Scribes, EMR please docs, save $600,000
Scribes, EMR please docs, save $600,000
New system a big selling point to attract physicians
Several EDs have introduced physician scribes to free up doctors to spend more time with their patients, but most of those departments use paper charting. At Tri-City Medical Center in Oceanside, CA, physician scribes work within the context of an electronic medical record (EMR). The approach has made a world of difference in terms of physician satisfaction, while generating financial savings of $600,000, says Gene Ma, MD, FACEP, chairman of the Department of Emergency Medicine and assistant clinical professor at the University of California San Diego School of Medicine. In addition, the department has seen a billing increase of 10% per provider per hour.
"I absolutely love it," Ma says. "We all had some hesitation at the very first, but a month into it, I couldn't take it away from the docs or they would rebel." Many physicians have said they enjoy practicing again, he says.
"It's a big selling point as well," Ma says. "We have a lot of applicants who want to come here because it's a workflow incentive, and all the part-time physicians fight to get shifts here."
Reid F. Conant, MD, FACEP, IT physician liaison at Tri-City Medical Center, says, "It makes me feel I'm providing more and better patient care. It gives a more personal experience to the patient and provides a better record." Conant also is chief medical information officer at Tri-City Emergency Medical Group and president of Conant and Associates, an independent IT consulting firm that also is based in Oceanside.
The new system has done more than win over the physicians, adds Ma. "We saved $600,000 in the first year by using scribes, and that was the most expensive year because of the training costs," he says. A quick look at how the system works makes it clear why it's both a staff pleaser and a performance improvement vehicle. "We think it eliminates concerns with EMR for the ED physicians who think it's not as quick as they'd like, because we take lot [of the work] out of the docs' hands so they can focus on the bedside and look at the patient at the same time the scribe enters the information," Ma explains.
The scribe, who stands in the back of the patient's room, grabs a small 'web tablet' when he or she sees the physician begin speaking to the patient.) The physician calls out parts of the physical exam and medical history, and the scribe enters the information. "Then we go back to the work station, I do my CPOE [computerized physician order entry] while the scribe cleans up my history. Whatever I couldn't get from the patient, they will pull in from the medical history, enter all meds into the history, complete the physical, ask me if there's anything I want to change or adjust, and then we're ready for the new patient," says Ma.
With this system, Ma explains, the physician's workflow doesn't stop for charting. As soon as the chart is complete, the scribes remind the physicians about labs or X-rays that are back, notify the physicians when the disposition is ready, and enter the diagnosis. They also prepare the discharge forms, including medication reconciliation, so they are ready for the doctor to sign.
Conant appreciates how the system enables him to multitask. "If I'm in the middle of a busy shift, I may be seeing 10 or 12 patients at a time, and I struggle to keep my head above water," he says. "With the scribe, I can be on the phone with the consultant, have a discussion, hang up, and then say, 'It sounds like Dr. Smith wants to admit the patient.'" The scribe will note that and then document his discussion with the family. "It allows the doctor and scribe to work together in parallel and leverages those strengths," Conant says.
Ma says, "If you ask doctors what they dislike most about medicine, most will say paperwork. This makes it so seamless for us and puts the focus back on the patient."
Conant says productivity has increased dramatically. "The typical response in an ED with EMR is a 20%-30% drop [in productivity], but we've seen a 6.45% increase in productivity based on patients seen per hour," he notes. "And, we've seen a billing increase of 10% per provider hour."
In addition, he says, "We have more complete charts and more robust documentation that is more easily codable to an appropriate level."
Sources
For more information on using scribes with an electronic medical record, contact:
- Reid F. Conant, MD, FACEP, Chief Medical Information Officer, Tri-City Emergency Medical Group, IT Physician Liaison, Tri-City Medical Center, Oceanside, CA. Phone: (760) 479-0303.
- Gene Ma, MD, FACEP, Chairman, Department of Emergency Medicine, Tri-City Medical Center, Oceanside, CA, Assistant Clinical Professor, University of California San Diego School of Medicine. Phone: (760) 940-3820.
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