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    How to use scribes to get off the computer and in front of patients


    EHR decreases patient satisfaction when it vies for the physician’s attention. One proposed solution is the use of scribes. Scribes are staff members who help reduce indirect patient care demands by documenting the patient encounter on the EHR for the physician. This enables the physician to focus only on the patient. The physician is free to concentrate on patient concerns, repeat key points, and take time to explain medical results to their patients in a simplistic way. After the encounter, the physician reviews the scribe’s note to ensure the documentation is complete, attaches orders, and signs the note. According to a 2013 study in the Journal of ClinicoEconomics and Outcomes Research, this results in physicians who feel more efficient when using scribes, and patients who believe the physician is more attentive, compassionate, and courteous during their interactions.


    Related: How to eliminate EHR-based medical errors


    Motion Sports MD is an innovative primary care office in Murrieta, California, that incorporates scribes with its EHR to maximize profit and increase patient satisfaction. Dr. Jerry Hizon, the physician-owner of Motion Sports MD, designed the office on the theory that “the key to a good EHR is the minimal touching of keys.” The office utilizes four scribes, each of whom underwent a minimum of 60 hours of supervised training where they learned medical terminology, basic medical questions to ask a patient, and how to take reliable notes in any routine outpatient healthcare scenario.

    At this office, the duty of the scribe is to update the medical records of the patient since his or her last encounter and determine the purpose for the patient’s visit. Once this information is presented to the physician, the scribe transcribes the physician-patient encounter through a combination of free typing and completion of pre-made templets. The scribe also documents all procedures performed in the office, new imaging and/or laboratory results, and any notes from outside physicians. After the patient leaves, the physician quickly reviews the scribe’s notes and uses voice dictation to make changes and place orders. The physician then either signs the note verbally or with minimal keystrokes to close the encounter.

    By using scribes, the physician does not need to type or even look at a computer screen during an encounter unless reviewing recent laboratory results or imaging, or educating a patient. Even in these instances, a second computer is present in each room and is connected to the internet with pre-bookmarked websites to allow for quick viewing of patient imaging and brief videos to educate patients on different diseases, injuries, and important preventative medicine topics.

    The room is designed so that patients can watch these educational videos on a mounted computer monitor while the physician is performing the ritual of the physical exam. This decreases the amount of time spent in silence, helps distract the patients so they are more relaxed, and gives patients a better understanding of their disease process. The remainder of the physician-patient dialogue is spent clarifying information for the patient and discussing the next step in diagnosis or treatment.


    Hot topic: Should physicians share their notes with patients?


    Dr. Hizon conducted a study to determine how effective his implementation of EHR was in improving patient satisfaction and office efficiency.  He found he was able to see an average of 35 patients in a day while maintaining an average patient satisfaction rating of 4.9/5.0. The use of scribes allowed him to spend 93.7% of each patient encounter directly interacting with the patient.

    Next: More profit and more efficient


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    • Anonymous
      A scribe shouldn't be in the room without patient consent first and foremost. If the patient is there for a physical for example, I'm sure they don't want someone else in the room with them. A scribe in the room will only serve to inhibit the patient so they won't really talk to their physician whereby wasting everyone's time. Not a good idea. Regards, Raffie
    • UBM User
      the authors tell us that emr "promotes quality care by improving provider to provider communication,endorsing pt safety,and promoting pt to pt relationships etc.I have searched high and low for any RCTs that come close to proving this I know that is the intent but other than wishful thinking I ask the authors to show any RCTs that prove this.EMR is are a failure in office practice and are now optional in many countries A nassive waste , burden saves no money and does not improve care except for the bank accounts of vendors ,coders and bureaucrats
    • Anonymous
      Scribes is such a great idea! Who pays for them? Are they reimbursed by insurance companies? Why does my office have to hire a coder to assign special codes for what I do so their insurance company will pay me? Can I get that reimbursed as well? That has nothing to do with medicine. It's just one more overhead/admin item that gets in the way of me treating my patients. Speaking of getting in the way, where will this scribe stand? My exam rooms (I practice in downtown Washington DC where office space is a premium) are already sometimes too tight for the patient and a family member. I feel like so much of the way medicine is heading is not based in practical reality (ie. getting paid based on customer satisfaction). That's like trying to befriend your kid....it's not a popularity contest and often I'm handing down advice my patients do not want to hear or they would already have healthy habits (eat less, stop smoking, move more). Oh well....let's just kick the can for the next generation of doctors and patients to fix, ahem, deal with.

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