As physicians attempt to identify ways to reduce the clerical load associated with electronic health records (EHR) data entry, they are increasingly turning to medical scribes. Research in many medical specialties has shown that the addition of medical scribes to the clinical team enhances physicians' practice experience and increases productivity. Scribes are now the fastest growing medical field. Estimates published in The Journal of the American Medical Association suggest that the number of scribes will grow almost five-fold by 2020 to over 100,000, with one scribe for every nine physicians.
In the Journal of American Board Family Medicine, a study concluded, "In an outpatient family medicine clinic, the use of scribes substantially improved physicians' efficiency, job satisfaction, and productivity without negatively impacting the patient experience.” The study noted that the physicians in the practice spent an average of 5.1 fewer hours per week on documentation, and the annualized projected return was more than double the salary cost for two scribes.
Scribes may perform a variety of functions, including doing pure transcription of the encounter, using templates or macros within notes, placing orders, finding information in the EHR for the doctor, or even responding to patient messages.
There’s a great deal of focus being spent on a national standard for the credentialing of medical assistants and the certification for scribes. And when it comes to Meaningful Use and certified EHRs, there are lots of questions surrounding the topic.
CMS recently clarified its policy on the use of scribes and stated, “Due to recent law, we are revising our policy on scribes for the Medicare and Medicaid HER Incentives Programs such that scribes may document in an EHR as long as the physician delegates this action, signs and verifies the documentation and the action is in accordance with applicable State law.” Additionally, California law does not yet require certification of scribes. But there is a lot of discussion about this requirement and from a medical liability standpoint, it makes good sense to utilize certified scribes within your practice.
Although there is very little regulation or standardization for scribe training, and researchers haven’t conducted any assessment of scribes’ ability to safely interface with the EHR, these risk strategies could reduce liability associated with the use of scribes:
- At a minimum, all scribe-generated orders should be signed by a provider prior to implementation.
- The practice should document the competency of the scribe for the functions the practice deems appropriate, especially with safe and effective use of EHRs.
- Routine quality checks should be implemented to identify areas for improvement in documentation.
Conclusion
The combination of rapid growth in scribe use, lack of licensure, variability in scribe experience, and variability in both EHR exposure and EHR workflows raises a concern for all practices that utilize or wish to use scribes. Utilizing credentialed medical assistants and scribes benefits your practice by providing a reliable quality assurance mechanism, more efficient use of resources, and more EHR entries counted toward CMS incentive programs.
Ann Whitehead is Vice President, Risk Management and Patient Safety for CAP. Questions or comments related to this article should be directed to awhitehead@CAPphysicians.com. The information in this publication should not be considered legal or medical advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.