To Scribe or Not to Scribe with an EMR: Q&A with Urgent Care Operators

In healthcare, much discussion exists about the use of scribes to help document the patient encounter. With the prevalence of EMRs in the industry, practices are determining what works best for their workflow and providers.

As an EMR and PM vendor, we were curious about what those in urgent care felt about the use of scribes with EMRs. We interviewed three urgent care operators to ask them what they thought of the scribing process—and how it works in the real world of urgent care.

Let’s look at what they had to say.

Q: Scribes are becoming common in healthcare, accompanying the rise of EMRs. What are your feelings on using scribes in urgent care? For or against?

Brannen: Our practice is in favor of scribes, however it is up to the provider if they want to use a scribe or not.

Spell: Depending upon the size of the practice. Our practice works with two clinical staff in the back office. Our providers scribe themselves using an iPad. Larger practices and/or primary and urgent care would benefit from the use of a scribe.

Harnett: For, as needed.

Q: Describe the benefits and drawbacks of using scribes.

Brannen: (No answer given.)

Spell: Additional staff cost for using a scribe when nurses, medical assistants, and radiology techs can perform the same task while triage occurs.

Harnett: Drawback obviously is the cost and the possibility of clinical documentation errors. Providers need to be sure they review every chart documented by a scribe to ensure accuracy. Benefits include more timely documentation, freeing the provider to focus more on the patient than the “paperwork”, in this case documenting in an EMR.

Q: Does your urgent care use scribes? Why or why not?

Brannen: Yes, Owl Now uses scribes, but not for all providers. First off, the number one patient complaint with a provider using EMR is that instead of a face to face encounter, they are looking at the computer screen the whole time. Patients still want to feel that the provider is looking at them, hearing what they are saying and interacting directly with them. With a scribe in the room, it frees the provider up to do this.

Second, having a scribe in the room speeds up the entire visit. The scribe is gathering all the information for the chart, the provider is one on one with the patient conducting an exam and the chart is for the most part finished when they walk out of the room. They don’t have to go into their office and finish the chart before moving on to the next patient.

Spell: We do not use scribes. Our SOP (scope of practice) calls for one radiology techs and one medical assistant and/or nurse on crew for 12 hour shifts. Our providers have plans and commons created that help with the workflow.

Harnett: We do use scribes but not extensively. We reserve them for physicians who have consistently demonstrated difficulty in the accurate and timely completion of charts.

Q: If you use scribes, what personnel role fills this need and what are their main responsibilities? Do scribes work for all providers or are they only used for specific providers?

Brannen: In our practice, some providers want scribes and some don’t, and this is strictly a provider preference. When a provider does want a scribe, we don’t hire additional personnel for this. We use staff already in place and they do this along with their regular work duties. Since staff is rotated, and not all providers want scribes, we want anyone on a shift to be able to scribe if necessary. However, over time, when a staff member scribes for a particular provider over and over again, they get used to their “system” of seeing patients and it becomes easier and easier to scribe for them.

Spell: We do not use scribes.

Harnett: They are used only for specific providers. We have generally filled the scribe positions from within the clinic as opposed to hiring from the outside. Their main responsibility is to make sure the encounter notes are documented accurately, timely, and completely.

Q: If you don’t use scribes, how to you ensure fast data entry into your EMR? What practices have you put into place to ensure quick, accurate chart completion?

Brannen: N/A

Spell: Common procedures, customized templates, customized exams, customized Rxs, and customized plans.

Harnett: Training, training, training—then auditing charts to see where providers make mistakes in using the software.

Q: Do you think a well-designed EMR doesn’t require a scribe or would providers still prefer scribes to enter data, no matter the design?

Brannen: In our office, again, since it is provider preference, no matter how well designed the EMR is, some providers will still want to use scribes. Again, the face to face encounter without a computer screen in the middle is important to patients.

Spell: No. A well-designed EMR that is customized does not require a scribe.

Harnett: That is very physician dependent. Some providers would require a scribe even with the “perfect” EMR.

Q: What’s your response to those who say scribes are a crutch for providers who don’t want to document in the EMR?

Brannen: This may be, however since each provider has a different personality and different way of interacting with their patients, some can do their own charting and still maintain the personal visit while in the room, and some work faster and better with not having to do that part of the visit. Either way, all providers sign off on charts, so whether the scribe typed it or the provider did, good patient care and documentation is maintained.

Spell: Would lean to the fact that providers are using scribes as a crutch. Our providers stand alone on the documentation. I believe proper education of the EMR would help wean providers from using a scribe.

Harnett: Once again depends on the physician.

Q: What are the legal or regulation concerns about having others besides providers enter data into the EMR? (especially considering Meaningful Use)

Brannen: I don’t have any concerns about this. Since all charts are signed off by the provider on his or her patients, they are verifying the information there and are comfortable with how it is documented.

Spell: If a case goes to court the time/date stamp could be used against the provider if he/she did not themselves enter the information into the computer. Also, to be true to the ePrescribe, a provider would need to be the one hitting the ePrescribe tab to send the medications to the pharmacy. This also allows the provider to double check the drug interactions that a scribe may not find important.

Harnett: Just need to make sure you follow the CMS guidelines—read them carefully and make sure you following them to the letter.

Q: Do you think scribes will be used more or less as EMR technology advances? What do you think the future is for scribes?

Brannen: Scribes will probably be used less. Let me put it this way—when I am in the room with a physician, since I work in an office that utilizes an EMR, I don’t have a problem with the provider looking at the screen while I am in the room and documenting my visit. My mother, who is a much older demographic, and is not comfortable with computers or smart phones, and is not used to technology, does not like that the provider is staring at a screen. I would guess as the patient demographic becomes younger, they will be used to it and expect it. They will not remember when the provider was not charting electronically when in the room and will not remember when patient charts were contained in folders. Our children will not know to expect anything different. The same goes for providers. As they enter into practice, and do clinical rotations, they will be expected to use EMRs. Then there will be less and less that will require scribes.

Spell: I think scribes will be used less in the future practices of the EMR. Scribes maybe utilized as a full medical assistant that completes many task within the office.

Harnett: Hard to say really. If they were free, I would probably have most providers use a scribe because it frees them up to practice medicine rather than spending so much time documenting. But they are not free so it is more economical if you have an EMR and a provider who can timely and accurately complete charts without a scribe.

What do you think about using scribes with an EMR? Do you apply this process at your practice—why or why not? Join the discussion and add your comments below.