The use of scribes to act as intermediaries between a clinician and a patient is now common practice in outpatient healthcare settings (see, for example: Shift of Hospital EMR Data Entry Tasks from MDs to Scribes; The Emergence of EMR Scribes as a New Category of Hospital Employees; The Explosive Growth of EHR Scribes; Back to the Future). This use of scribes relieves the clinician of the laborious responsibility of entering data into the EHR. The clinician only interacts with the patient and the scribe extracts the necessary and appropriate EHR information from the conversation without any cues from the clinician. Disadvantages of the use of scribes is that they add to the expense of patient visits and are also expensive to recruit and train. Another scribe option is now available -- virtual scribe services (see: How a scribe tool linked to Epic EHR is helping ease physician burnout). Below is an excerpt from an article on this topic:
Chief among those administrative burdens [ cited by physicians and leading to burnout] was documenting in the electronic health record. Many physicians were spending two hours or more after each clinical session documenting in the EHR. As a result, they were missing family events and staying up late at night typing clinical notes. And in the office, they were too burdened to add new patients to their panels or focus on improving care and outcomes of their existing patients....[Massachusetts General Hospital] already had a relationship with vendor IKS Health, which had demonstrated success in allowing physicians to delegate and centralize clinical tasks – in that case, transferring medications from the legacy EHR to the current Epic system. Building on the vendor's clinical delegation abilities, Massachusetts General Physicians Organization engaged IKS Health to implement its virtual scribe technology, dubbed Scribble. Scribble provides a hybrid technical-human system where a physician uses a secure device to obtain an encrypted audio recording of the patient encounter, with the patient's consent. The recording is accessed by an IKS Health physician partner, who then synthesizes a complete, concise clinical note in the EHR, ready for the Mass Gen physician to review, edit if necessary, and sign. In addition, IKS Health coders review the documentation and provide billing and coding guidance. "....There are many scribe technology vendors on the market. These vendors include iScribeMD, Physicians Angels, Scribe America, Scribe Healthcare Technologies, Scribe Technology Solutions and Skywriter MD.
The virtual scribe technology consists of the clinician launching a digital audio recorder of the patent encounter with the patient's consent. The virtual scribe vendor then makes this recording available to one of its employees (physician or trained scribes) who listens to it and enters the encounter summary into the hospital EHR. This latter document can subsequently be edited by the responsible physician who interacted with the patient. As noted above, a vendor health coder can also review the same document and provide billing and coding guidance. This latter is non-trivial because it provides a double check on these data entries.
Although more expensive, the work of a scribe accompanying a physician in the examining room will often be of a higher quality, particularly as the scribe learns the habits and pace of the his or her physician. In the early years of medical scribes, they tended to be assigned to speciality physicians who generated higher revenue for the hospital. However, it has become the norm for more clinicians to be assigned scribes. The cost of virtual scribes is undoubtedly less expensive because the work lends itself to mass production. The lesser cost allows the hospital to provide such services to a larger swath its physician employees.
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