Physician Scribes

1. Physician Scribes Monica Carvajal, MD January 5, 2011

2. History of Physician Scribes • The first scribe program was based in Reno, Nevada • In 1995 a physician practicing in Fort Worth, Texas discovered the Nevada program and decided to start a program at Harris Methodist Hospital • PhysAssist Scribes began in 1995 with five scribes from Texas Christian University as a solution to one emergency physician's muddled handwriting • While chart accuracy was the main impetus for the program, it soon became evident that the benefit of scribes extended far beyond the creation of legible charts. • Over time, the unintended, but significant benefits of scribes came into full view.

3. What Was Discovered? • As a result of the scribe's data entry… • Doctors began to have more time to see patients • As doctors began spending more one-on-one time with their patients, an increase in patient satisfaction was quickly realized. • Scribes created better work-flow for the individual doctors and the department. • Doctors repeatedly testified to the realization that their shifts were simply more enjoyable • Physicians had time to concentrate on those things that drew them to emergency medicine in the first place. • As a result of the advantages of implementing a scribe program… • ED physicians over the last 15 years have sought out scribe companies or hired scribes individually to provide them with the same invaluable service.

4. Scribe Program Perks • Increase physician direct patient care. • Decrease the time a patient will wait to see a doctor • Increase the time the doctor can spend with the patient • Enhance patient satisfaction. • Decrease the overall time a patient must spend in the ED • Improve documentation. • Improve the working environment in the ED for all members. • Expedite patient flow through the ED

5. Increase MD Direct Patient Care • Emergency physicians spend at least 20% of their time doing chart work and over 30% of their overall time is spent doing clerical work. • Scribe services’ promotes optimal patient care by returning the physician to the patient. • Reduce the burden of documentation on the physician especially now that the American Recovery and Reinvestment Act of 2009 mandated that healthcare providers will be required to implement Electronic Medical Records (EMR’s) by the year 2014.

6. Enhance Patient Satisfaction • Decrease the overall time a patient will spend in the ED • Increase the amount of time a physician spends with the patient

7. Improve Documentation • The Scribe reviews each chart to verify that all the necessary data has been recorded to meet the appropriate coding level for each patient.

8. Improve the Working Environment in the ED • Scribes can chaperone, get labs, make calls and do other tasks to facilitate physician productivity • Fills in the gaps for nursing and unit secretary duties

9. Expedite Patient Flow • Manage department flow by prompting physician when all studies are back • Increase flow by following up on laboratory/radiology testing

10. Benefits to the ED/Hospital • Increase physician performance • Efficient physicians can see more patients • Increase physician job satisfaction • Increase overall patient satisfaction • Better patient care with less waiting time • Improve physician recruiting and retention • Improve chart accuracy • More accurate records for legal and reimbursement purposes. • Decreased documentation costs • Decrease patient length of stay • Increase communication among ED staff • Fill in the gaps for nursing and unit secretary duties

11. Benefits To The Doctor • Increase physician performance • Increased efficiency and decreased paperwork, allowing more patients to be seen. • Increase physician job satisfaction • More time to spend at home with family • Job satisfaction in working with future medical professionals • Increase overall patient satisfaction • Decrease patient length of stay • Improve physician recruiting and retention • Improve chart accuracy • More complete and accurate charting for legal records and reimbursement • Increase communication among ED staff • Prompt and help organize the physician • Decreases the demands, stress & interruptions on the physician

12. Benefits To The Scribe • Observe and learn first-hand what a physician does • Get a head start on medical school, physician assistant, or nurse practioner knowledge • Receive valuable recommendations • Learn how to perform physicals and record history • Understand the basics of ordering tests • Become proficient in interpreting lab results and reading x-rays • Working experience in a clinical setting. • Being a valued member involved with patient care. • Building personal relationships with physicians and other medical professionals. • In the process, the scribe gains a working knowledge of medical terminology, treatments, and pathophysiology.

13. Benefits to the Patient • More accurate and complete charts for future visits. • Ability to be seen by physician quicker. • Decrease length of stay • More face time spent with physician.

14. What Is A Scribe? • Personal assistant & clinical information manager to the physician • Makes the physician more efficient and productive • Essential member of the ED team. • Immediate Assistant

15. Job Description • The primary role of a medical scribe is to assist the ED physician with the documentation of patients' charts, which is done under the supervision of the attending physician. • Document • Patient's history • Physician's interaction with the patient • Procedures performed (life support, reducing dislocations, suturing, etc) • Medications ordered and effects • Results of laboratory/radiology studies, and other pertinent information. • Document consultations (patient's personal doctor, family members, or on-call physician) • Document all diagnoses, treatment plans, prescriptions, and disposition (discharge/follow-up information for each patient and/or placing admission order sets on chart) • Order laboratory/radiology studies as dictated by physician • Monitor/Notify the physician when important studies or workup is complete • Make recommendations to physician in regards to billing/coding components. • Ensures that all the forms are signed.

16. Qualifications • Must be at least 18 years of age with excellent English language skills • Must possess a basic knowledge of medical terminology • Must have proficiency in keyboarding and computer operations • Must have legible handwriting • Must be mature, reliable, and sharp • Must have a positive attitude and be highly motivated. • Must be able to multi-task under stressful situations with attention to detail • Must work well in a professional, fast-paced setting • Must have excellent people skills • Must be able to balance school and work • Must be a college student, with two years of undergraduate education, at an accredited University, or post baccalaureate with a premedical degree, nursing with desire to become NP, or physician assistant degree plan. • May also be (but not as common) a paramedic , EMT, CNA , ER Tech, and/or Nurse • You must have a passion for medicine, and a goal to be a nurse, doctor or physician assistant.

17. “How Are Scribes Trained?” An intensive 40 hour home based study program, one day in-class orientation and 3-5 days of on-job training program This curriculum based, interactive program teaches the various tools and techniques for functioning in the clinical environment as a Physician Scribe. • Documentation training • Processing information & critical thinking • Coding & reimbursement • Clinical information management • Procedures & diagnostics documentation • Patient flow management • Customer service responsibilities • Scribe trainees receive classroom and on the job training focusing on medical vocabulary and CMS documentation guidelines. • Scribes are periodically audited for performance and have opportunities for advancement • After successful completion of the Scribe Academy, the Scribe will receive closely supervised ED clinical training in the Emergency Department. • Following intensive didactic training and clinical orientation, scribes are equipped to function as a clinical information manager and personal assistant to the physician.

18. “Is the Scribe program worth the investment?” • The program pays for itself through… • Increased physician job satisfaction • Increased physician productivity & revenue • Reducing physician overtime • Increased average chart value

19. “How has the Scribe revolutionized the delivery of patient care?” • Research has shown that implementation of physician scribes will result in… • a decrease in door to doctor time • decrease in over all length of stay • increased physician and facility reimbursement and • expedited patient flow through the emergency department.

20. References • Links and Resources • The following are informational links on the value of medical scribes from reputable third party sources: • "Scribes Hold the Key to ED Efficiency"Emergency Physicians Monthly, September 16, 2009. • Video: Rick Bukata on ED Scribes.Emergency Physicians Monthly • "Hospital Improves ED Discharge Rate by Replacing Doctors with Scribes for EMR 'Secretarial Work'"Inside Electronic Medical Records, Vol. 1, Issue 3 - April 24, 2008 . • "Strategy: Could You Use a Scribe?"Physicians Practice, April 2007 • "Expediting the ER Process: The Emergence of Emergency Room Scribe Programs,"The Journal of Young Investigators, 15:5, June 2007. • "Scribes Keep The Record Straight"Star Tribune, March 2006. • "The Era of the Scribe: Lightening the EP's Load"Emergency Medicine News, 26:2, February 2004.