Scribe support may help alleviate documentation, trim physician burnout
A pilot project at UW Health used virtual assistance to assist clinicians and shows the potential to enhance revenue while giving doctors some relief.
Ever since the inception of electronic health records, the actual act of documentation has weighed heavily on the clinicians using EHR systems. Requirements for compliance, quality reporting and claims have pushed clinicians to spend even more time in front of computer screens to complete notes and insert codes in patients’ records - detracting from patient interactions and cutting into physicians’ personal time. That’s a recipe for job dissatisfaction and burnout, which has been quantified by studies cited by the American Medical Association, which found that family physicians were working 11.4-hour days, of which 5.9 hours were spent in the EHR. In fact, the top four factors that physicians relate to job dissatisfaction and burnout are related to EHRs, the AMA reports.
A more recent study by athenahealth cited EHR documentation as a contributor to burnout. That study notes that organizational culture affects documentation and patient loads, and the pandemic has amplified the digital workload that clinicians are feeling.
The cost of turnover
With the increased focus on physician overload and burnout, hospital executives are looking to adjust strategies for eliminating extraneous pressure on clinicians. Retaining clinical staff is becoming a strategic imperative because vacancies negatively impact the ability to deliver care. And the AMA estimates that the cost of recruiting and replacing a physician is $500,000 to more than $1 million.
The COVID-19 pandemic has only increased challenges related to physician workloads and burnout. A report by KLAS Research, conducted through its Arch Collaborative, found that the pandemic was increasingly cited as a reason for rising burnout rates among clinicians, particularly exacerbated by unabated case rates related to vaccine reluctance and widespread disease misinformation.
The role of scribes
One solution receiving more consideration is using “scribes” to assist physicians with documentation and clinical information workflows. Beyond just ameliorating clinician workloads, more organizations are looking for ways to assist clinicians to improve their quality of life and the quality of care they can deliver, says Dale Kivi, senior director of communications for AQuity Solutions, which provides documentation services, including virtual scribes.
Giving clinicians a hand with the documentation load offers tangible burnout reduction from “having the doctor thinking about the documentation while they’re talking to the patient,” Kivi says. “The provider can be fully focused on the patient – it’s a totally different work style, a very different thought process.” For example, scribes can listen to a physician’s dictated notes about an encounter and then populate the EHR. Scribes also can perform other clerical tasks regarding the chart, and because their focus is entirely on the record, they can work on optimizing the notes in the record – often by keeping them concise.
Pilot program shows benefits
There’s some evidence that scribe services have the potential to help enhance revenue.
A study at University of Wisconsin Health, a Madison-based system with seven hospitals, found a scribe program provided financial benefits in addition to gaining support from the 100 physicians who participated in a pilot program. The organization already provided services to clinicians to facilitate documentation, such as transcription and voice-to-text automation, says Christine Wiliams, UW Health’s director of health information management. But it took the extra step of conducting an 18-month scribe pilot project for primary and specialty care physicians, using virtual outsourced scribes from AQuity. The initial program was partially sponsored by a grant from the AMA Transforming Clinical Practice initiative.
Scribes complete necessary records documentation by listening to physician interactions and recorded instructions or notes. Clinicians are able to offload other records-related tasks to scribes as well.
The pilot sought to offset the costs of the scribes by asking physicians to see one more patient for each four-hour “session” in their day, with the additional patient load providing a return on the investment. Williams says the projected contract expense of $2.24 million was more than offset by additional revenue, resulting in a projected net gain of $1.65 million. While there was no change in clinician satisfaction with the records system itself – “it didn’t improve their love for the EHR,” Williams notes – participating clinicians were won over and did not want to give up their scribes, she says. “They were using the scribes almost all the time” to alleviate myriad clerical and documentation workloads, she adds.
UW Health plans to increase the program to 300 physicians; it has seen rising interest in the use of scribes among inpatient and emergency department clinicians, Williams says. Clinicians are willing to increase their patient loads to reduce their “pajama time” with EHR documentation. Participating clinicians also say the scribe program enables them to provide the type of patient care that initially attracted them to the field, Williams says. And the increase in patient encounters enables the healthcare system to improve access to care in the Madison metropolitan area, she adds.
But beyond ROI, a potential benefit of the scribe program is to help prevent clinician attrition, Williams contends. “A lot of people really focus on the money, but if we don’t have the clinicians – if we can’t reduce burnout and thus don’t have clinical staff as a result – then we are losing money with turnover. I respect the financial aspect, but we have so much more of a benefit by reducing that fatigue.”
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