In recent years, the use of medical scribe services has grown to help physicians with their mounting documentation burdens; but in the age of COVID-19, providers may have to reevaluate using them.
Scribes typically transcribe what a physician says during a patient exam and complete clinical documentation for the physician to review and sign off on. That can allow a physician to dedicate more time to direct patient care.
But now, as hospitals work to limit exposure to the novel coronavirus among patients and staff, they’re bringing scribes online to support telemedicine visits, and weighing the pros and cons of even having a scribe—another body—in the same room for non-emergent care.
UAB Medicine has had success with virtual scribes, or scribes who work off-site transcribing a physician’s notes.
Birmingham, Ala.-based UAB Medicine uses an asynchronous service, in which an off-site scribe hired by IKS Health creates a clinical note based on audio recordings of a patient visit. That means a physician will need to speak out loud any details they want to include in the clinical note, since the scribe isn’t able to see the encounter. UAB Medicine rolled out the service nearly two years ago for primary care and has since expanded to other specialties.
Physicians have been using the virtual scribe service for telemedicine, too, which has proved useful in the wake of the pandemic. For these visits, physicians set up a tablet for audio recording next to the computer being used to speak to the patient.
A completed clinical note is ready for a physician to review by the morning after the patient visit, said Dr. Stephen Stair, an associate professor of internal medicine and medical compliance officer at UAB Medicine.
Stair said it only takes him a minute or two to review and sign off on each note.
“I have to edit some,” Stair said. “But it’s a lot better than having to do the whole note from scratch.”
Before the COVID-19 outbreak, most customers of Skywriter MD, a company that offers virtual scribe services, were using scribes for the first time—they weren’t replacing an in-person scribe, said Tracy Rue, the company’s CEO. But he’s seen a significant uptick in inquiries for his services over the last two months.
Providers are increasingly “not wanting to have a third party in the room,” Rue said.
ScribeAmerica, a company that provides both in-person and virtual scribes to hospitals, has already seen a threefold increase in its virtual business since the start of the pandemic, said Dr. Michael Murphy, CEO of the company’s parent, HealthChannels.
Physicians at a cardiothoracic intensive-care unit at Northwell Health had just started using in-person scribes from ScribeAmerica in late 2019, just a few weeks before the U.S. saw its first reported COVID-19 case. In April, the system opted to let those scribes work remotely, and access data and audio recordings of patient assessments through an app.
“The last thing we wanted to do was put a scribe in harm’s way by having them come into the building and actually be exposed to COVID,” said Paul Travlos, senior administrative director for cardiothoracic surgery at New Hyde Park, N.Y.-based Northwell.
Having a scribe has helped physicians spend more time with patients. And during COVID-19, it’s given doctors more time to call patients’ families—a particular benefit when loved ones aren’t allowed to visit in-person.
There’s also a financial improvement component, since more complete documentation makes it easier for coders and billers to submit notes for reimbursement.
“There’s less chance of having any of the notes getting rejected from insurance because (they were) missing vital information,” Travlos said.
Those coding improvements, as well as the potential for doctors to see more patients with time saved by minimizing documentation activities, can help offset the cost of a virtual scribe service.
Travlos said Northwell’s cardiothoracic surgery service line hasn’t decided whether it will stick with virtual scribes or return to in-person scribes once the pandemic subsides. It might be up to what the scribe prefers as long as the end result—the clinical note—is of the same quality whether virtual and in-person scribe services are used, which is what they’ve seen so far. “I would support either way,” Travlos said.