Maximizing scribes: Six tips to better practice management

Physician burnout was already an issue before COVID-19. Now, during a pandemic, it only continues to become more acute.

One culprit: electronic medical records (EMRs). The increasing demands for making timely EMR entries, and keeping up with additional documentation and coding, is adding hours to an already overloaded practitioner’s workdays and, quite often, nights. EMRs are sapping physician productivity and revenue, hurting patient-physician interactions and relationships, and causing widespread frustration leading to burnout.

Many practices are turning to scribe services to take care of EMR entries and other support services so they can devote more time and attention to their patients, streamline ancillarytasks, and increase revenue - without increasing work time.

A study in the Annals of Family Medicinefound that using scribe services led to significant improvements in overall physician satisfaction, chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Ultimately, the researchers found utilizing scribes to be a promising strategy to improve health care efficiency and reduce physician burnout.

The potential for utilizing scribe services virtually is opening even more opportunities as doctors, and their patients, become more comfortable with telehealth and other remote technologies. Practices large and small have been reporting the benefits of using well-trained, dedicated scribes to supplement staff, overcome labor shortages, and curb the increasing costs of running a healthcare business.

Here are six tips for optimally structuring and leveraging medical scribe services:

• Here, there, and everywhere: A scribe can be in the room during an exam, and participating as a staff member. They can work from a remote office in the states, or abroad.Using telehealth, scribes at an offshore location can listen to the narrative of an exam while it’s taking place and make real-time entries into the EMR while a doctor focuses exclusively on the patient. U.S. scribes are in high demand, short supply, and they’re costly. Another drawback of an in-person scribe is that social distancing may be an issue with an infected patient, or a patient finds it uncomfortable to discuss certain sensitive medical topics with a scribe present. By outsourcing scribe services, you can get unobtrusive, highly trained, experienced scribes at a more economical cost, which maximizes the revenue boost.
• No time like real-time: Scribes are more helpful, and productive, when they are working in real- time. Some services merely record a physician and patient talking and listen to the recording later to update charts. The disadvantage is that doctors can’t rely on those scribes to put in orders or process referrals in real-time. A scribe who is connected remotely during an exam can also clarify a doctor’s instructions or a patient’s comments immediately. This speeds the process so that doctors can feel confident about reviewing their charts briefly, without having to spend time trying to recall and clarifying and adding additional information after hours.
• In scribes we should trust: When a physician can count on their scribe’s capabilities, their relationship can be much more productive. Capturing and entering health information into an EMR is only one aspect of a scribe’s function. Working with a dedicated scribe (or scribes) who understand the practice opens many possibilities. A scribe can plan ahead and prep charts for the next day’s patients. They can help arrange drug lists, vaccine referrals and respond to messages from providers. They can also handle the endless minutiae of generating letters for a patient’s primary care provider, create lab and radiology test results and the myriad of patient education documents. 
• Quality increases revenue: Every practice must report on a range of quality measures pertaining to different diagnoses. It can be difficult for doctors to find the time to do this; however, if they don’t report on these measures accurately, they miss out on opportunities to increase reimbursement via the full portfolio of value-based care programs. While per visit percentages may seem insignificant, they can add up to significant revenue when multiplied by hundreds of patients. A scribe will follow along in the visit and, for example, if a patient is markedly overweight the scribe can prompt the doctor to discuss dietary indiscretion and recommend a dietician as well as print out a nutrition chart.The scribe can document this counseling in the EMR, thereby satisfying tracking and reporting on one of the CMS Quality Measures and improved patient outcomes.
• Compliance reliance:Scribes are a part of the team. Therefore, it’s vital to include them in a practices’ compliance program. They should participate in training and be included in the thought process when developing policies and procedures. They should be closely monitored to ensure accuracy and adherence to guidelines. And they should be audited periodically for continuous improvement of documentation quality, privacy, and security practices.
• Make more by keeping score: If you’re using scribe services, and haven’t begun to benchmark their progress and effectiveness, now’s the time. First, agree on and establish benchmarks to be reviewed monthly. Use them to fine tune how you utilize both scribes and internal staff. This data will clarify the financial benefits of using scribe services, measured by increases in patient visits, reductions in coding and billing mistakes, increased revenue per encounter and eliminating charting backlog, and ultimately optimizing the revenue cycle. Ask your scribe service to help identify these benchmarks, whether they focus on less time working after hours or maximizing revenue. You CAN have it both ways.

The evidence is clear: it has been proven through research, and anecdotally, that scribes are just what the doctor ordered to maintain a more productive, profitable practice. Managing that relationship efficiently will enable a doctor to focus on what is most important: the patient.

Terry Ciesla is senior vice president of ScribeEMR located in Woburn Massachusetts. www.scribeEMR.com