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MGMA11: Physician Scribes—MU Helper or Crutch

October 24, 2011
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One Oregon medical group describes the efficiencies, but are scribes a good fit for every group?

At a short presentation in the Healthcare Innovations Pavilion on Sunday at MGMA11, which is being held in Las Vegas this year, Oak Street Medical Group CEO Betty Evans spoke about the increased productivity that physician scribes have yielded her Eugene, Ore.-based practice. Because of scribes, physicians are able to see more patients daily and maintain the quality of their care, as well as help meet the added documentation required by meaningful use, she says. Evans says the financial impact of having scribes have been mitigated by the increased productivity of the practice. MGMA reports multispecialty groups are currently running at a ratio of 5.31 support staff per full‐time physician; OakStreet is running at a ratio of 4 to 1.

Evans described that in her practice, as in many, a roomer brings the patient to the exam room and performs vital signs, medication review, and documents the chief complaint or reason for visit. A scribe, on the other hand, is generally still in medical school or has a higher-level of medical knowledge than a roomer and stays with the physician in the room to document all aspects of the patients visit. Evans says a physician has to verbalize his findings both positive and negative as he goes through examination for the scribe to document. The scribe then hands off the patient back to roomer, who follows up with items such as orders, and referrals, and generates the visit summary for the patient to take home, which is also a meaningful use requirement. Taking the doctor out of written documentation ensures the physician is doing physician-only work, Evans said.

First and foremost, when introducing scribes in a practice, Evans says to look at the current interpersonal staff dynamics to see who communicates well together, and pair accordingly, as well as involve the physician in staffing choices. Evans emphasizes the importance of good communication while setting up this team-based concept by holding regular group staff meetings to get staff buy-in. It’s also good to have the roomer and scribe meet regularly with the physician so the physician can give specific preferences in how he wants certain orders and diagnoses worded. In the Oak Street practice, scribes are directed to memorize the different pages of their physicians encounter note forms because, as Evans says, the patient doesn’t always stay on task, and might skip to a different part of chart, so the scribe can easily jump to that part of chart to continue documentation.

Evans also gave some good advice regarding EHR development for medical groups. She said her practice builds custom forms based on personal physician style. “We wanted each physician to continue to practice like they normally practice,” she said. “How do they meet with the patient, what is their normal flow, and then we created their forms based on that protocol and customized them to their individual preferences.”

Evans mentioned that they set up medication favorites that included the common medications the physician ordered for a set of common diagnoses, and set it up before go-live. Oak Street also sets up lab favorites that identify what labs the physician orders most often for particular symptoms. “Getting those set up in the system, prior to go-live, just makes the transition go easier, and makes the office visit more fluid. In our system we have the orders/referrals scenario, we predefine the referral sources and whether they require specific needs and a certain specification that goes with them, and we put those notes into the orders so they pop up for the staff. We all know that when it gets busy, there are just so many things to try to remember, so any tools we could set up to remind them so they don’t forget, makes it that much better.”

What do you think about physician scribes? Are they indeed the answer for the increased burdens physicians are carrying in the era of accountable care or they just a crutch keeping physicians from participating in the technological necessities needed for increased documentation? I’m curious to get your thoughts. Please take the survey below.