Is Technology Disrupting Medic Scribe Industry?
Physicians spending between 1.5 hrs to 4 hours on EHR software every working day to create clinical documentation. This leads to over work, loss of productivity and burnout among doctors. This has been validated by by Mayo Foundation for Medical Education and Research also confirms this. Mayo Clinic proceedings “The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians”. An excerpt from the research "The usability of contemporary EHRs, as measured by US physicians using a standardised metric of technology usability, is significantly poorer than that of most other technologies, and thus receives an F." There was a robust dose-response association between EHR usability and physician burnout risk. Given the link between EHR usability and physician burnout, enhancing EHR usability could be a useful strategy for reducing health-care burnout.”
Clinical scribes, more common in North America, were introduced to reduce the burden of electronic documentation on clinicians. Scribes are trained to work with clinicians, translating information in clinical encounters into meaningful and accurate records, and allow clinicians to better focus on the clinical aspects of the consultation. Having scribes on the team can improve revenue and patient/provider satisfaction, and may also improve patient throughput. but this EHR ‘workaround’ also liberates clinicians to focus more on patients.More likely, human scribes are a role model for a new generation of documentation technology the digital scribe.There are three basic methods for finding a scribe: Physical medical scribe, virtual medical scribe, and technology lead documentation .
Let us examine the benefits and drawbacks of each choice.
1. Completely Human Led Medical Scribing In Physical Form
A medical scribe is a physician's assistant who records patients' family and medical histories, treatments, allergies, lab results, and any information dictated to them or relevant to the patient's visit. Because they are familiar with medical language and have some clinical knowledge, a medical scribe frequently writes like a doctor would, checking for errors. In the event of inconsistencies, they notify the doctors, assist in resolving the issue, and even complete records. They are not, however, in charge of deciding on the patient's therapy or care.
The scribe electronically captures all information, and their work is accessible to clinicians who need to review the patient's medical history. Managers, who are frequently nurses or quality assurance specialists, oversee the work of medical scribes. Scribes enable doctors to focus on their patients while performing clerical responsibilities by noting every occurrence and treatment procedure. A medical scribe's good work improves the efficiency of the doctor-patient relationship and ensures the correctness of vital health data.
These people accompany doctors and are there during patient visits to help doctors while simultaneously recording all information in EHRs. They enter inquiries into EHRs so that doctors may monitor the patient's development and decide on the next course of treatment. Historically high turnover rates amongst scribes who are often awaiting medical school acceptance or credentials for a provider role and the cost & time associated with training and onboarding scribes to a practice’s workplace and the inefficacy of medical scribe companies become crystal clear. The average cost of a physical scribe may exceed US$ 3000.
Scribe America vendor.
2. Partly Technology Led Medical Scribing In Virtual Form
When a summary is generated from human speech instead of a set of documents, additional tasks emerge, such as speaker identification and SR, as well as more classic natural language processing tasks. These include mapping recognised words and phrases to a common language reference model, and the use of hybrid methods, such as rules to populate pre-defined templates, e.g. for well-defined sections of a clinical note such as medication or allergies.Deep learning methods can be used in tandem with such approaches, or on their own. Once a machine readable summary is created, methods for the automated generation of text from such structured representations can create a human readable version of the information.Whilst much effort is currently focussed on automating the summarisation process, it should not be forgotten that humans are a ready source of context cues. Many difficult problems in natural language processing may be solved by good human computer interaction design.
Many hospitals are now remotely recruiting medical scribes from countries such as India to connect with doctors via video or audio chats. Hospitals typically hire through an agency, however certain companies may hire directly. These organizations are in charge of guaranteeing compliance and facilitating interactions between doctors and scribes. Because the interactions entail sensitive information about the patient, they take place over highly secure lines.The average cost of a virtual scribe is $16 per hour. They are far less expensive, but incur costs for audio conferencing services and remote log in software licenses.
Some services offer a hybrid of technology and human engagement, as well as virtual medical scribing. The fees might be reduced at US$ 12. Cost, availability, turnover, learning curve, and human mistake are all disadvantages.
Physicians Angels, Microsoft Nuance, Augmedix, and Scribe4me are among the vendors.
3. Medical Scribing By Robots
A third type of digital scribe, the "autopilot" digital scribe, is totally computer-driven in the documentation process. Human involvement is only used to help the machine resolve certain ambiguities in the therapeutic encounter, such as clarifying aims and intents, requesting missing details, or resolving contradictions. For highly controlled and well-defined encounters, such as routine clinic visits to monitor patients for chronic illness or post-operative recovery, the entire documenting process may be entrusted to automation, with humans only called in when deviations from the expected process may occur.
Achieving this level of documentation system necessitates the use of AI, machine learning, cognitive science, and autonomous technologies such as robotic process automation. These systems will automatically log clinical contacts and will only prompt humans in extreme cases. These systems have high quality location aware automatic speech recognition and medical NLP, which when combined with speaker identification, allows for speech-driven interaction anywhere in an environment.This may cost as little as $500 to $750 per month and be available 24/7 with no constraints on the number of patients or hours. Disadvantages include communication difficulties, scribe turnover, a steep learning curve, and human mistake.
Recommended Reading: Digitalization Of Health Records Using Robot Medical Scribes
Cost, Workflow Challenges
The implementation of any new system, program, or practice brings its own separate set of challenges that must be considered and managed carefully. The use of a medical scribe is no exception to that fact. Challenges include:
- A non-physician provider (i.e., nurse practitioner, physician assistant) in the role of a scribe in a physician setting would only be counterproductive in most cases. The non-physician provider would be used most effectively by independently seeing other patients.
- Scribes in the exam room may cause patients to be less honest and forthcoming with pertinent information for accurate diagnosis and treatment, impacting the overall quality of care.
- Scribes will change current documentation workflows and responsibilities. These workflows will need to be redefined and responsibilities identified to streamline the process.
- Provider verification and authentication of scribed documentation for accuracy may slow down overall workflow.
- Use of scribes may help cut costs. However, if the scribe is inexperienced and does not have medical terminology and clinical workflow knowledge, this may cause documentation errors leading to greater issues (i.e., increased costs, decreased turnaround time, and billing and medical errors).
- Some providers may not take the time to review scribed entries for accuracy before authentication. So, the possibility for errors is present. These errors can affect patients’ plan of treatment, coordination of care, coding, billing, and other documentation requirements due to lack of detailed and accurate documentation in the health record.
- Scribes in the exam room may not result in the providers’ ability to generate additional revenue to offset the expense of the scribe.
- When a scribe is not available, providers may not be able to navigate the system independently or efficiently.
Topics : Ambient Intelligence In Healthcare