3. HEALTHCARE
PROVIDER ISSUES
• Complex medical documentation
– Insurance
– Legal
– Patient Safety
• Declining reimbursement
• Documentation time is unreimbursed
4. “A scribe is one who follows the doctor
around and writes word for word, what
the doctor says as he’s examining the
patient – a sort of human tape
recorder.”
SCRIBES DEFINED
5. • Scribe must
document
– Physician’s presence
– Their role as a scribe
– Their credentials
• (Degree, Title)
– Signature
• Physician must
document
– Accuracy of document
– Work actually
performed by
physician
– Signature
DOCUMENTATION REQUIREMENTS
6. SCRIBE LITERATURE: CASE REPORTS
ED Manag 2009 Oct;21(10):117-8
– 10% increase in billable charges
– 6.45% increase in number of patients seen
– $600,000 in savings in first year
Retinal Physician 2011 Mar:3-9
- 25-100% increase in number of patients seen
Optometric Manag 2011 June:30
- $75,000 increase in annual revenue per scribe
- Collections per patient were $300/encounter
7. PHYSICIAN PRODUCTIVITY
Acad Emerg Med 2010 May;17(5):490-4
– 13 ED physicians x 18 months
• Compared shifts with scribes to shifts without scribes
– Increase per 12 hour shift
• 9.6 additional patients p < 0.005
• 28.8 additional wRVUs p < 0.005
Hospital absorbed the cost of the scribes
8. JOB SATISFACTION
J Urol 2010 Jul;184(1):258-62
– 5 physicians x 10 months
• Clinic days randomly assigned to have a scribe
– Improved physician job satisfaction
• 69% with scribes versus 19% without scribes p = <0.001
– No effect on patient satisfaction (trend towards positive)
Medical Students acted as Scribes
9. • Costs
• Quality
• Efficiency
• Learning curve
• Patient satisfaction
• HCP satisfaction
• Medical Legal Issues
– Is there balance in
what is documented
• Patient comments?
• Other comments?
– Accountability
• Can scribes be sued?
• Who has supervisory
responsibility?
CHALLENGES WITH SCRIBES
10. COST ANALYSIS
Hourly
Wage
Annual
Wages +
Benefits
Net Profit
(Added Revenue Minus
Wages, Benefits)
ROI
$10 $25,192 $11,470 46%
$15 $37,788 -$1,126 -3%
$20 $50,384 -$13,722 -27%
Estimate: $36,662 revenue increase with addition of 1 Scribe
Based on
10% increase in revenue in a single study ED Manag 2009 Oct;21(10):117-8
Median Collections of $366,622 for Internal Medicine MGMA 2011
Benefits are 34% of wages (BLS Employer Cost Report June 2011)
40 scribe hours/week, working 47 weeks/year
11. WORKFLOW ANALYSIS
History +
Exam
Document
Review +
Charge
Total Encounter Time
20 Min
7.5 Minutes
Possibly reduce by
50% with scribe?
7.5 Minutes 5 Minutes
Possibly save 3.75 minutes/Patient
Possibly see 1 more patient/hour
12. • Physician Factors
– Improve skills
• Documentation
• Coding
• EHR use
– Utilize templates
• Documentation
prompters
• Improve efficiency and
proficiency
• EHR Factors
– Documentation needs
– Responsiveness
– Flexibility
– User Interface
– Mobility
– Training
– Speech to Text
software
ALTERNATIVES TO SCRIBES
13. • Scribes can aid documentation process
– High cost for little benefit
• Little published data to support use
• Scribes transcribe without Knowledge or
Context
– Poor substitute for high quality health care provider documentation
• Unclear risks
• Lower cost alternatives exist
– Education, Speech to Text software
SUMMARY
14. • References
– ED Manag 2009 Oct;21(10):117-8
– Acad Emerg Med 2010 May;17(5):490-4
– J Urol 2010 Jul;184(1):258-62
REFERENCES