Using Scribes - Keys to Patient and PCPCH Team Satisfaction April - PowerPoint PPT Presentation

Using Scribes - Keys to Patient and PCPCH Team Satisfaction April 13, 2018 Heidi Beery and Dan Paulson

Overview What is a medical scribe Benefits to the Patient and Physician with utilizing a scribe Hiring and Training a Scribe Keys to Team and Patient Satisfaction

Disclosures None

Improving Primary Care Team Guide: Scribing Model https://youtu.be/lfuxH3htduM

What is a Medical Scribe? ● A medical scribe is the eyes and ears of a physician. They shadow physicians as they care for patients, perform exams and procedures, and review medical tests ● Scribes record all pertinent elements of the patient encounter ○ Prior to a patient’s visit, they review the medical history and help prepare the physician for the patient encounter ○ During the visit, they record the details of the patient’s complaint and examination ○ They review the test, treatment, and follow up plan with the physician ● While scribes enter information into the EMR, physicians are able to give patients more personalized attention ● Scribes allow the physician to focus on the medical decision making, thereby improving patient flow and overall outcomes.

Stats ● The American College of Medical Scribe Specialists estimates 20,000 scribes were employed by the end of 2014, and it expects this number to grow to 100,000 scribes by 2020. ● As of April 2015, at least 22 companies supplied scribes across 44 states, according to the Journal of the American Medical Association . The largest company is ScribeAmerica, with more than 5,000 scribes in more than 570 healthcare facilities across 44 states.

Benefits to the Patient and Physician with utilizing a scribe The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions J Am Board Fam Med May-June 2015 vol. 28 no. 3 371-381 and our experience

Improve Clinical Satisfaction ● You can enjoy being a doctor by delegating your clerical tasks

Improve patient-clinician interactions ● You can have more “real” face time with patients during their visit a. You have the time to address more than the chief complaint ● Patients receive more personalized attention a. Your medical scribe interacts with the EMR so you don’t have to ● Patients like having more people in the room caring for them

Time-related efficiencies ● You can quickly sign off on thorough patient notes ● Eliminating the burden of writing notes affords more time for panel management (avg of 66.8 min of inbox work per day) during the day and not after the workday, so you can go home on time and not feel burned out ● Patients are seen more quickly a. They can book appointments and see their physician sooner b. Last minute appointments are more easily accommodated

Improve Productivity and Revenue ● No studies in primary care but we can share our experiences

Ensure Quality Documentation

Medical scribes ensure your patient notes are: ● Comprehensive ● Logical, well written, and tells the story of the patient encounter ● Complete with all protocols to support essential billing codes ● Documented in real-time and ready for approval and submission ● More likely to be closed within 48 hours a. Completing charts in a timely manner is important for effective care coordination and safety

Medical scribes ensure your chart submissions are: ● Accurate ● Reimbursed at the proper chart level and not down-coded ● Reimbursed upon first submission with fewer claim denials ● Paid in a timely manner, avoiding delays and non-payment

Hiring and Training a Scribe

Options for Hiring a Scribe ● Train current staff (usually an MA) ● Hire new staff ○ Someone with a background in Medical coding, English major, Pre-nursing student, Pre-medical student, Medical assistant or certified medication aide, or Medical transcription ● Scribe company ○ Which may include virtual scribes. A Virtual Medical Scribe is a non-clinical off-site assistant who documents remotely with the use of visual and audio technology. Given the remote access, a VMS may work from any location worldwide.

Components to Training a Scribe ● Their role and responsibilities ● HIPAA compliance ● Professional etiquette ● Clinical operations ● How to use an EMR ● How to properly document the patient encounter ● Billing codes and protocols

My favorite tools ● Time of Care - website with loads of assessment and plans cited from AAFP a. www.timeofcare.com ● Billing guide a. https://www.mdedge.com/sites/default/files/Document/September-2017/5711JFP_Article2.pdf

Regulations The Joint Commission does not endorse or prohibit the use of scribes. The Joint Commission permits scribes to document the previously determined physician's dictation and/or activities, but does not permit scribes to act independently, with the exception of obtaining past family social history and a review of systems, a technique providers use to get the patient's medical history.

Scribe Certification ● Allows scribes to enter Computerized Provider Order Entry (CPOE) and assist all clinicians with Clinical Decision Support (CDS) duties. CPOE support includes laboratory, radiology, and e-prescribing. ● Clinician who use non-credentialed medical assistants or scribes are unable to use those personnel in attesting compliance with Medicare and Medicaid EHR Incentive Programs. ● A Certified Medical Scribe Specialist (CMSS) is a credential issued by the The American College of Medical Scribe Specialists (ACMSS) ● A person holding the CMSS credential has met 200 hours of unassisted clinical workload documentation or has completed a 50-hour clinical training program.

Keys to Team and Patient Satisfaction

Chart Prep ● Scribe should arrive 30-60 minutes prior to first patient ● Scribe prepares all patient charts for the day a. Review records b. Generate preliminary notes c. Populate a template in the EMR d. Summarize pertinent medical history e. Prepare to order quality metrics that are due

Scribe Introduction ● Great opportunity to improve patient satisfaction “This is Aaron, he records for the medical record, so that I can focus on you. ● “This is Emily, she is a medical scribe who records the computer records so ● that I can spend more time with my patients.” “This is Ryan, he is a medical scribe who helps me with the computer stuff ● so I can focus on patient care.” “We use scribes so that doctors can keep their patients happy.” ●

In Room Communication ● Have a plan with your scribe how to communicate in the room a. Can the scribe interrupt at any time? b. Does your EMR have a messaging system they can use? c. Ask the scribe at the end for their questions or if you missed anything. d. Scribes may enter (***) if they were unable to hear or understand and need to add more information in that area of the chart

Real Time Documentation ● ALL Documentation in the room should be done by the scribe This may be painful at first, but this is how they learn a. ● If simple changes need to be done, tell the scribe during the visit ● If a complex change needs to be done, leave the note open and discuss it when there is a break, at lunch or at the end of the day.

Patient Instructions ● Scribe completes the visit summary by the end of the visit Physician reviews the note and visit summary and then the scribe prints the ● visit summary Scribe may then hand instructions to patient and instruct them how to check ● out.

Post Visit Discussion ● Physician and Scribe should spend time after each visit to discuss any question or additional details that may need to be added a. Details about the physical exam the physician did not clearly state in front of the patient b. Ensuring the chart note is complete and accurate

CPOE ● If your scribe is certified in accordance with ACMSS guidelines, per Meaningful Use guidelines, scribes are able to enter orders and sign and tee up prescriptions but not sign. ● Make sure provider verifies all orders are correct

Administrative Duties ● Scribes can perform specific administrative duties to maximize their value during slow times in clinic. It is up to each clinic/provider to determine what other duties their scribe may perform.

Tips from a scribe ● Be patient ● More information is better ● Be clear about your expectations ● Review the notes and give continual feedback

Successful Scribe Users ● Attached at the hip ● Great communication ● Willingness to allow slight stylistic issues to slide ● Proactive with preferences ● Keep MA’s/nursing staff informed.

Questions or comments?