patient satisfaction decreases with the use of onsite scribes. In fact, a systemic review covering multiple peer-reviewed studies reported that scribes have no effect on patient satisfaction. Another advantage is the lack of physical constraints. If a practice has small patient rooms, having an additional person in the room with the patient and provider can feel crowded.
Now, virtual scribing has also been known to have its drawbacks. The absence of the scribe’s presence in the practice prevents the scribe from being able to perform additional tasks, such as retrieving medical instrument packages for in-office procedures. After an onsite scribe spends some time with their provider, they will learn what to document by observing the provider and how they practice. This allows the scribe to document faster by way of anticipation. Virtual scribing is entirely audio and the scribe can only document by listening to the patient-provider dialogue or provider’s dictations. Furthermore, virtual scribes are not able to perform clerical tasks such as faxing, phone calls, and paperwork that are related to the patient notes.
An onsite scribe documents the patient notes while in the room with the patient and provider. In order for this to be successful, the scribe must either have a standing mobile desk for their workstation or enough counter space in the patient room to place their laptop.
Onsite scribes have the advantage of quicker documentation through anticipation as described above. They are able to do more than documenting the visit. They may also assist with clinical procedures and perform clerical tasks, serving as an adjunct medical assistant. Most scribes are pre-health professional students and become scribes to increase their clinical experience and medical knowledge. Many providers have reported that they enjoy the mentorship that comes with having an onsite scribe. Onsite cross-trained scribes have the additional benefit of being able to act as a medical assistant, which allows for a more productive practice. If a medical assistant becomes overloaded with patients, the medical scribe can switch their role and share some of the workload.
The disadvantage of onsite scribes is the lack of patient and provider privacy, as there is an intrusion on the patient’s personal life. However, as previously stated, studies have shown that medical scribes do not affect patient satisfaction. With that being said, if a provider enjoys to practice in solitude, an onsite scribe may not be the best option.
Scribe Solutions for Independent Practices
Independent practices have two options when acquiring a scribe: contract a scribe or prime a scribe (hire and train a scribe themselves).
There has been an influx of medical scribe staffing companies to keep up with the increased demand for medical scribes. Although the number of staffing companies continues to rise, the majority of medical scribes are hired and trained by the provider. According to the Doctor’s Company and Oregon Health and Sciences University, a survey of 335 respondents revealed that 55% of scribes are trained by the doctor. Many providers believe contracting to be an easier option. The staffing company does the recruiting, hiring, and training. Furthermore, they handle employee management including providing an alternative scribe if the primary scribe is absent.
The trade-off for having another company run onboarding and management is high-priced contracts. Although the investment is worthwhile, the cost of contracting with a scribe staffing company can be high. The prospective study covered earlier has physician revenue as one of its measured research outcomes. In order to quantify that revenue, the investment had to be considered. The study’s method involved contracting onsite scribes from a staffing company at a rate of $25 per hour. It is important to note that the mentioned study was carried out seven years ago, and because of the increased demand for scribes today, prices are even higher. Virtual scribes tend to be a little less expensive. Another point to consider is that when contracting with staffing companies, there is a clear delineation of the scribe’s duties. Strict guidelines from the scribe’s employer ensure that the scribe is only used for documentation purposes. This means that the scribe cannot be cross trained to medical assist. Furthermore, the scribe cannot assist with any in-office procedures or take on clerical tasks.
Medical scribes are compensated $10-$15 per hour depending on the cost of living. For some companies, scribe’s compensation begins at $9 per hour for the first three months. Therefore, providers who hire scribes without a third party could save approximately 50% of the cost of a scribe contract. A few companies may argue that hiring your own scribe will result in startup costs reaching $6317 per scribe, but these companies failed to subtract several expenses that do not pertain to independent practices, such as clinical shifts. Along with training costs, staffing companies contract with clinics and pay an additional clinical shift cost to allow the scribe to receive a more didactic training. Independent practices have their own clinic, therefore clinic shifts would not be an expense. Furthermore, medical scribe training companies such as Great Scribes Nationwide have found solutions to reduce startup costs to $1300-$1700 depending on the scribe’s compensation. These startup costs could be even lower if the hourly paid training rate is lower than the hourly paid salary rate. Another point worth discussing is that scribes that are trained by the practice they work for receive a training more tailored to their practice. For this reason, there is a smaller learning curve following the training process. A provider who primes their scribe also can utilize their scribe in many ways that are not possible with contracting, such as medical assisting and clerical tasks. If the provider’s EMR has a cloud-based component, they can allow their scribe to work virtually if needed.
The downside of an independent practice priming their own scribe is not having the time or experience to do so. Many providers have difficulty finding time during the day to train their scribe. Consequently, providers who train their own scribe typically opt to train one of their medical assistants to scribe instead of recruiting a new hire. Given that their medical scribe already has experience with their EMR and specialty, they expect for the training process to be shorter. A few medical scribe training companies also teach and assist providers with scribe recruiting and integration. This assistance allows providers to recruit, hire, and train scribes without having experience or sacrificing time. Abdulai Bangura, medical scribe training expert and founder of Great Scribes Nationwide hosts Free Live Web Classes to teach providers how to prime their own scribes.
Case #1: Jennifer Keller, DPM – Shenandoah Podiatry
Dr. Keller owns and operates a two-doctor practice in Roanoke, VA. She employs two certified medical assistants and one onsite cross-trained medical scribe for her clinic. Her doctor-scribe relationship has been life-changing and something she takes on as a “mentorship.”
According to Dr. Keller, “Before having a scribe, I would have to use my lunch hour, evenings, and weekends to complete patient notes. I would still get backed up on notes, charges were never billed on time, and that resulted in a delay with revenue. After employing a scribe, notes were completed and billed on time and this allowed me to have a better work-life balance.”
In regards to her workflow, she reports that her “two medical assistants are responsible for rooming patients, performing X-rays, dispensing durable medical equipment, and preparing in-office procedures. Although my scribe was cross-trained, she would primarily act as a scribe and switch to a medical assistant role only if help was needed.”
When it comes to acquiring a medical scribe, Dr. Keller offers the following suggestion, “I have hired multiple scribes and learned that the most successful scribes are individuals with an interest in advancing in medicine. It is unfortunate that these individuals typically work 1-2 years before pursuing a postgraduate education. Although this is the case, their level of performance is worth having to repeat the hiring process.”
Case #2: Timothy Shea, DPM – California Integrated Foot Care
Dr. Shea owns and operates a two-doctor practice in Concord, CA. He employs three certified medical assistants and one onsite cross-trained medical scribe for his clinic. He believes that having doctor-patient relationships is an “ethical responsibility” and mentioned that having a medical scribe has allowed him to do that.
According to Dr. Shea, “When I did not have a scribe, I could not give my patients my full attention as I documented my notes while speaking to them. I would then leave the computer to perform physical examinations and share my plan with the patient. After speaking to the patient, I would have to remember what was done in the room. If I had other patients to see and could not do the note at that time, I could forget pieces of information and notes start to pile up. I used to spend 2-3 hours after patient hours and the weekends to complete patient notes. Now, I spend approximately 30 minutes after patient hours only to revise patient notes.”
When asked about the benefits of his medical scribe, he responded, “Having a scribe allowed me to listen to my patients; not only to what they say, but to how they feel, and determine what emotional state they are in. My medical scribe has been an extra hand that is always there to get me through the patient visit. She performs quick chart reviews in the patient’s room to keep me well informed of the patient’s progress. The real-time documentation is protective against medical lawsuits. The quality of the note is better. When I used to do the notes myself, I just wanted to get through it. Now, the vast majority of it is done in real-time, and I could quickly review it and sign it. My only drawback is having to train the scribe myself, especially given that the position has a high turnover rate.
As for his suggestions he states, “I highly recommend making sure that your scribe is computer literate. When hiring your own scribe, you can either use the same process as you would hiring a medical assistant or contact your local emergency department and local colleges.”
Frequently Asked Questions
Question: As a provider, should I be concerned about the quality of documentation?
Answer: Although some of your patient notes may require a few modifications during the first few weeks of having your scribe, studies have shown medical scribes to increase relative value units and the level of service billed due to more well-documented notes.
Question: Most of the EMRs now have pre-existing templates, do providers still need medical scribes with this feature available to us?
Answer: If pre-existing templates are used by providers for faster documentation, just imagine how much faster your documentation will be if your scribe used these templates in real-time. A few practices reported having some of their patient notes completed before exiting the patient room.
Question: The doctor still has to review the notes that were prepared by the scribe, how does this save time?
Answer: When a doctor transitions from doing their own notes to using a scribe, they go from documenting entire notes to simply revising notes. It takes approximately 1-2 minutes or less to revise a note. As your scribe becomes better, the time is reduced. As shared above, Dr. Shea went from spending 2-3 hours after patient hours documenting patient notes to approximately 30 minutes revising patient notes.