EHR Scribes
A Post-Implementation Strategy
Ann Murphy, MD -- Charles Kitzman CIO – Michaela Mangas
Shasta Community Health Center, Redding CA
Fast facts….
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30 FT Provider FQHC
Live on
since May 2007
130,000 encounters annually
Multiple services
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Primary Care
Pediatrics
Primary Care Neuropsychiatry
Urgent Care
Homeless Van
Various Specialties – Rheumatology, Podiatry, Neurology, etc
and a partridge in a pear tree…..
Live on EHR….so what’s the problem?
Pilfered from thisisindexed.com
Weighing the results
Eh?
Good stuff
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Legible charts
ePrescribing
Solid lab interfaces
Flexible platform
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Enhancement process
Individual practices
Reduced access/capacity
Flexible platform
2 areas to address….
Documentation/Quality
• Organizational
undercoding
• Data capture could be
better
• Pt. Satisfaction surveys
were critical of EHR
processes
Productivity
• Very gradual decline in
productivity
• Increase in billable hours
• Clinician burnout
• Difficult recruitment
• Primary care less popular
than $pecialty care
Big on ideas, short on cash….
Score!
Grantor
3rd party Evaluator
4 month evaluation period*
*Probably too short but more about that later
Scribing Goes Way Back!!
Applying old methodologies to newer processes
Early on….setting the table
• Clinician interest was quite low
• Trust/Control Issues
• Our method of “selling” the idea was flawed
• “Barnum & Bailey – Get ‘em in the Tent” approach
• Learned quickly that familiarity is best
• Had to develop Training/Assessment Process
• Michaela was a big help – ER experience
• System/Clinical parts – Set guardrails
• Develop standards for scribe candidates
• College educated – Interest in medicine
• “JV Residency”
Scribe Profiles
Lead Scribe Works with Clinician
Train New Scribe Candidate
Outline Preferences
Train w/Clinician
Document workflow Learns System
Clinical Homework Shadow Lead Scribe
Dev Training Tools
Handoff
Query for Common “Scribrary”
• Dx – Meds - Ordering
Sample Visits
See 1 - Do 1
Go live
Recruitment and Training Process
Risks
• CPOE numbers could be impacted
• Clinicians could be left “stranded” if they don’t
have a scribe
• Gender issues may interfere with care
• Learning/Training curve might negatively impact
access
• Scribes might be traumatized by our patients
Sample Group & Criteria
Control Group
Surprises
• “Saves at least an hour of work.”
• “I enjoy the ability to focus on my patients.”
• “My notes are actually better and contain
more data.”
• “It makes a difference in how my day goes.”
• “I sure miss my scribe when she’s out sick!”
Clinician Testimonials
Case studies
• First Case – MD
Veteran Clinician
• Documentation – Initial E/M coding 90% Chief Complaint 90%
W/Scribe showed Moderate improvement.
• Improved timeliness of notes
• +108 Encounter over the same period the year prior
• 1.09 Enc/Ttl Hours  1.32 Enc/Ttl Hours
Case studies
• Second Case– FNP
With Practice 5 years
• Documentation – Initial E/M coding 45% Chief Complaint 75%
• W/Scribe showed good excellent improvement.
• Decrease in getting notes done day of visit
• Access - +2 encounters over same period year prior
• 1.23 Enc/Ttl hours 1.42 Enc/Ttl hours
Case studies
• Second Case– MD
Approaching Retirement
• Documentation – It’s Better to actually show you.
Conclusions
Conclusions
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Clinician/Scribe Perspective
Questions