EHR Scribes
A Post-Implementation Strategy
Ann Murphy, MD -- Charles Kitzman CIO – Michaela Mangas
Shasta Community Health Center, Redding CA
Fast facts….
30 FT Provider FQHC
Live on
since May 2007
130,000 encounters annually
Multiple services
Primary Care
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
Weighing the results
Good stuff
Legible charts
Solid lab interfaces
Flexible platform
Enhancement process
Individual practices
Reduced access/capacity
Flexible platform
2 areas to address….
• Organizational
• Data capture could be
• Pt. Satisfaction surveys
were critical of EHR
• Very gradual decline in
• Increase in billable hours
• Clinician burnout
• Difficult recruitment
• Primary care less popular
than $pecialty care
Big on ideas, short on cash….
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
Query for Common “Scribrary”
• Dx – Meds - Ordering
Sample Visits
See 1 - Do 1
Go live
Recruitment and Training Process
• 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
• Scribes might be traumatized by our patients
Sample Group & Criteria
Control Group
• “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.
Clinician/Scribe Perspective

similar documents