Scribes are one way to alleviate the burden of documenting clinical data, and according to the Journal of the American Medical Association (JAMA), can even reduce physician overtime and allow you to see more patients. In this post we’ll cover how to know if hiring a scribe is the right decision for your practice, pros and cons, and hear from pediatrician Dr. Katrina Skinner, MD, FAAP, who has led a team of multiple scribes in her medical practice for over a decade.
What is a Scribe and How Do They Help?
A scribe is a non-clinical professional who is responsible for documentation during and between patient visits. Scribes may be medical students or have other qualifications that will offer added benefits to your practice and foster the scribe’s clinical experience. But why hire a scribe for documentation?
Pediatric electronic health records (EHRs) allow for easy access and organization of data, but can take away the face-to-face interactions with patients and families that allow pediatricians to make solid connections and focus on the patients’ presentation of symptoms and body language. Scribes are delegated the role of documentation expert to take notes, note visit minutes, and according to JAMA Internal Medicine, can even allow physicians to see more patients, work less overtime, and practice more efficiently.
Who Needs a Pediatric Scribe?
“[Using scribes] is superior to anything else, because the pediatrician does tasks only the physician can do while delegating the documentation to someone else.” -- Dr. Katrina Skinner, MD FAAP
Hiring a pediatric scribe may be a great choice for your practice to improve productivity and reduce documentation overload, but it could also be a hindrance in tight exam rooms or if the budget is tight. Dr. Jeanne Marconi, a pediatrician and PCC client, shares a few reasons why and when hiring a scribe is a good choice:
- Documentation overburden -- if physicians at your practice suffer from “note bloat,” or onerous notation techniques, they spend too much time documenting, or are swamped with data entry tasks
- If your documentation is not always timely, accurate, or complete
- If A/R days are suboptimal. For a look at how your A/R days measure up, visit this calculator by the Pediatric Management Institute
- If you notice lost revenue due to poor documentation and poor coding capture
Pros of hiring a scribe include documentation that improves over time as the scribe gets to know the physicians’ note-taking habits and preferences; improved documentation; the possibility of improved diagnosis and even increased revenue, as physicians are less taxed by the task of charting and scribes may document for higher code capture. Cons of the practice may vary depending on the physician’s preference, but include the costs, turnover, the addition of another person in the exam room, and the need to train and review the scribe’s work.
How to Hire a Clinical Documentation Expert
When hiring, you should be aware of specialties or additional services you’d like to require from your scribe. If you’d like the scribe to be available both in-person and via the phone for “tele-scribing”, or if you expect them to be experts at the EHR, you should mention both in your job posting and the interview process. By the way -- if you’re considering a digital scribe, physicians have rated human scribes well above their automated counterparts for accuracy and relevance.
A great scribe should also mesh well with the pediatrician they will be working with. Since a scribe is sometimes referred to as a physician’s “right hand” or “shadow,” a scribe with less experience who gets along well with their physician may be an overall better fit than an experienced scribe who doesn’t fit the practice culture or the physician’s way of practicing medicine.
A qualified scribe may possess accreditation or license from a veritable source, such as from the American College of Medical Scribe Specialists, or ACMSS. You could also hire from an agency such as ScribeAmerica. Dr. Skinner notes that she has had excellent experience with scribes without accreditation.
Improved Efficiency, Revenue: A Pediatrician’s Perspective
According to Dr. Skinner, physicians looking to hire or train a scribe can look forward to a plethora of benefits. “The practice of using scribes is not unique to pediatrics, but in terms of the volume of patients and barriers to happiness and success, scribes can help pediatricians in terms of documentation, efficiency, and increased revenue.”
Dr. Skinner says that both non-clinical and clinical staff can be trained as scribes -- the benefit here is that employees are more easily trained on the EHR, and are already familiar with the practice and physician they work with. Electing a scribe who has the right motivations and personality is a big factor, too. Plus, she says, the customer service that patients receive is wonderful.
“Having an extra person in the room has almost never been a problem. For our practice it’s normal, it’s expected. From the customer service aspect, it’s better because the scripts, the referrals, and orders are going out promptly, which is advantageous to the patient.” She also points out that as a pediatrician, having the additional person in the exam is reassuring in case she should ever need a witness.
By training her scribes herself, Dr. Skinner has the opportunity to organize her practice extremely efficiently. She reports that she works with two to three scribes in order to have someone present with the patient throughout the entire visit, so that she as the physician can be present for the most relevant work of diagnosis and care plans, and can delegate the documentation to a scribe she trusts.
Dr. Skinner is such a huge proponent of scribes that she’s created an online ebook for pediatricians looking to get started with the process. You can access the ebook on her website here.
She’s not the only pediatrician who’s an enthusiastic fan of the practice -- Dr. Nelson Branco of Tamalpais Pediatrics in California says that scribing for his practice has worked excellently:
“It was great - not only did it allow me to interact with the patient without having to document or look at the chart, it allowed me to focus on listening to the patient and performing the visit rather than writing the note. It also meant that more information was captured; the scribe is documenting real-time rather than my note writing afterward. I would finish my day with all of my notes written, including the challenging to document behavioral health visits.”
Hiring can be an intimidating process when you’re searching for a new role or looking to expand your practice of pediatrics in new ways. Be sure to check out our webinar with Tim Rushford of PedsOne to learn more about the all-important “inner-view”, how to organize interviews, and much more to ensure you’re hiring right.