Ask any doctor what it's like learning how to chart on the electronic medical record (EMR), and you'll likely get a response similar to that of Dr. Chris Johnson.
"The transition to any electronic medical record is extremely painful," says Dr. Johnson, Medical Director at Community Memorial Hospital (CMH) in Ventura, CA.
Healthcare providers nationwide are facing a federal mandate that requires all patient records to be electronic based by 2014. For doctors accustomed to paper charting, it's a move that not only reduces productivity but could potentially cost millions in lost revenue.
Maine Medical Center in Portland, Maine cited a $13.4 million loss over 6 months after implementing their EMR system. The reason: Reduced charge capture due in part to the lack of training clinicians received on capturing billable codes in the EMR.
Dr. Johnson said hiring trained EMR specialists called "scribes" helped offset the initial costs by allowing doctors to focus on patient care rather than documentation.
Medical scribes are non-clinicians whose sole focus is capturing data during the patient examination. They are typically pre-health students who use the position as a way to gain experience before applying to medical school. CMH pays about $20 per hour for a scribe vendor but Dr. Johnson says the return on investment has been surprisingly high.
"Scribes have made the transition to the EMR practically seamless," says Dr.Johnson, who uses Emergency Medicine Scribe Systems (EMSS), a scribe vendor based out of Los Angeles. "The scribe program provided by EMSS has helped us increase our patients per hour over the past two years by about 12.5 percent. Our charges per hour have gone up about 15 to 20 percent, and we haven't had to increase physician hours."
Dr. Kevin Parkes, Medical Director at San Antonio Community Hospital in Upland, CA said their quality of charting went down after switching to the EMR.
"One of our biggest problems was losing the detail of the hospital course," said Dr. Parkes, who started using EMSS scribes in 2007. "Since we got the scribes, the detail and the content of the hospital course is far better than it was, and that's very important in terms of patient care."
Dr. Parkes also said they covered the cost of the scribe program almost immediately since providers were able to see 1 to 2 more patients per hour.
Currently, about 500 hospitals use scribes and most of them are in the Emergency Department. But the number of hospitalists and outpatient clinics using scribes is growing.
Peg Loos, COO and Chief Compliance Officer at District Medical Group, says they brought EMSS scribes to their Phoenix children's clinic for a smoother transition to the EMR.
"We wanted to have scribes in place to relieve some of the anxiety that surrounds implementing the EMR," says Loos. "I think it helped tremendously reduce the stress level and increase overall efficiency and patient satisfaction. Many of our physicians love having scribes and said they wish they could have them in their other offices too."
EMSS President Garret Erskine says scribes are quickly becoming a solution for doctors who otherwise face learning a new charting system. EMSS trains scribes to optimize the EMR resulting in improved charge capture for the provider, according to Erskine.
"Instead of having a physician who makes $150 or more per hour focus on clerical work, we can offer scribes to chart for a fraction of the cost," he says. "This frees up the doctor to focus on the patient, which ultimately improves productivity and patient satisfaction levels. Meanwhile, the scribe is capturing all the data for accurate reimbursement."