Medical Scribes: Pros and Cons

Most of you have already implemented an EHR, but not all of you are happy about it. Thirty-three percent of physicians who use an EHR say the system has made their work flow less efficient; and nearly 60 percent say they have experienced no return on investment, according to our 2014 Technology Survey, Sponsored by Kareo. EHR complaints from physicians range from gripes that entering information into the system is difficult and time consuming, to protestations that it creates a barrier between physicians and patients.

So what if we told you that there may be a solution to your EHR headaches? Many practice consultants say medical scribes - who assist physicians with entering data into the EHR during patient visits - improve physician productivity, physician satisfaction, and patient satisfaction.

Yet, while scribes are growing in popularity - according to our Technology Survey one out of every five practices with an EHR is using them - many managers and physicians are asking: Is a scribe the right move for my practice? To provide some guidance, we asked practice management experts and consultants to weigh in. Here, they share more about who a scribe is, what pros and cons to consider prior to employing one, and what qualifications to look for before bringing one on board.

DEFINING A SCRIBE

Usually, scribes have some background in the medical field, such as someone who previously worked as a certified medical assistant, or a pre-medical student or medical student who wants to make a little extra money while gaining more experience.

Practices have several options when hiring scribes. They might secure one from a scribe staffing agency; hire someone with experience that matches their requirements; or, if the opportunity presents itself, train a current staff member to take on the role. Another option is to outsource scribing duties to a virtual scribing company, in which case the scribe might listen to (and document) the patient encounter from a remote location.

While scribes take on many of the documentation duties associated with patient care, it's important to keep in mind that they don't eliminate them entirely, as physicians must still review the documentation and sign off on it after the patient visit. "The physician, ultimately, is responsible for every word that's in their notes in the medical record," says Cheyenne Brinson, a consultant at practice consulting firm KarenZupko & Associates. "... Even though they have a scribe, it's their medical license; it's their Tax ID that is associated with that; so the physicians ... need to ensure that [the record] is 100 percent accurate."

CONSIDERING THE BENEFITS

Brinson, who describes scribes as a "win-win" for practices, says one of the biggest benefits they provide is improved productivity. In fact, she says most of her clients have found that scribes enable them to get back to the same level of productivity they experienced pre-EHR. A 2013 report published in ClinicoEconomics and OutcomesResearch backs up that reasoning. The study, which evaluated four cardiologists in an outpatient clinic over 65 clinical hours, found that they were able to see 81 additional patients when using scribes.

In addition to productivity increases, scribes improve the "quality of patient encounter," says emergency medicine physician David Strumpf, a Santa Barbara, Calif.-based physician who has practiced with scribes for more than 10 years. "It's a challenge to be both data entry person and clinician, and it's very distracting to the process [of patient care]," he says. With a scribe's assistance, physicians can focus more on patients and talk freely with them, which leads to a more productive and valuable interaction.

Strumpf, who is the chairman and a cofounder of Medical Scribe Systems, a scribe staffing company, adds that scribes with the right training also help physicians reap higher reimbursement. Scribes from his agency, for instance, receive medical billing and coding training. This enables them to "fully appreciate the acuity of any given encounter," he says.

CONSIDERING THE DRAWBACKS

Despite the many benefits scribes provide, there are some important drawbacks to consider. Incorporating any new staff member into a practice takes time and resources; incorporating a new staff member with a new role can be even more challenging. Practices often need to invest significant time in training the scribe, adjusting their work flows to accommodate the scribe, and ensuring that the scribe and physician work well together.

Brinson says that based on her own experiences with scribes, it takes about two months to three months for a scribe to become fully acclimated in a practice. Still, she says, that may vary depending on the scribe's experience, the physician with whom the scribe is working, and the practice environment in which the scribe is working. For instance, a scribe will have a harder time acclimating to a physician and practice with a highly complex and varied patient population.

Another potential drawback to consider is, of course, the cost of employing a scribe. Brinson says her clients typically pay between $13 to $16 per hour, depending on the individual's prior experience and the demand for scribe services in the area.

Still, Brinson says, the improved productivity scribes provide quickly offsets the costs associated with their employment. "I don't want people seeing this as an additional cost," she says. "Look at it for what it is: It is a return on investment and the physician time."

FINDING THE RIGHT FIT

If you determine that the benefits of employing a scribe outweigh the drawbacks, do your homework before hiring one. At press time, there was still no single broadly accepted training and certification process for scribes, so practices must take the time to carefully define their desired qualifications.

Brinson recommends requiring previous experience in your specialty; strong spelling, computer, and keyboarding skills; and an understanding of medical terminology. She also advises a skills assessment to evaluate typing speed and accuracy. Carol Stryker, founder of practice management consulting firm Symbiotic Solutions, has similar recommendations, adding that a medical vocabulary test is also worth consideration. If you are hiring a scribe from a staffing company, be sure to request documentation of such training and evaluations.

While a pre-medical student or medical student is a great option for a scribe, think twice before hiring one if longevity is important to you, says Brinson, noting that turnover may be higher among these individuals. "As long as the physician is OK with that, then I would certainly consider that route," she says.

To ensure that the applicant is the right fit, come up with some scenarios to assess how the applicant would respond to various situations, and also assess whether the scribe's personality and work style will mesh well with the physician, she says.

Finally, make sure the applicant is comfortable asking questions, says Stryker. "... It's going to be real important that they have the type of personality to raise their hand when they encounter something they don't know how to handle."

CALCULATE THE ROI OF YOUR MEDICAL SCRIBE

If you already have a medical scribe in your practice, or if you are considering adding one soon, it's important to keep an eye on how that investment affects your revenue. This is easier than you might think. To learn how to easily calculate the return on your investment, visit bit.ly/ROI-scribes.

Aubrey Westgate is senior editor for Physicians Practice. She can be reached at aubrey.westgate@ubm.com.