As physicians look for ways to reduce the clerical load associated with EHR data entry, they are increasingly turning to medical scribes.
Scribes help physicians with EHR navigation, retrieval of diagnostic results, documentation and coding. This allows the physician to free up time for patient care.
Yet while the use of scribes is growing, the position remains minimally regulated. There are no requirements for certification, for instance. Any certification received by scribes is voluntary, and the minimum qualification to work as a scribe is a high school diploma.
Here are 17 things to know about scribes.
Basic duties and numbers
1. Scribes typically go with the provider into the exam room and document the patient's encounter with the provider. The provider may also dictate the patient encounter to the scribe, and the scribe gathers data for the physician such as nursing notes, prior records, labs and radiology results, according to the American College of Emergency Physicians.
2. "Medical scribes do the bulk of documentation for the provider, says Michael Murphy, MD, cofounder and CEO of ScribeAmerica, which provides scribes to hospitals and medical practices. "They're tracking down labs, they're notifying of delays, they're helping in scheduling appointments. They're basically handling 80 to 90 percent of the ancillary duties for providers."
3. The American College of Medical Scribe Specialists estimates 20,000 scribes were employed by the end of 2014, and it expects this number to grow to 100,000 scribes by 2020.
4. As of April 2015, at least 22 companies supplied scribes across 44 states, according to the Journal of the American Medical Association. The largest company is ScribeAmerica, with more than 5,000 scribes in more than 570 healthcare facilities across 44 states.
Benefits
5. A study published last year by the National Center for Biotechnology Information found physician productivity in a cardiology clinic was 10 percent higher when scribes were used. The study compared the productivity during routine clinic visits of 10 cardiologists using scribes versus 15 cardiologists without scribes. According to the study, physicians with scribes saw 9.6 percent more patients per hour than physicians without scribes. Physician productivity in a cardiology clinic, overall, was 10 percent higher for physicians with scribes.
6. This same study showed physicians with scribes generated an additional revenue of $24,257 by producing clinical notes that were coded at a higher level. Total additional revenue generated was $1.4 million at a cost of roughly $99,000 for the employed scribes.
7. Additionally, another study showed correlation between a scribes system and thousands of dollars in savings per patient. The study compared standard visits (20-minute follow-up and 40-minute new patient) to a scribe system (15-minute follow-up and 30-minute new patient) in a cardiology clinic. Direct and indirect revenue combined resulted in $2,500 more per patient with the use of scribes.
8. While the use of scribes has resulted in increased productivity and a revenue boost, evidence also suggests scribes may improve clinician satisfaction, as well as patient-clinician interactions, according to a study published in the Journal of the American Board of Family Medicine.
The authors identified five peer-reviewed studies from 2000-2014 assessing the effect of medical scribes on healthcare productivity, quality and outcomes. Three studies assessed the use of scribes in an emergency department, one assessed the use of scribes in a cardiology clinic and one assessed the use of scribes in a urology clinic. Two of the studies reported scribes improved clinician satisfaction, and one study reported improved patient-clinician interactions.
9. Dr. Murphy says scribes are helping alleviate productivity challenges associated with EHRs, but they are also helping providers through the transition to ICD-10 —the 10th version of the World Health Organization's medical classification system that took effect Oct. 1, 2015.
Regulations
10. CMS does not provide official guidelines on the use of scribes, but has responded to direct inquiries about using scribes, according to the American College of Emergency Physicians.
11. CMS does not bar non-physician providers, such as physician assistants, nurse practitioners and clinical nurse specialists, from using scribes.
12. A scribe does not need to be employed by the hospital they work at, according to the American College of Emergency Physicians. Hospitals may use scribes to bridge volume gaps, enabling a smaller number of physicians to treat a greater volume of patients, says Dr. Murphy.
13. The provider must add and sign an addendum to the scribe's note when the scribe makes an entry on a paper medical record and correction is needed, rather than cross out or alter what the scribe has written, according to the American College of Emergency Physicians.
14. The Joint Commission does not endorse or prohibit the use of scribes. The Joint Commission permits scribes to document the previously determined physician's dictation and/or activities, but does not permit scribes to act independently, with the exception of obtaining past family social history and a review of systems, a technique providers use to get the patient's medical history.
Education and training
15. As of January 2016, the average pay for a medical scribe is roughly $12 an hour, or $29,595 annually, according to PayScale. The Bureau of Labor Statistics does not provide salary information specific to medical scribes. However it does provide data for medical transcriptionists. According the bureau's latest numbers available, from May 2014, the average pay for a medical transcriptionist is $17.11 an hour.
16. The general minimum qualification for medical scribes is a high school diploma, although some pre-med students work in medical scribe positions to gain experience from shadowing physicians, according to an article published by U.S. News & World Report.
17. Scribes are not required to go through a certification process. However, there are organizations, mostly scribe service vendors, that train and certify scribes, one of which is the American College of Medical Scribe Specialists.
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