Presentation about the evidence that scribe use improves the EHR user experience and patient care.

1. SCRIBES AND THE EHR
DREAM OR DISASTER?
ROBERT ROBINSON, MD
ASSISTANT PROFESSOR OF CLINICAL MEDICINE

2. • Efficiency
• Effectiveness
• Work flow
• Learning curve
• Performance
• Patient satisfaction
• Documentation needs
• Complexity
• Capability
• Reliability
• Functionality
• Flexibility
CHALLENGES WITH EHRS

3. HEALTHCARE
PROVIDER ISSUES
• Complex medical documentation
– Insurance
– Legal
– Patient Safety
• Declining reimbursement
• Documentation time is unreimbursed

4. “A scribe is one who follows the doctor
around and writes word for word, what
the doctor says as he’s examining the
patient – a sort of human tape
recorder.”
SCRIBES DEFINED

5. • Scribe must
document
– Physician’s presence
– Their role as a scribe
– Their credentials
• (Degree, Title)
– Signature
• Physician must
document
– Accuracy of document
– Work actually
performed by
physician
– Signature
DOCUMENTATION REQUIREMENTS

6. SCRIBE LITERATURE: CASE REPORTS
ED Manag 2009 Oct;21(10):117-8
– 10% increase in billable charges
– 6.45% increase in number of patients seen
– $600,000 in savings in first year
Retinal Physician 2011 Mar:3-9
- 25-100% increase in number of patients seen
Optometric Manag 2011 June:30
- $75,000 increase in annual revenue per scribe
- Collections per patient were $300/encounter

7. PHYSICIAN PRODUCTIVITY
Acad Emerg Med 2010 May;17(5):490-4
– 13 ED physicians x 18 months
• Compared shifts with scribes to shifts without scribes
– Increase per 12 hour shift
• 9.6 additional patients p < 0.005
• 28.8 additional wRVUs p < 0.005
Hospital absorbed the cost of the scribes

8. JOB SATISFACTION
J Urol 2010 Jul;184(1):258-62
– 5 physicians x 10 months
• Clinic days randomly assigned to have a scribe
– Improved physician job satisfaction
• 69% with scribes versus 19% without scribes p = <0.001
– No effect on patient satisfaction (trend towards positive)
Medical Students acted as Scribes

9. • Costs
• Quality
• Efficiency
• Learning curve
• Patient satisfaction
• HCP satisfaction
• Medical Legal Issues
– Is there balance in
what is documented
• Patient comments?
• Other comments?
– Accountability
• Can scribes be sued?
• Who has supervisory
responsibility?
CHALLENGES WITH SCRIBES

10. COST ANALYSIS
Hourly
Wage
Annual
Wages +
Benefits
Net Profit
(Added Revenue Minus
Wages, Benefits)
ROI
$10 $25,192 $11,470 46%
$15 $37,788 -$1,126 -3%
$20 $50,384 -$13,722 -27%
Estimate: $36,662 revenue increase with addition of 1 Scribe
Based on
10% increase in revenue in a single study ED Manag 2009 Oct;21(10):117-8
Median Collections of $366,622 for Internal Medicine MGMA 2011
Benefits are 34% of wages (BLS Employer Cost Report June 2011)
40 scribe hours/week, working 47 weeks/year

11. WORKFLOW ANALYSIS
History +
Exam
Document
Review +
Charge
Total Encounter Time
20 Min
7.5 Minutes
Possibly reduce by
50% with scribe?
7.5 Minutes 5 Minutes
Possibly save 3.75 minutes/Patient
Possibly see 1 more patient/hour

12. • Physician Factors
– Improve skills
• Documentation
• Coding
• EHR use
– Utilize templates
• Documentation
prompters
• Improve efficiency and
proficiency
• EHR Factors
– Documentation needs
– Responsiveness
– Flexibility
– User Interface
– Mobility
– Training
– Speech to Text
software
ALTERNATIVES TO SCRIBES

13. • Scribes can aid documentation process
– High cost for little benefit
• Little published data to support use
• Scribes transcribe without Knowledge or
Context
– Poor substitute for high quality health care provider documentation
• Unclear risks
• Lower cost alternatives exist
– Education, Speech to Text software
SUMMARY

14. • References
– ED Manag 2009 Oct;21(10):117-8
– Acad Emerg Med 2010 May;17(5):490-4
– J Urol 2010 Jul;184(1):258-62
REFERENCES