Kevin McGrath, MD, FACAAI, is a solo allergist who was fed up with the amount of time he was spending entering chart notes into his patients’ electronic health records (EHR). He was spending hours each night and on weekends trying to stay caught up and ensuring his notes were thorough and complete. All that changed about three months ago when he began using a scribe. “Using a scribe brought joy back to the practice of medicine. I no longer feel like I’m wasting most of my time entering data into the computer,” said Dr. McGrath. “I have more time to spend with patients, and my documentation has improved.”
What is a scribe, and how can one help you? Medical scribes are professionals who transcribe information during clinical visits in real time into EHRs under physician supervision. Scribing frees allergists from note documentation and entering orders, which, in turn, allows them to focus on patients. A recent study conducted by researchers from Kaiser Permanente found the use of scribes results in lower physician documentation burden and improved efficiency, workflow and patient-physician interaction.
So how does the process work in practice for Dr. McGrath? A medical assistant begins the visit by entering the chief complaint, the patient’s medications and any refills needed into the EHR. Next, Dr. McGrath and the scribe see the patient together. Dr. McGrath introduces his scribe to the patient and explains their role. The scribe documents the visit in the EHR as Dr. McGrath conducts the visit and exam. After the scribe completes the note, Dr. McGrath reviews it and makes any corrections before signing it.
“The scribe doesn’t take the place of my medical assistant,” said Dr. McGrath. “Both roles are key to efficient workflow. While the scribe and I are with one patient, the medical assistant can begin another patient’s office visit, or do a spirometry.”
None of his patients has objected to having a scribe in the room. If a patient wants to discuss a personal issue (emotional or family related, for example), he asks the scribe to step out of the room so they can talk privately.
Before getting a scribe, Dr. McGrath documented most of his visits on paper and later keyed the information into the EHR. This was a time-consuming process that was not very effective.
He first tried using Dragon, the voice recognition software, but it didn’t work well for him. Now, however, with a scribe, his notes are more complete. Since information is entered by the scribe during the visit, he doesn’t have to remember every detail at the end of the day.
How do you find a scribe? You can contract through a scribing service or hire one on your own. Scribes from scribing services will usually cost more, but they are trained and frequently more experienced. However, either way, you will need to spend time training them on your protocols and preferences, as well as in the allergy specialty if it is new to them. Scribes that you hire independently will usually require more training, especially if scribing is new to them. Initially, you might be better off starting with a scribe service or hiring a scribe with previous scribing experience as you add this functionality to your workflow.
Unfortunately, turnover can be an issue, as many scribes are working to gain experience prior to applying for medical, nursing or pharmacy school.
According to Dr. McGrath, the time saved by using a scribe has been phenomenal, and his quality-of-life is much better. He is also more productive and able to see a few more patients a day with less stress. Dr. McGrath isn’t alone in his praise of scribes; he knows of a group of seven allergists in his community that all use scribes as well.
For more information about scribes, check out the free AMA STEPS Forward™ module on team documentation.