Nuances In Medical Scribing : 6 Practical Tips To Make It Work

According to the Joint Commission, a medical scribe is an unlicensed employee hired to input information into an electronic health record (EHR) or chart at the instruction of a physician or licensed independent practitioner. Scribes work in doctor's offices, hospitals, emergency rooms, long-term care homes, public health clinics, and ambulatory care centres. They work as independent contractors for healthcare organisations, physicians, or other licensed independent practitioners.Most physicians spend 1.5 to 4 hours daily on EHR software to compile clinical documentation. This results in overwork decreased productivity, and burnout among doctors. Medical scribes are crucial in reducing physician burnout. They eliminate clinical document burden and EHR usability concerns.Physicians have used medical scribes to assist with clinical documentation load and EHR-related data entry. However, there are numerous difficulties in medical scribing operations in both hiring through a scribe service vendor or hiring the scribes directly. This post aims to provide practical advice on improving the efficiency of medical scribe operations in the physician's office setting. We will be discussing in detail on the below 

 

• Why Do I Need A Medical Scribe ?

• Hiring A Medical Scribe 

• What Skills Should A Medical Scribe Have?

• Scribe Onboarding Protocol

• Evaluation & Monitoring Of Medical Scribes

 

1. First Thing First: Why Do I Need A Medical Scribe?

The first step is to define the pain points you want to address with the induction of the medical scribe. It's critical to understand why you're employing a scribe. Physicians typically cite the following pain points: 

• EHR system usability issues.
• Slow system response time.
• There isn't enough time for documentation. 
• Clinical notes backlog.
• Medical terms take longer to spell check and edit.
• Patient data search takes a longer time
• Quality of notes
• Revenue loss as a result of excessive time involved in paperwork

If this sounds familiar, a Medical Scribe could be of great assistance.The next step would be arriving at the time lost daily due to the identified pain points. The time spent in documentation or other activities you gain from inducting a  scribe will be the key input in working out the cost before the scribe and aid in measuring the program's success. We will see more about this in the subsequent sections.

Physicians must set care entity set clear and specific goals. Goals can include increasing revenue, provider productivity, patient satisfaction, timely record authentication, or improving provider morale. Establishing particular, measurable objectives for the medical scribe program may involve an interdepartmental team that includes multiple disciplines. Regardless, all goals should be clearly stated and metrically tracked.

 

2. Don’t Hire A Medical Scribe If You Can't Find Answers To This.

The pain points you endure in clinical documentation may look valid on the face of it for hiring a scribe, but for a medical scribe program to succeed and sustain itself, a return on investment is required. There are two criteria to the question of when.

1. A medical scribe program should result in significant cost reductions or help you in improving revenue.

2. When you a ready to make changes to your workflow to accommodate scribing.

 

• ROI on scribing
  

​​​​​​​Typically, when you cannot accommodate additional patients owing to excessive documentation time, or you are spending extra hours in a clinic or at home to catch up on paperwork, it is time to hire a scribe. An objective assessment would give you confidence that a medical scribe program has the potential to sustain and succeed is an essential second step.The conventional rule of thumb is that utilising a scribe increases productivity by roughly 15%. The hourly fee for these scribes was $20.51 per hour.A 19-minute reduction in duration of stay resulted in a $26.91-per-hour savings in cubicle expenditures per patient. The total amount saved was $51.66. After deducting the scribe's fee, The savings per scribed hour were US$ 31.15. An 8-hour workday saved US$ 252 a day, and a 20-day work month saved US$ 5040.The doctor saved US$ 5040 per month by hiring a scribe. The physician decided it was time to engage a scribe. Clinicians already performing higher than the benchmark should start using a scribe.Even if the savings are zero, it may still make sense because it reduces the burden of documentation for doctors and allows them to spend more time with patients.It becomes problematic when you cannot add the patient to the saved cubicle due to the Medical scribe addition. In this case, the cost of care rises.In a nutshell, to achieve financial savings, practices should have unmet demands to increase productivity through scribes. If clinicians are not productive at baseline, they may not have enough demand for their services, so they may not be able to generate the additional productivity requirements to make the scribe program work. 

 

Recommended Reading : 6 Sources Of ROI

 

• Changes to workflow                                                                               

Another prerequisite for hiring a scribe is to check if the Physicians are willing to modify their workflows to integrate and leverage the scribe fully. Some of the changes that physicians have to adopt will be

a) Start by introducing the scribe to the patient. 

b) Verbalise the encounter in a standardised fashion so that the scribe can follow.

c) As per JCS guidelines, Scribes should only document what a physician directs. So, verbalising their observations is a critical change that physicians need to make.

 

• Exam room setup                                                                         

Another prerequisite is the size of the exam room if you need to accommodate a physical scribe. In some hospitals, these rooms are small and may not allow the presence of a third person in addition to the provider and patient. Another challenge may be the placement of computer equipment. It is essential to minimise or eliminate distractions to patient care. If an exam room is an issue provider should explore the virtual medical scribe option.

 

3. Hire the best Medical Scribe by process

• Minimum knowledge, experience, and education qualifications
• Definition of roles (i.e., scribe vs. provider)
• Responsibilities and precise scope of practice

When hiring medical scribes, doctors should focus on analysing essential skills. The physicians should conduct Competency assessments and performance evaluations. 

• Domain knowledge - The ability to learn and apply technical (medical ideas, compliances) and professional knowledge, skills, and judgment to achieve results and efficiently serve clients. It is also essential for the scribe to understand HIPPA compliance and Meaningful Use. Learning medical terminology is similar to learning a foreign language because there are ambiguous and contradictory pronunciation standards, acronyms, abbreviations, redundant and overlapping phrases, and even slang. The scribing companies usually assess and train the scribes before being assigned to work with specific HCOs.

• Understanding clinical process abilities - Scribes must understand medical terminology, workflow, clinical documentation, and regulatory issues. Practices should verify that appropriate pre-employment training is provided and, if working with a vendor, consider a contract clause to cover the organisation's costs if a scribe's performance is unsatisfactory.
• Knowledge of tools - The ability to employ technologies (EHRs, software tools, etc.) to achieve goals and objectives and carry out work functions; applies office automation technology. Working knowledge of the software tools utilised in the process and the ability to train others. Extensive knowledge and practical expertise with at least ten EHRs 

Some of the abilities required for the medical scribe to succeed are as follows:

• Verbal communication - The verbal expression of ideas, thoughts, and facts is a critical need for scribes. To effectively convey ideas, use perfect grammar, acceptable body language, good tone, and intonation, recognise nonverbal cues, and respect the audience.
• Listening ability - The ability to tune in to a voice or auditory message, including nonverbal clues are important skill scribes should possess. It is necessary to check the alertness and the ability to pay close attention to the speaker.
• Written communication - The ability to express ideas, thoughts, and facts in writing. Ability/skill in communicating a message in writing utilising accurate language, spelling, sentence and document structure, accepted document formatting, and specific literary approaches.
• Typing ability - Touch typing at a rate of more than 50 words per minute.
  

 

4. Follow The Medical Scribe Onboarding Methodology: A Step-By-Step Guide

Turnover among scribes can be very high, considering that most of them are pre-med students. The cost of hiring, training, managing, and high turnover tends to be higher than expected. A structured approach that can reduce costs and improve the program's success is critical. The following section outlines a methodology that practices should follow to help the new Medical scribes learn the knowledge, skills, and behaviours they need to succeed in their new organisations quickly. Some aspects of the methodology are: 

• Clinical documentation processes manual 
• Medical Scribe Formal Induction program
• Hands-on training  
• Quality checks

The following section provides details about the methodology. 

 

A) Clinic Documentation Processes Manual (CDPM)

To ensure medical scribes follow established workflow methodology,  an internal CDPM that explains the specific workflow of the physician has to be available. CDPM serves as the Scribe Documentation Guidelines. For the new scribe, the practice should provide training as per the physician-specific CDPM. The scribes are mandated to follow the documentation guidelines outlined in CDPM for the place of service (i.e., inpatient, outpatient). Some of the sections of the CDPM and not limited to are: 

• The CDPM, in addition to outlining the standard documentation requirements of an encounter, also includes the separate authentication duties for the scribe. 
• The next section of the CDPM stresses the data entries regarding a patient’s health information
• It should describe the practice’s policies and regulatory requirements for authentication of each access and on-time completion of documentation.
• The process of capturing information in the exam room and entering the data in real-time, using their individually assigned security rights to access the EHR, is in detail outlined in the CDPM with screenshots of EHR. 
• CDPM also includes providers' directions to the scribe on the proper responses for advisories and other alerts that may appear on the screen.
• CDPM also includes the third-party payers' specific guidelines for how a scribe documents and how a physician must apply the electronic signature
• CDPM also outlines the do’s and dont’s for scribes as per the practice guidelines.
• CDPM  includes the policy on signing (including name and title) and dating all entries into the medical record for both electronic and manual documentation. The role and signature of the scribe must be identifiable and distinguishable from that of the physician or licensed independent practitioner and other staff. 
• Typical
• Documentation Duties for Medical Scribes is part of the CDPM. The  information entered by a scribe may include, but is not limited to: 
  
  
  • History of the patient’s present illness
  • Review-of-systems (ROS) and physical examination
  • Vital signs and lab values
  • Results of imaging studies
  • Progress notes
  • Continued care plan and medication lists

Ascribed encounter notes should indicate the involvement of a scribe. The scribe’s note should include: 

• History of the patient’s present illness
• Review-of-systems (ROS) and physical examination
• Vital signs and lab values
• Results of imaging studies
• Progress notes
• Continued care plan and medication lists

The provider is ultimately responsible for the contents of the document, the note should indicate:

• Confirming the physician's presence during the encounter 
• Verification that the provider reviewed the information
• Confirmation of the accuracy of the information
• Any additional information needed
• Authentication, including date and time

 

 ​​​​​​​B) Medical Scribe Formal Induction Program

The purpose of a formal induction program is to help the medical scribe settle into their position in practice.A checklist specifies all the documents and information new staff will receive on their first day on the job. A short checklist to be provided for scribes is as below: 

For outsourced scribes, some of the points may not apply. 

• An introduction to the organisation, business, colleagues, and critical stakeholders. 
• Code of conduct and Clinic Documentation Process Manual 
• Job description for the scribe with title, roles, and responsibilities. 
• Details of the work schedule
• Copy of their employment agreement, company handbook, and HR   manual
• Induction and setup of workstation, phone, and IT systems
• ID card, access control keys, name badge, etc
  
• Contact list of staff members
• HR must give training specifically to the organisation and role.
• If the physician employs the scribe, all non-employee HR standards also apply.
• Scribes must be given orientation to all information management, HIPAA, HITECH, confidentiality, and patient rights standards, just as other hospital personnel.
• Practices should make certain scribes complete training on the EHR and all other requirements before moving to the hands-on training phase.
• The medical scribes are provided knowledge of Healthcare Insurance Portability and Accountability Act compliance, medical terminologies, documentation structure, clinical procedures, billing, and coding processes. 

It’s considered best practice to give the employees plenty of written material they can reference later to refresh their knowledge.  

 

C) Hands-On Training

Working with a scribe is a significant adjustment in the workflow. As a result, a one-day trial should happen before proceeding with implementation. During the first trial days, the veteran scribe will shadow the physician for a few patients and scribe for the rest of the day. The trial's purpose is to determine the skill set for the position. Create routines to make the best use of a scribe. New medical scribes may not have “hands-on” scribing experiences. The trainee would shadow or practice scribing on fundamental clinical shifts, sometimes with a senior scribe trainer who provides supervision and feedback. After training, scribes may be subject to continuous evaluation and monitoring, such as notes review and regular meetings with a supervisor.

During on-the-job training, they should work in the production process instead of the simulated learning process. HR should introduce the scribe to the team and the company's values during the first step of the on-the-job training. The supervisor will collaborate with the trainee on specialty-specific medical terminology and then participate in simulated doctor/patient scenarios. They listen to the physician's conversation (barging) to understand accent, pronunciation, and experience real-time disease condition examination.Charting shortcuts or dot phrases increase speed and efficiency while matching the physician's preferences.

The trainee must undergo hands-on training at three levels before moving to production. 

• At level 1 of hands-on training, the scribe listens to physicians' conversations to understand accents and pronunciations. They experience real-time disease condition examination and transcribe the findings. Supervisors have to evaluate the transcribed report and provide feedback.  
• At level 2 of hands-on training, the scribe starts charting live encounters for at least two patients per day in the EHR. Pros and cons of the OJT were identified and addressed. Supervisors have to evaluate the transcribed report and provide feedback.
• At level 3 of hands-on training, the scribe handles most of the charts under the constant observation of the supervisor. 

Some of the challenges at this phase are time overrun, distraction, and safety. On-the-job training can take a long time and be disadvantageous for the organisation when the new scribe doesn't have the required skills. Time overrun may cost the company more since it takes the trainer and materials out of production for the duration of the training time. On-the-job training can often cause distraction from the regular working day, affecting productivity. Trainers should introduce Scribes to the practice's safety features and safety precautions before starting the scribing.  

 

D) Quality Checks 

The possibility of errors in documents created by scribe is a reality.  These errors can affect patients’ plans of treatment, coordination of care, coding, billing, and other documentation requirements due to a lack of detailed and accurate documentation in the health record. Organisations must include scribe programs in the organisation’s comprehensive compliance program.All staff must be educated and receive ongoing training for adherence to policies, procedures, and overall management expectations. Monitoring is also a critical factor in meeting compliance. Medical scribes are subject to audit for documentation quality,  privacy, and security practices. 

When creating policies and procedures for implementing a scribe program, the following documentation considerations, at a minimum, should be considered. 

• Authentication guidelines
• Regulations and guidance
• Continuous training
• Documentation of auditing protocols
• Privacy and security auditing protocols
• Certification and licensure
  

 

5. Performance Evaluation & Monitoring Of Medical Scribes  

The daily activity reports are delivered to the doctor at the end of the day to summarise the day's charting activities. This report will provide the inputs for monitoring the activities and performance measurements. The scribe's progress must be tracked and measured, and changes made as appropriate. It is vital to monitor and analyse the situation to ensure that you have the suitable scribe for the role in terms of personality and skill set and to make required adjustments.

The physician practice can evaluate the success of the medical scribe program by measuring critical indicators compared to the set goals. Examples of goals may include reductions in transcription/scribing costs, improvements in overall documentation, reduced turnaround time for authentication, and increased patient satisfaction. Organisations can analyse the benefits of a scribe program through standard metrics currently in use in the facility or practice. The metrics include, but may not be limited to, 

• The use of scribes contributes to at least a 15 percent revenue increase
• It has improved patient satisfaction scores.
• Changes in the number of patients seen after the scribe  per hour or day, 
• Percent of clinical time versus administrative time, 
• Number of incomplete medical records, 
• Arrival to consultation complete time

These five tips are borne out of a decade of experience in virtual medical scribing. Not all methodologies make perfect for all. You need a particular kind of methodology for your practice. Use these tips to create a method for your practice to onboard and manage Medical scribes.  

 

 

Topics : Scribing Company