Points to Consider Before You Hire a Scribe for Your Practice
By COPIC’s Patient Safety and Risk Management Department
The average physician in an outpatient setting spends 1–2 hours an evening finishing their medical records.1 This has led providers to look for new ways to decrease EHR frustration and improve patient interactions, while still maintaining personal satisfaction. Is a scribe a possible fix for documentation tasks? What should you consider before hiring a scribe? Is there a risk of introducing a scribe into the physician-patient experience?
Key Considerations
The Joint Commission (TJC) released updated information2 in April 2020 about using scribes that identified the following potential quality and safety issues:
Unqualified staff performing documentation assistance
Unclear role and responsibilities when providing documentation assistance
Documentation assistants using the physician log-in rather than independently logging in to the EMR
Failure of physicians or licensed independent practitioners (LIPs) to verify orders or other documentation entered during clinical encounter
TJC also updated its definition of a scribe to say that “A documentation assistant or scribe may be an unlicensed, certified (MA, ophthalmic tech) or licensed person (RN, LPN, PA) who provides documentation assistance…consistent with the roles and responsibilities defined in the job description, and within the scope of his or her certification or licensure.”
At a minimum, TJC noted that all persons performing documentation assistance have education or training on the following:
Medical terminology
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Principles of billing, coding, and reimbursement
Electronic medical record (EMR) navigation and functionality, as appropriate based on job description
Computerized order entry, clinical decision support and reminders, and proper methods for pending orders for authentication and submission
The amount of training will be dependent on a person’s experience and skills. TJC says that clarity regarding roles and responsibilities of a scribe should consider the following:
Policies and procedures: Each organization should develop a policy/procedure regarding processes associated with personnel providing documentation assistance. Policies may include proper log-in procedures (such as prohibition of documentation assistants from using the physician or LIP’s log-in), the scope of documentation that may be entered, requirements for physician review of information and orders entered by the documentation assistant, and the order entry and submission process.
Job description: All organizations utilizing personnel to provide documentation assistance must have job descriptions that define the minimum qualifications to perform this function and the allowable scope of activities that can be performed. Job descriptions should also specify plans to periodically assess performance and continued competence.
Orders: All types of personnel performing documentation assistance may, at the direction of a physician or another LIP, enter orders into an EMR. The use of repeat-back of the order by the documentation assistant is encouraged, especially for new medication orders. Documentation assistants who are not authorized to submit orders should leave the order as pending for a certified or licensed personnel to activate or submit the orders after verification.
The Upside
Data is scarce about how scribes might affect productivity. One EM study suggested that a scribe can increase productivity by 0.8 patients an hour.3 Another University of Chicago study4 found that an average of 1.3 new patient visits per day was required to recover the cost of a scribe at the one-year point. And for returning patient visits, it is two or three patients per day. The physician satisfaction was higher in this study and physicians felt less rushed.
Potential Downsides
An integral part of the provider-patient relationship is the patient interview. Certainly, a third person in the room may be perceived as threatening and might alter the course of discussions. One best practice is to introduce the scribe and ask permission for the use of a scribe.
Turnover with scribes is another key issue. Premed students who might be the best place to find a scribe are clearly looking to move on so they might only be around for a year or two. Ramp-up time can also be a challenge as one study5 noted that it took four weeks for each new scribe-physician team to get up to speed and adjust to each other.
1 https://pubmed.ncbi.nlm.nih.gov/27595430/v
3 Acad Emerg Med. 2010;17:490-494.
4 https://pubmed.ncbi.nlm.nih.gov/33017564/
5 Fam Pract Manag. 2016 Jul-Aug;23(4):23-27.