Monthly PCMH/HH Webinar
The Use of Scribes in the
Patient Centered Medical Home
Wednesday, March 26, 2014
7:30AM & 4:30PM
Tel. 866.740.1260, ID: 2520060#
Important Webinar Notes
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Tel. 866.740.1260, ID: 2520060#
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PCMH / HH Core Expectations
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10.
Demonstrated leadership
Team-based approach
Population risk-stratification and management
Practice-integrated care management
Enhanced access to care
Behavioral-physical health integration
Inclusion of patients & families
Connection to community
Commitment to waste reduction
Patient-centered HIT
Tel. 866.740.1260, ID: 2520060#
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Webinar Objectives
 Explore how the scribe model is implemented and
utilized to enhance team-based care and improve
access
 The Wright Center for Primary Care
Courtney Dempsey
Terri Lacey
 Learn about what is working from PCMH/HH colleagues
 Best practice sharing from PCMH/HH practices
 Review important updates/information
Tel. 866.740.1260, ID: 2520060#
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The Use of Scribes in the Primary
Care Setting
Courtney Dempsey, BS, Medical Scribe
Terri Lacey, Vice President Clinical
Operations
Unlocking and Aligning Human Talent
and Work Capacity
Unlocking Capacity:
Provider Team
SCRIBE
Objectives
• Understand the use of scribes and how they
can enhance a team-based approach to care
as well as access.
• Understand what is involved in scribe training
and recruitment.
• Learn how to get- buy-in from providers to
use scribes.
• Describe who would benefit from a scribe.
• Explore the financial side of using scribes.
But Isn’t Automation Suppose to Help?
• In most industries, automation leads to
increased efficiency, even employee layoffs.
• In health care, it seems, the computer has
created the need for an extra human in the
exam room.
Growing Popularity of Scribes
• Five years ago, only 10 percent of hospitals
and doctors’ offices used electronic health
records.
• But now the adoption rate is nearly 70
percent, thanks to tens of billions of dollars of
federal incentive payments.
Transcriptionist vs. Scribe
• Medical transcriptionists are not new. Since the
1960s, physicians have dictated their notes into a
tape recorder and given them to transcriptionists
to convert into written reports, interpreting
medical terminology and abbreviations as they
worked. The notes appeared on paper charts
hours, sometimes even days, later.
• Scribes simply speed up the process, entering data
as it is gathered so that records can be viewed and
assessed instantly.
Attributes of a Scribe
Computer and Typing Skills
Knowledge of Medical Terminology
Self-Motivation
Adaptability
Intelligence
Punctuality
Attention to Detail
Responsible
Professional
Capable of working in a high stress environment
Training
• Medical scribes are trained medical
paraprofessionals who provide medical
documentation services for physicians,
physician’s assistants, nurse practitioners or
other providers.
• Many scribes are university students who
want to pursue careers in medicine, but some
have chosen medical documentation specialist
as their full-time career.
Role of the Scribe
• The medical scribe performs many tasks in the
emergency room, clinic or hospital.
• Under the physician’s close direction the
scribe will usually witness the patient
interview and physical exam, and create a
medical record for the patient based on the
interaction.
Impact on Workflow
• Medical scribes synthesize and enter this
complex information into the electronic
medical record.
• Scribes are also fundamental to workflow in
the clinical setting, following up on lab results,
facilitating specialist consultation, assuring
the radiological procedures and results are
obtained in a timely manner.
Impact on Satisfaction
• “Making physicians into secretaries is not a winning
proposition,” (Dr. Christine Sinsky), a primary care
physician at Medical Associates Clinic and Health Plans,
in Dubuque, Iowa, who also researches physician
dissatisfaction.
• Dr. Sinsky, who was an author of the article in Health
Affairs, has visited more than 50 primary care practices
over the past five years, in the course of studying ways
to stem high rates of physician burnout.
• She has found that physicians who use scribes are
more satisfied with their work and choice of careers.
• A study published jointly in October by the American
Medical Association and RAND Corporation found that
electronic health records were a major contributor to
physician dissatisfaction, as doctors negotiate between
talking to and examining the patient, and the constant
demands of the computer.
• A recent article in the journal Health Affairs concluded
that two-thirds of a primary care physician’s day was
spent on clerical work that could be done by someone
else; among the recommended solutions was the
hiring of scribes.
Triple Win
• “The patients get undivided attention from the
physicians,” … “The scribes are continuously
learning while making an important contribution,
and the physician gets the satisfaction of doing
the work they went into medicine for in the first
place.”
http://www.nytimes.com/2014/01/14/health/abusy-doctors-right-hand-ever-ready-totype.html?_r=0
Privacy Implications
• Some physicians are concerned about the
privacy implications of introducing a third
person to the examining room.
• According to one study of scribes in clinical
settings, roughly 10 percent of patients were
uncomfortable with having the scribe present.
Cost
• The cost of hiring a scribe, borne largely by
the physicians themselves, is also a concern.
• Companies typically charge $20 to $25 per
hour for scribes, who in turn are paid $8 to
$16 per hour.
• Yet physicians who use scribes say they come
out even, or ahead, financially, as they can see
up to four extra patients a day.
Time-Driven Activity-Based Costing
•
•
•
•
•
Estimating the cost per time unit of capacity
Estimating the unit of time for activities
Deriving cost-driver rates
Analyzing and reporting costs
Updating the new model
–A
Robert S. Kaplan and Steven R. Anderson. (2004). Time-Driven Activity-Based Costing.
Harvard Business Review Reprints, 1-10.
Time Based Primary Care Visit
Process Map Example w/o a Scribe
Time Based Primary Care Visit
Process Map Example with a Scribe
Time-Driven Activity Based Costing
Function
Position
Time on Min.
Per Min. Rate
Cost
Schedule
Appoint
Scheduler
3
$0.25
$0.75
Check-In
Front Office Staff
4
$0.25
$1.00
Room Patient
MA
8
$0.26
$2.08
Documentation
MA
3
$0.26
$0.78
Physician Eval
Doc
13
$1.89
$24.57
Documentation
Doc
10
$1.89
$18.90
POC Testing
MA
6
$0.26
$1.56
Check-Out
Front Office Staff
4
$0.25
$1.00
Total Visit Cost
$50.64
Time-Driven Activity Based Costing
Function
Position
Time on Min.
Per Min. Rate
Cost
Schedule
Appoint
Scheduler
3
$0.25
$0.75
Check-In
Front Office Staff
4
$0.25
$1.00
Room Patient
MA
8
$0.26
$2.08
Documentation
MA
3
$0.26
$0.78
Physician Eval
Doc
12
$1.89
$22.68
Documentation
Scribe
10
$0.26
$2.60
POC Testing
MA
6
$0.26
$1.56
Check-Out
Front Office Staff
4
$0.25
$1.00
Total Visit Cost
$32.45
• Dr. David Reuben, a geriatrician at the University of
California, Los Angeles, uses “physician partners,” who do
the work of scribes, with expanded responsibilities such as
scheduling appointments, filling out test requisitions and
completing the checkout process.
• Preliminary results from a six-month study Dr. Reuben
conducted of geriatricians and general internists suggest
that the physicians saved an average of three minutes per
visit by using the scribes.
• Just as important, the physician partners or scribes
dramatically reduced the amount of work for the doctor to
do at the end of the day.
• And a vast majority of patients said they thought the
assistants helped the visit run smoothly.
Cost / Access Impact
Visit Cost Savings - 18.19 WITH a Scribe
One additional patient per hour more than covers the
cost of a Scribe.
Time Savings / Provider = 11 minutes / visit
=88 minutes / Day
=440 minutes / Week
=21,120 minutes / Work Year
=1,920 Additional Patients Seen
Key Measures Considered for
Evaluation
• Increase revenue per patient through increased
charge capture,
• Decrease medical record delinquency rate,
• Increase Productivity,
• Improve meaningful use data indicators,
• Increase patient access, decreasing the amount of
time to wait for a scheduled appointment,
• Increase provider satisfaction.
Questions?
“On the Ground” Insight from Practices
 7:30 AM webinar:
 Bonnie
Roundy, Inland Medical Associates
 Debbie Jacobs, Blue Hill/EMHS
 Paula Eaton and colleagues, Martin’s Point Bangor
 4:30 PM webinar:
 Catherine
Princell, Debbie Jacobs, and Shawna
Ambrose-Pasternack, Blue Hill/EMHS
 Theresa Brown, Eastport Healthcare
Tel. 866.740.1260, ID: 2520060#
* 6 to MUTE, *7 to UNMUTE
Monday, March 31st / 5:30- 7:30pm
Augusta - Alfond Center for Health, Education Pavilion
Presque Isle – Univ. of Maine, Room TBD
Brewer - EMHS, Cianchette Auditorium
Portland – Univ. of Maine, Wishcamper Center, Rm 102
Lewiston - University of Maine campus, Rm 170
Waterville – Thayer Center for Health, Dean Auditorium
Machias - University of Maine campus, Science Bldg, Rm 102
For more info and to register,
call Judy Ward at 620-8526, ext. 1016
Keynote Speakers:
Registration and Agenda
details available at:
http://www.cvent.com/d
/54qpbc/1Q
Doug Eby, MD
John Santa, MD, MPH
Susan Burden
PCMH/HH Spring Regional Forums
 Topic: Building Collaborative Partnerships between
Primary Care Teams and Skilled Nursing/Rehab
Facilities to Improve Care Transitions
 Remaining date:
 Tues,
April 8 - Orono
Tel. 866.740.1260, ID: 2520060#
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Upcoming Webinars
Next PCMH and HH Webinar:
 Wednesday, April 23, 2014
 7:30 – 8:30 a.m. or 4:30 – 5:30 p.m.
 Topic: Optimizing the Care of Complex, Multi-
Needs Patients
 Want to share what your practice is doing?
Contact your QI Specialist
Tel. 866.740.1260, ID: 2520060#
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PCMH/HH Learning Sessions
 Learning Session for all PCMH/Health Homes
 June
20, 2014 at the Augusta Civic Center
 Primary Care Leadership in a Changing World:
The Next Big Thing
Care management
 Health info technology
 Inclusion of patients/families
 Using social media in primary care
 Substance abuse screening and care coordination
 Pediatric-specific content
 Much more!

Tel. 866.740.1260, ID: 2520060#
* 6 to MUTE, *7 to UNMUTE
Tel. 866.740.1260, ID: 2520060#
* 6 to MUTE, *7 to UNMUTE
Contact Info/Questions
 Your Quality Improvement (QI) Specialist
 Maine Quality Counts
 www.mainequalitycounts.org
Maine
PCMH webpage
(See “Our Work”  Maine PCMH Pilot
Maine PCMH/HH Learning Collaborative)
Tel. 866.740.1260, ID: 2520060#
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