A common complaint regarding the use of electronic medical records (EMRs) is that physicians spend the majority of their time with a patient “tinkering” on a computer rather than interacting with the patient.
Use of EMRs is now mandatory in the U.S., creating many advantages: Patient information can be more easily shared in a secure environment, there are no lost files or records and, of course, the issue of physician hand writing has been forever resolved. But there are downsides, perhaps none more so than the burden of EMR documentation on physicians.
The action of EMR documentation is referred to as “clicks” amongst physicians. There is the free text typing, or “keystrokes,” which captures the detailed notes documenting the course of the patient’s treatment. The “clicks” describe the navigation between different sections of the EMR, such as reviewing old charts, or for selecting items from a form, such as checking off whether or not a patient has a fever, chills or other symptoms. Oftentimes physicians are required to “click” numerous checkboxes during an examination, not for the patient’s benefit but to fulfill widespread documentation requirements. In fact, government and payors have driven increased documentation and coding requirements to capture three and a half times more data from each patient encounter.
It is common to hear physicians’ frustrations with too many clicks, so we conducted a small study to find out how many clicks is “too many.” We measured the number of keystrokes and clicks across four physician specialties on four separate days, as physicians examined patients throughout their normal days. (The physicians we tracked evaluated between six and 14 patients a day. The average was just under 10 patients per eight-hour day. The scheduled patient visit was typically 45 minutes). Then we compared those findings to common activities any individual might complete on a computer.
We found that in seeing one patient, a physician makes enough clicks to complete eight different pizza orders. And over the course of the day, one physician makes enough clicks and keystrokes to complete 200 different pizza orders or 140 different movie ticket orders.
It comes as no surprise that the process of documenting a patient’s medical condition is significantly more complex than ordering a pizza. It would be more of a concern if it wasn’t.
So what is the issue? These clicks and keystrokes can have a significant impact on physicians — and their patients. Physicians have two choices: Either spend time outside of a patient visit completing the patient’s chart, which means longer hours, or aim for efficiency by documenting the encounter while the patient is in the room, which impacts quality patient care. It is inevitable that the physician endeavors to complete some of this documentation burden during the patient visit. Hence the physician working on the computer rather than interacting with the patient. Ultimately it is the patient that suffers.
Physicians don’t dispute the importance of high-quality clinical documentation, but when their sacred relationships with patients are impacted, it becomes an issue.
Fortunately, a solution to this issue has emerged: medical scribes. In recent years, use of medical scribes has increased significantly as more hospitals and physician offices have gone live with EMRs. In fact, the recent 2014 Tech Survey published in Physicians Practice found that approximately 21 percent of physicians now use medical scribes.
Medical scribes specialize in charting physician-patient encounters in real-time in the EMR during medical exams, freeing physicians from the click burden. They are typically bright, tech-savvy college students or recent graduates interested in pursuing a career in medicine and other healthcare disciplines. Many of them go onto medical school and become physicians themselves, having gained invaluable experience and insights into real-world medicine through scribing.
In the more than 10 years that I’ve personally been using a scribe, I have observed how they are easing the burden of EMR documentation on physicians, as well as other significant benefits.
First, patient satisfaction increases when they receive a physician’s full and focused attention. In fact, studies show improvement of 40 to 45 percent in Press Ganey patient satisfaction scores to overall levels of 90 percent and higher when scribes are used.
Second, by reducing their time on EMR documentation, scribes enable physicians to focus on delivering the highest quality care (vs. on clicking to enter data), work at the top of their license and achieve optimal work/life balance. Without scribes, documentation requirements typically mean longer work hours for physicians; for every 60 minutes of clinic time, physicians spend about 30 minutes charting, typically after hours on their personal time.
Third, scribes can have a positive impact on the bottom line at hospitals and specialty clinics by helping improve medical documentation quality, resulting in billing and coding processes that are more accurate and efficient. Using scribes has resulted in 14.8 to 17.1 percent increases in relative value units (RVUs) per hour, or 2.1 to 2.4 units per hour per physician, according to recent studies. (RVUs are a measure of value used in the U.S. Medicare reimbursement formula for physician services.)
And finally, scribe programs can deliver positive return on investment, enabling physicians to see more patients in the same amount of time. Studies suggest scribe programs result in physicians seeing approximately 0.5 more patients per hour.
As hospitals and specialty clinics continue to make significant investments in information technology to meet the Affordable Care Act’s EMR adoption deadlines, the documentation burden on physicians will continue to increase. Medical scribes are one way to ease this burden, since for them, there are never “too many clicks.”
Kathleen Myers is an emergency physician and founder/chief medical officer, Essia Health.
Image credit: Shutterstock.com
