As the US healthcare system faced an unprecedented public health challenge with COVID-19, being prepared had never been more difficult, or more necessary.
As the pandemic stretches toward its sixth month in the U.S., thought leaders in healthcare, nurses and physicians, as well as system administrators are rising to the challenge and proposing innovative solutions in rapid succession. What has become clearer now, more than ever, is how the pandemic requires adaptability throughout the organization to expand capabilities—from IT administrators and supply chain operators to the clinical workforce triaging patients.
Answering the Call
Many strategies have already been employed to address the pandemic over the past few months, including re-enlisting retired providers to help support over-taxed care teams. However, many of the retired task-force answering the call are themselves at risk due to age in retirement, and prevalence of comorbidities.
Still, as Susan Salerno, president of the New York Academy of Medicine, who describes herself as in good health and in her 60’s, tells NPR “…if I can use my skills in some way that will be helpful, I’m ready to step up.”
The fortitude and selflessness of our frontline workers is nothing short of astonishing. Unfortunately, as many of our current healthcare providers are near retirement themselves, a lasting solution is needed to support frontline workers during the remainder of this pandemic, and beyond.
Tackling the Documentation Burden
What should health systems focus on during the current window of opportunity to get ahead of the next curve? One solution is to address the previous healthcare pitfalls, including ways in which the health systems prior inefficiencies slowed systems down.
In a recent Op-ed in the New York Times, Teresa Brown, clinical faculty member at the University of Pittsburgh School of Nursing made a case for enlisting nursing and medical students to alleviate some of the pressure, including Electronic Medical Records. She makes the case for enlisting students in their final semester and deploying them to support the documentation needs of care teams by completing notes for non-critical patients to allow nurses and providers to focus on COVID-19 cases. She suggests, “Records of care need to be kept, too—not only for billing, but to make the course of treatment clear. Hospitals across the country are already reaching surge capacity, and the need for more front-line staff will grow.”
In a similar call to action, Erik Perakslis PhD, a Rubenstein Fellow at Duke University and Erich Huang MD, PhD Chief Data officer for quality for Duke Health suggest taking non-clinical labor to support the nurses and providers. Driven by data from a recent physician efficiency study, the scholars laid out the case plainly in STAT magazine; “Put humans to work, Scribes have been shown to cut by half the time it takes a clinician to document a patient encounter. While scribes may be a luxury for most practices and health systems in normal times, they may be essential during an outbreak to increase the efficiency of clinicians.”
Deploy “Super Scribes”
To meaningfully reduce clerical work and free providers to perform at the top of their license, Medical Scribes are adapting to minimize administrative duties. Scribes close documentation gaps to ensure health systems in the midst of crisis do not get hit with a tsunami of downcodes when the patient surge is under control.
Medical scribes comprise a highly-trained, dedicated workforce, ready to document the details of every day care delivery and reduce the burden put on providers and nurses. What’s more, medical scribes are often students passionate about healthcare, studying for medical, nursing and PA school. For medical scribe alumni, becoming a scribe is often an integral part of their career planning.
Scribes are also EMR agnostic, trained in medical coding and provider patient workflows. In fact, overwhelmed providers have turned to medical scribes to deliver better care to their patients for decades. Today, scribes enhance efficiency by becoming “super scribes.” With constantly shifting priorities, especially in the ER care environment, scribes assist with documentation but they do not stop there. From printing discharge information to scheduling referral appointments while ensuring the patient remains in the network, scribes can be utilized to close care gaps and enhance care plan adherence.
Care for Non-COVID Related Patients
As we have seen, not all of the coughs and fevers presented in the ER are due to COVID-19. Cardiac arrest, appendicitis, the daily traffic of emergency care has not slowed down.
In Outpatient clinics, and Emergency Departments alike, with the increased adoption of telehealth solutions, scribes are able to work remotely away from the exam room, yet remain within a hospital. Moving to a ‘war room’ in a separate part of the facility allows scribes to utilize telehealth modalities to support providers as they focus on PPE protocols and staying safe. Many systems are deploying TeleScribes to supplement telehealth for non-acute patients who would rather not travel to hospitals.
Across settings, virtual or in person, “SuperScribes” are able to prompt providers to ask questions about documentation, an essential tool, considering the clinical note must show evidence of care provided in order for there to be proper reimbursement. As one provider in Philadelphia shared, “When I am reading through the PPE protocols, making sure I am protected, I don’t have the bandwidth to remember to document CPR start time. Without a scribe, my notes would be slim and ineffective.”
The role of the Medical Scribe has evolved to complete coordinated care activities under the supervision of a Chief Scribe, Quality Assurance Manager, and a hierarchy of command that ensures efficient documentation is not an added burden on overworked staff.
Protecting Providers in trying Times
Protecting staff from time consuming clerical activities with a highly-trained workforce allows providers to focus on saving lives. Scribe support has become a valuable asset to thousands of care teams across the nation. Most importantly, before the COVID-19 outbreak emerged as a public health emergency for the ages, scribes completed timely documentation for providers, and offered a much needed life line.
Our motto at ScribeAmerica, “Doctors Save Lives, Scribes Save Doctors” has never been more timely than it is today. The decree was formulated nearly two decades ago when it became evident that providers were being asked to do much more with their time than see patients. Overwhelming providers with administrative tasks is not a sustainable method for the fight against the coronavirus.
Devising an emergency plan for the frontline caregivers is not too late. As leadership looks for answers and calls on retired staff to rejoin the ranks, working with medical scribe support and developing telehealth solutions will ensure the newly trained or re-enlisted are focused on patients, not paperwork.