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“I spent over a decade preparing to become a doctor. But so much of our work has become about documentation and not primary care itself. Sometimes hours after my shift ended, I’d still be completing charts. And during the encounters, I always had to divide my focus between patients and my computer.”
At a community health center in Tucson, Arizona, a team of seven physicians – five PCPs, a sports medicine practitioner and a psychiatrist – struggled to work efficiently and offer engaged caregiving despite their documentation burdens. Much of family medicine requires managing and noting chronic disease processes, preferably with all possible sensitivity. But because of the EHR interface, providers here were often forced to have their backs to patients while they inputted data.
The psychiatrist at the site wasn’t the only one frustrated with difficulty achieving a strong therapeutic encounter, one with consistent eye contact and the physician’s full attention. All of the providers hoped to improve the documentation process and patient experience. While they were spending a half hour or more in most visits, the doctors were only being compensated for roughly 10 minutes. It’s the difference between discussing an HPI with a patient and being able to sufficiently code and bill for it. Without a scribe, the doctors were missing details of the history, the full review of systems, as well as assessments and plans. They added notes as best as they could in order to move on and help the next patient.
There were already live medical scribes at work elsewhere in this health system. But at the primary care setting, its administration judged a TeleScribe solution preferable for patient privacy and space limitations. Implementation began in October of 2017 and almost instantly transformed the workflow. The support is very unobtrusive, relying on the HIPAA-compliant, secure, and real-time feed on iPads rolled into the examination room. The providers in Tucson quickly discovered that TeleScribes are a part of the healthcare management team, “in the room” seeing and documenting patients as they are counseled. Meanwhile, because of the iPad’s positioning in the room, patients can’t see or hear the scribe.
“When you’re with your doctor, you want engagement. You don’t want to feel like a task for completion. That’s the impression physicians unintentionally give when they’re staring at the computer. But with my scribe’s help, patients I see have a fuller interaction. They have my attention and a better experience.”
The physicians introduce the offsite TeleScribes at the start of each encounter. Sometimes a patient will request to see the scribe, and the doctor will briefly flip the screen before continuing the visit. There have been occasions at this site when a doctor addressed the TeleScribe, only to hear the patient remark, “I forgot she was in the room. You’re so quiet.” And it’s not uncommon for patients to be more filtered with live scribes present. The offsite support for the Tucson clinic encourages a different and helpful degree of candor.
In addition to greater patient satisfaction, the site went from seeing a single provider average of 13 patients to more than 17 per shift. The productivity certainly covers the cost of the program. The charts also are more accurate. Before TeleScribes, a PCP might write “see previous note” for the HPI instead of aiming for the now more attainable level 4 chart in billing and coding. Today, scribes for these clinicians help them to address the Health Maintenance tab for appropriate screenings and other guidelines, which improve patient outcomes and revenue at the site.
“In our pre-scribe world, providers had so much to handle just on prescriptions and orders alone. There wasn’t always time to consider and chart the latest recommendations. So that was a goal with TeleScribes, incorporating reminders that improved efficiency, our patients’ health, and our bottom line.”
To ensure the program implementation remained successful, the TeleScribes Operations Manager had biweekly phone calls with the practitioner site’s Medical Director. Not only were the providers comfortable with their scribes; there was virtually nothing but positive feedback. In the event of open shifts, the TeleScribes utilize their cross-training to assist more than one physician. They understand multiple workflows and make important contributions to patient education, placing information inside the chart, which they communicate to the MA or directly prompt to physicians. This includes resources like GoodRX, particularly helpful to this patient population.
“I understand they’re going to add TeleScribes to 16 more providers in our system. That’s great because essentially all I have to do now is proofread and sign off on notes. We’re talking minutes of work instead of hours. And a lot more patients who feel they are truly being seen in each encounter.”
Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.