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    Scribes slash EMR burden

    Provider satisfaction ‘off the charts,’ says one urologist

     

    On the frontlines of care

    Brian R. Stork, MDDr. StorkBrian Stork, MD, a urologist practicing at West Shore Urology in Muskegon, MI, said he found it was becoming increasingly stressful to listen to and maintain eye contact with his patients while simultaneously entering their information into the EMR.

    Read - ‘I can’t keep up’: Pay cuts, prior authorization take their toll

    “I thought there had to be a way I could practice better, and serve my patients and the community in a way that would be quite frankly more fun than sitting at a keyboard, talking to the patient and typing,” he said.

    Dr. Stork told Urology Times that he solved that problem more than a year ago by hiring a scribe.

    “Nursel, our certified medical scribe, and I walk into the exam room together. She sits at the computer monitor and basically transcribes to the best of her ability, while I’m talking to the patient. I don’t touch the computer at all when I’m in the room,” Dr. Stork said. “I feel like I can actually really listen to a patient without having to worry about what box I’m going to click to make the office visit billable.”

    Muskegon, MI urologist Brian Stork, MD, works closely with his scribe, Nursel Dogan. Dr. Stork says Dogan, who has a background in accounting, is another set of eyes looking at billing.  (Photo courtesy of Brian Stork, MD)

    Muskegon, MI urologist Brian Stork, MD, works closely with his scribe, Nursel Dogan. Dr. Stork says Dogan, who has a background in accounting, is another set of eyes looking at billing. (Photo courtesy of Brian Stork, MD)In addition to doing the documentation, Dr. Stork said his scribe, who has a background in accounting, is another set of eyes looking at billing, to make sure it’s correct.

    “Because of her accounting background, when I am out of the office or in surgery, she helps us in the business office,” Dr. Stork said.

    Barry Kogan, MDDr. KoganBarry A. Kogan, MD, chief of urology at Albany Medical Center in Albany, NY, is glad to have the help of a scribe.

    Dr. Kogan, who was among the authors of the 2010 Journal of Urology study looking at scribes in urology, said he is not a great multitasker.

    “I think my face would be in the computer screen much of the patient visit, and my typing would be a mess,” Dr. Kogan said.

    The scribe facilitates a better physician and patient interaction and dramatically reduces the burden of EMR documentation.

    “I merely review, make a few small edits (if more than that, I need to do additional training of the scribe), and sign the note,” he said. The only disadvantages, according to Dr. Kogan, are cost and the time and energy required to train a scribe.

    Also see: OIG targets IMRT, chronic care payments in 2017

    At Dr. Kogan’s practice, the scribe’s primary role is to type into the EMR. The scribe prepares notes before the patient arrives. For example, for new patients, the scribe might add x-ray and culture reports to the results section of the note, he said. And for follow-up patients, the scribe summarizes data from the previous note and copies results of previous studies and procedures. The scribe accompanies Dr. Kogan into the room and records the patient’s history and physical findings that he points out. The scribe records the discussion of Dr. Kogan’s plan for the patient and the diagnosis.

    “Of course, they cannot make any independent judgments,” Dr. Kogan said.

    Next: Increasing efficiency

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...

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    • brian@------.com
      Dear Anonymous, Great questions! When I first started using a scribe, our front desk handed all of my patients a written explaination detailing the scribe's role on our healthcare team. Patients were always given the option of seeing me without a scribe in the room. I almost always have my scribe step out of the room for the patient exam, unless I need a chaperone and no one else is available. I can count on one hand the number of patients in the past year who have asked to see me without a scribe in the room. We also try hard to be very sensitive to the nature of the patient's visit. Not uncommonly, my scribe will volunteer to step out of the room in an effort to make the patient feel more comfortable - particularly during discussions about sexuality and sexual dysfunction. Patients seem to really like the eye contact and focused attention that having a scribe affords me. I believe that since I started using a scribe my documentation is better and my orders and coding are more accurate. Plus, she is just super nice and really fun to work with! Again, thank you for your question. I'd be happy to try to answer any additional questions you might have about how we use a medical scribe in our office. - Brian Stork
    • Anonymous
      Scribes are all well & good for the practice. My question is did the doctor ask the patient if it was okay with them that someone else is in the room? Many don't ask the patient. Does the scribe leave the room before any exam is performed? I know in some practices they don't. I look forward to hearing from you. Regards, Raffie
    • Anonymous
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