Although the influx of electronic health records (EHRs) in physician practices over the last several years has had constructive effects on many aspects of patient care, this technology movement does have its drawbacks too: in doctors’ exams rooms these days, patients often find their doctor’s attention is being focused on a computer or laptop. As such, some doctors have hired scribes, assistants to make notes into the computer while the doctor speaks with the patient; others enter the information themselves as they talk to the patient.
For small and solo physician practices especially, the negative side effects of their EHR implementation—such as the burdens of data entry and box-checking—surely hit harder than they do for larger patient care organizations that can better shoulder the costs with the resources to bring in more physicians. But for these health systems’ smaller brethren, the constant attention being paid to the IT systems can hurt the doctor-patient relationship. Par Bolina, M.D., chief innovation officer at New York City-based healthcare solutions company IKS Health, compares the lack of face-to-face interaction to “doctors who text while driving.”
IKS Health’s virtual scribe technology is currently being used by more than 200 physicians in the U.S., one of them being Ryan Jones, M.D., an internist at USMD Medical Clinic of North Texas. Jones started piloting the virtual scribe software last January after hearing about the potential of the service from other doctors at a medical conference. “Just trying to get everything done that a primary care physician encompasses is virtually impossible in the scope of one day. Any help is welcome,” Jones says.
The technology specifically works by installing microphones in the exam room that record the patient and doctor discussion, which then automatically transcribes the visit into an EHR for follow-up care. Jones says that at the beginning of every patient encounter, the nurse goes in the room to get his or her consent. Then, the recording begins when Jones comes in herself, though the patient has the right to ask for the microphone to be turned off at any time. After the patient visit is completed, the recorded encounter gets sent to a team of medical professionals who Jones works with in India, who listen to the recording and turn it into a “thoughtful note.” Those files are then transferred to IKS where they are encrypted; this security measure means they are not able to be played on any terminals outside of IKS’ network. Jones will review the note the next day and approves of the coding, such as tests that need to be done or medications that need to be managed.
What helps the progression go smoothly is that the outside team in India is comprised of all MDs, so Jones says they are able to process the note in the same way that she would, despite a rocky beginning in which back-and-forth calls between Jones and the team took place every day. “But after a few months, there was hardly anything to edit; we’re on the same page. It flows very nicely,” she says.
Ryan Jones, M.D.
Prior to deploying the technology, Jones says she was always doing the notes herself. She had a computer in the exam room and was typing while at the same time talking to the patient, thus doing the majority of the note while being in the room with the patient. “I would have to finish some of the chart at home during the night; I was trying to strike a balance between attempting to make eye contact with the patient and typing a coherent sentence. “But with this [approach], the notes weren’t pretty at the end of the day. It was a hard balance to strike,” Jones says. “A few times I brought my nurse in with me to do some of the typing while I saw the patient, but that was never the most comfortable for the patient, and the nurse had a million other tasks to do outside of the exam room. So I didn’t think that was a very viable option.”
But now, with the virtual scribe, Jones says that the quality of her notes is drastically improved. “I am always strapped for time, so I am now able to articulate my thoughts while I’m in the exam room with the patient. And the patients love that; they hear your thought process as you are describing it for the scribe, because all of the documentation is done during the patient encounter. It’s not like the old system where you leave the room and dictate the note after the patient leaves. It’s all in front of the patient,” she says.
What’s more, Jones isn’t the only one benefiting from the software assistance. According to Dr. Bolina, the collected and measured outcomes from all physicians who have used the virtual scribe service in the last year have proven very positive, including: a 65 percent decrease in documentation time (which translates into about 1 to 2 hours of time saved per doctor per day); a 5 to 10 percent increase in patient visit volume (depending on how much time the doctor reinvests); a 25 percent increase in coding accuracy; and an 80 percent reduction in after-hours use. IKS Health officials also said that more than 98 percent of all patients have approved of the recording after explanation.
Jones says that in her practice, the patient approval rate is actually higher than 98 percent. She notes that the EHR she has at USMD is the only one she’s ever known since coming out of residency six years ago, meaning she doesn’t have much to compare it to. “But I will say that the patient experience has definitely improved now that I am not buried in my computer so much. There just aren’t enough hours in the day and we have a lot of people to take care of. The virtual scribe has helped that relationship.”
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