Think back to your last dental visit. “Number thirty M-O-D,” your dentist rattled off in tooth-speak to his assistant as you lay back in the chair.
Translation? A decades-old molar filling is crumbling away. “Stop smoking,” he chides you while probing your gum line. “Three-two-three and four-one-four,” he again reports to his assistant — apparently disappointing combinations, because they earn you a “concerned parent” talk on your increasingly probable trip down Periodontal Lane.
Your dentist remains fully focused on you while you swear you’ll change your evil ways, and he ends the exam without making a single patient note. Still, every detail about your less-than-stellar exam appears in your record. How? Someone is recording it for him — a dental assistant à la court stenographer. Essentially, a medical scribe.
What a boon to you both. Your dentist doesn’t need to pause repeatedly during the exam to record his findings. Rather, he discusses issues with you, uninterrupted by having to rifle through paper charts or enter data into EMR templates. However you may feel about going to the dentist, this sustained attention — thanks to the scribe — has helped you receive a thorough examination.
Of course, physicians need, want, and try to focus on their patients the same way. So why don’t they use medical scribes as well? Some do, but it’s mostly confined to emergency medicine. Many emergency medicine physician groups and hospitals across the country have established medical scribe programs to help ER docs with charting and taking care of their other nonclinical support duties in a timely manner. The benefits: The physician operates more efficiently, while the scribe — usually a pre-med student — gains valuable knowledge, experience, and networking opportunities to help launch a career in medicine.
Yet the use of scribes has not caught on widely among private practice physicians. But perhaps in this day and age of increasing patient panels and decreasing reimbursements, the time has come to incorporate medical scribes into practices as a matter of necessity. The benefits of doing so can include increased efficiency, fatter bottom lines, greater job satisfaction, and better patient care.
The medical scribe, defined
A “typical” medical scribe is a pre-med student who works part time while in school for roughly two years with an emergency medicine physician group. Scribes assist physicians on a real-time basis with the clerical aspects of patient care. Clinically, a scribe remains “hands off.” A medical scribe should not be confused with an intern, a nurse, a nonphysician provider, or any other healthcare support worker. Scribes have received little to no clinical training and, as such, are precluded from performing any clinical duties. Rather, they allow the physician with whom they work to shift his focus off of his tablet PC or paper chart to his patient. Specifically, a scribe is responsible for:
Taking patient histories, often before the physician begins examining the patient.
Transcribing details of the physical exam and patient orders. This includes any lab tests, imaging tests, or medications ordered by the physician. A scribe may also be present to record a physician’s consultations with family members or other physicians about a specific patient’s case.
Documenting procedures performed by the physician or any other healthcare professional, including nurses and physician assistants.
Checking on the progress of lab, X-ray, or other patient evaluation data and transcribing the results into patient charts so that a patient’s workup is complete and the physician can make sound treatment decisions.
Recording physician-dictated diagnoses, prescriptions, and instructions for patient discharge and/or follow-up.
Who benefits, and how?
Arnie Winden, practice administrator for the North Fresno Emergency Physicians Medical Group, says that establishing a scribe program within his practice eight years ago has made a measurable difference in patient care. He estimates that the program has lopped off 10 percent of the time his physicians need to spend with individual patients. During these shorter encounters, physicians can focus on the clinical problems at hand while verbally reporting their findings to a scribe as the exam progresses.
And patients notice. Sick or injured people need and want help now. Winden says that one major reason the practice decided to incorporate scribes was to enhance efficiency: “Nobody wants to come in here and wait for eight hours for some help. Scribes have helped with that.”
The practice as a whole benefits from its scribe program, explains Winden. With clerical duties relegated to dedicated “apprentices” rather than clinically trained, overworked medical personnel, workplace satisfaction has gone up across the entire staff. A scribe’s full concentration on creating a complete chart results in improved compliance, more accurate (read: higher) coding, and, therefore, increased reimbursements — both on a per-patient basis (less under-coding) and a patient load basis (more patients seen per day).