How are front-line Memphis doctors going to continue to maintain good medical practice, avoid burnout, increase revenue and maximize patient-doctor interaction in the new era of dwindling reimbursement, primary care physician shortages, increased numbers of patients and electronic medical records?
Some experts propose the use of medical scribes. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) defines a scribe as “an unlicensed individual hired to enter information into the EHR or chart at the direction of a physician or licensed independent practitioner (physicians, advanced practice registered nurses, physician assistants).”
“Previously, scribes were being used in emergency departments to allow the maximum involvement of the physicians with the patients,” said Soumitra Bhuyan, PhD(C), MBBS,
MPH, professor of health administration at the University of Memphis. “Now we are witnessing an increased use of scribes in other areas like hospitals and physician offices. This is an interesting trend. It is partly due to federal government’s push for adoption of EHRs.”
Alan Flippin, MBA, CMDS, has been a medical practice consultant in Memphis for 21 years. He serves medical offices and forecasts that the use of scribes within his clientele will increase from 15 to 50 percent in the next one to two years.
“For revenue generation in a doc’s office at this time, it’s one of the best things they can do and not change their practice,” he said. “Before, they would see 25 patients a day; now they really need to see 35 to make the same amount of money since reimbursements have gone down. Anytime doctors are typing, they are not seeing patients.”
He also said there is the benefit of not facing dictation at the end of the day. The time saved can be used to study the latest treatments, drugs and technology emerging. He added that studying the 50,000-plus additional ICD-10 codes to be enacted Oct. 1, 2015 is not a good use of doctors’ time. Flippin said some of his clients are adding exam rooms to meet the demand of extra patients seen as a result of the efficiencies of using scribes.
The Feb. 12, 2014 issue of Information Week: Health Care reported that the numbers don’t always work in the positive for doctors. Citing an internist who maintained his own EHRs, the story said he could not justify scribes for primary care due to lower income. It is too early to tell whether scribes can boost physician productivity outside emergency departments where they are more commonly used, said an Aug. 24, 2013 article in Modern Healthcare.
Use of medical scribes also brings up other issues, according to Bhuyan. “As this profession is not fully grown, there are still concerns about patient confidentiality among other legal issues,” he said. “Some patients might not like the idea of the presence of a third person in the exam room, which may negatively impact their communication and sharing relevant information with their physicians.”
He also said scribes might not have a clear understanding of terminologies and disease management, which could result in documentation errors. Lastly, he said that scribes are still an unlicensed profession, so the physician clinic or hospital employing them must ensure that scribes follow the patient care documentation guidelines.
A quick survey of scribe usage in larger Memphis hospital emergency departments showed St. Francis with no comment, Regional One not using scribes, Baptist using a scribes agency and Methodist self-hiring them.
“We grow our own and teach them ourselves,” said Ray Walther, MD, medical director, emergency department, Methodist University Hospital. “We employ about 25 here, a few full-time ones and most part-time. They are pre-med or pre-physician’s assistant.”
Walther said they find the use of scribes cost-effective because it makes physicians more efficient and provides reminders of when test results are back. He said it also gives them extra time with patients. He said he had tried EHRs with voice recognition technology and all the advances in software, and he was still not satisfied and preferred scribes.
Walther sees the use of scribes enduring with the fast pace of the ED.
One hospital spokesperson said he thought scribes were temporary, or a stopgap measure until older physicians retire and younger, more technology-proficient physicians enter the workforce.
Bhuyan agreed it might be true that younger and more tech-savvy physicians will find it easier to use EHRs. But, he pointed out, with the Affordable Care Act, more Americans have access to health insurance, many for the first time, and the transition to ICD-10 codes will be challenging. Use of EHRs can add to this stress, he said, with time-consuming data entry and interference with face-to-face patient care.
He cited a study published in Journal of the American Medical Association in October 2012 that said nearly 46 percent of physicians in the study had at least one symptom of burnout. The study reported that burnout is more common among physicians than other U.S. workers, and the highest rates were found in internal medicine, family medicine and emergency departments – where scribes are more likely to be used.
“If medical scribes can contribute to reduce the physician’s stress associated with EHR use, I think it will continue to grow in the future,” he said.
