Health Care & Insurance  June 16, 2017

Doc gets more patient time with scribe at the keyboard

In ancient times, a member of a learned class who copied holy writs and often served as a teacher was known as a “scribe.”

Today’s scribes are copying and teaching as well — but as invaluable members of health-care teams, helping doctors and physician’s assistants complete medical records in real time.

Physicians used to be able to focus solely on patient care, but with the advent of electronic health records in the 1970s, they suddenly found themselves burdened with documentation and clerical responsibilities that got in the way of interacting with people in their care.

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Enter the medical scribe, essentially a personal assistant to the doctor. The scribe takes notes as the doctor talks with and treats a patient, thereby freeing up the physician both to have more face time with each patient and see more patients.

According to ScribeAmerica, a national company that trains and places scribes and whose Colorado offices include locations in Fort Collins and Loveland, being a scribe is a great experience for a pre-medical student who can gain real-world experience by shadowing a doctor.

Dr. John Bender, owner of Fort Collins-based Miramont Family Medicine, sees the job of scribe a bit differently.

“I don’t think a med student would make a good scribe — but they should learn how to use scribes,” he said. “Maybe they can work in that position for the first few months so they’re nicer to the scribe.”

Bender began using scribes “kind of inadvertently,” he said.

About seven years ago, “I had a partner who was diagnosed with a brain tumor,” Bender said. “I came into the office and told my office manager that we had to either cancel all his patients for six weeks and lay off a third of the staff or figure out how to see all of his and my patients at the same time.

“We’d just gone live with electronic health records. I didn’t really like typing all the time anyway, and asked my two most senior medical assistants if they could type while I was talking. They just had to fill in the template and I would give them the care plan. They would be able to finish with the patient still in the room, and I could get started in the next room with the other MA. By the time I was finished, the first MA would be ready again; we could just leapfrog.

“Before,” he said, “even though I was in the room 20 minutes with a patient, about half that time I wasn’t looking at the patient, just typing. Now I could spend more time with the patient.”

Bender and his staff worked that way until his partner returned, then decided to extend the system — “and so our scribing program was born,” Bender said.

“There’s a lot of misunderstanding about how scribes can be used,” he said, noting that at a recent conference in Kansas City, he asked how many of the doctors used scribes and “not a single hand went up.”

Bender often fields colleagues’ questions about scribes, such as, “Will you excuse a female scribe when doing sensitive work on a male patient?” He answers, “No, I don’t.” They ask, “At the end of the day, don’t you check her work?” He answers, “No, I don’t need to.”

What about privacy? “It’s actually to patients’ advantage to have that person in the room,” he answers. “They quickly realize she is an access person to me. They can call between visits, and my scribe will answer the phone.

“Care coordination happens at a much quicker pace. The competency level is at a much higher level. She acts in some ways as a co-pilot. A good scribe will know my care plans almost as well as I do. If I’m treating a patient and forget something, my scribe will say, ‘Oh, Dr. Bender, don’t you also want to order such-and-such?’ She’s a cross check.”

Bender emphasized that his scribe is a full partner in patient care.

“This isn’t just a DragonSpeak thing where they’re just mindlessly typing the words,” he said. “It’s a team-based platform where we are talking back and forth, like a pilot and copilot in the cockpit.”

Pre-med students who serve as scribes in hospitals sometimes make as little as $10 an hour. Even though it’s not much money for a large time commitment that’s on top of a full undergraduate course load, many feel the experience is worth it.

In Bender’s scribe model, however, “We pay ours a little better than some — maybe $22 to $27 an hour,” he said. “At the absolutely lowest, I could pay $15 to $16 an hour, but I’d lose ’em to UCHealth and Banner (for other types of health-care jobs there) within a year.”

Many hospitals and health-care facilities haven’t figured out how to make scribing profitable yet “or made the business case for it,” Bender said. “We’ve been able to figure it out.”

Whereas a physician’s assistant is a provider who can diagnose and prescribe, while a medical assistant performs more rudimentary tasks such as taking vital signs and medical histories, Bender said, a scribe “sits in the room with the doctor and puts in all parts of the note. I can step out of the room and trust that the scribe is going to get all parts of my observation correctly.”

That trust is earned through careful training, he said. In Bender’s system, prospective scribes would work at Miramont for at least a year and earn a positive performance review. They’d need good basic English, syntax, grammar and spelling, and prove their skills as a medical assistant and customer-service provider. Next would come a six-week training program, “in which they shadow one of our scribes,” Bender said. “Then we put them onto a team and review their notes for about two weeks. They’re also reviewed by a biller because they know how to bill and code.”

Bender’s current scribe of choice, Amelia “Maley” Birdwell, has worked with him for three years.

Armed with an associate’s degree in radiology from Aims Community College, Birdwell was hired at Miramont in 2013 as an after-hours X-ray technician.

“I worked for a year, including some nights, with Dr. Bender,” she said. “I was transferred to days, then we got really busy one day. I knew my scribe training was coming, but he said, ‘Have a seat. Your scribe training begins now.’

“I like that I learn something new every day, from him and our patients — things I’d never learn in any other job,” Birdwell said. “I’m getting more medical knowledge and ways to better myself in the workforce, much more than being an MA roaming around and doing patient intake.”

Birdwell said it took her about six months to feel that she knew what Bender was thinking.

“Now, I can start typing the care plan even before he finishes telling the patient,” she said. “That’s been pretty fun. It happens every day. I know what he’s going to do sometimes even before he says it. But every decision I make, I go back to Dr. Bender and make sure that’s something he would like.

“I enter the room a couple moments after Dr. Bender has already started, so he has a chance to address a patient’s complaints,” she said. “I enter the room as he’s doing that, and I take over the computer. When he leaves, it’s my responsibility to walk the patient to the front to our checkout station, where I do what’s called a ‘warm handoff’ to our receptionist to schedule future appointments either with him or any of our other services, including psych, clinical or the pharmacist.

“I hand them a care plan, printed out, because they might understand it in the room but as soon as they leave the building, they’re like ‘What was this again?’

“Some of them say they’d come and see me if Dr. Bender was out of town,” she said. Even though she knows that as a scribe she can’t perform the duties of a physician’s assistant, “those statements are pretty cool to hear.”

Cool enough to want to advance to the post of PA — or even physician?

“Dr. Bender asks me every week if I’m going back to school to be a PA,” Birdwell said. “Every week, I tell him, ‘Not quite yet; I really appreciate what I do. Just being able to experience what our doctors and nurse practitioners do daily is rewarding. I’m really happy where I’m at right now.”

For Bender, that spells relief.

About 64 percent of U.S. physicians show signs of burnout, he said, mostly from dealing with regulations and electronic health records.

“Scribes go a long way to alleviate both physician and patient unhappiness,” Bender said. “It improves my quality of life. I’d never go back.”

In ancient times, a member of a learned class who copied holy writs and often served as a teacher was known as a “scribe.”

Today’s scribes are copying and teaching as well — but as invaluable members of health-care teams, helping doctors and physician’s assistants complete medical records in real time.

Physicians used to be able to focus solely on patient care, but with the advent of electronic health records in the 1970s, they suddenly found themselves burdened with documentation and clerical responsibilities that got in the way of interacting with people in their care.

Dallas Heltzell
With BizWest since 2012 and in Colorado since 1979, Dallas worked at the Longmont Times-Call, Colorado Springs Gazette, Denver Post and Public News Service. A Missouri native and Mizzou School of Journalism grad, Dallas started as a sports writer and outdoor columnist at the St. Charles (Mo.) Banner-News, then went to the St. Louis Post-Dispatch before fleeing the heat and humidity for the Rockies. He especially loves covering our mountain communities.
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