Doctors are being driven daffy by electronic health records, or EHRs.
Updated: January 16, 2019 – 12:13 PM
Sally Pipes, for the Inquirer
That’s the takeaway from a recent report in the Journal of the American Medical Informatics Association. Seven in 10 Rhode Island doctors surveyed who used electronic health records said that the technology stressed them out. Those who reported health information technology-related stress were anywhere from 1.9 to 2.8 times as likely to burn out. In Pennsylvania, 45 percent of physicians report feeling burned out, according to a separate survey from Medscape.
They can thank the federal government for these professional headaches. A decade ago, the Obama administration pushed doctors to adopt electronic records in hopes they’d speed up the provision of care and improve health outcomes. Ten years on, these mandates have delivered much the opposite.
The federal mandate that doctors adopt electronic health records was included as part of the American Recovery and Investment Act — more colloquially known as the 2009 stimulus package.
The feds yielded a variety of carrots and sticks. Doctors that demonstrated meaningful use of the technology were awarded part of $17 billion in incentives. Doctors who didn’t risked having their payments from Medicare and Medicaid slashed.
President Obama boasted that the program would “cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests.” The idea was that a mass upgrade of the nation’s health IT would facilitate the sharing of information among physicians and hospitals — and ultimately lead to more accurate diagnoses and more effective and efficient treatment.
The information technology revolution had transformed so many other parts of the American economy. Why couldn’t it do the same for health care?
The government’s carrots and sticks worked. From 2009 to 2015, the share of hospitals using a basic electronic health records system increased from 12 percent to 84 percent.
They may have adopted electronic records. But that doesn’t mean the technology works — or that it’s improving patient care.
The programs on the market are often clunky, time-consuming, and insensitive to the complexities of modern medicine. Physicians, who already face suffocating administrative burdens, are logging ever-increasing amounts of data that have little clinical relevance. Time with patients is disrupted by an endless flood of alerts and messages.
Two-thirds of doctors say electronic records degrade their patient interactions, according to a survey from the Physicians Foundation. More than half of physicians report that the records reduce efficiency; more than a third say they diminish the quality of care.
Screen time has replaced face time. Only one-fourth of the average doctor’s day is spent face-to-face with patients. Half is devoted to electronic health records and other administrative tasks, according to a study published in the Annals of Internal Medicine.
Our country can ill afford to have physicians spending three-quarters of their time on things besides patient care. Our population will require more and more care as it ages. That’s among the reasons the Association of American Medical Colleges projects that the United States will be short as many as 120,000 doctors by 2030.
The shortage could grow even worse if doctors react to the burdens federal pressures have foisted upon them by leaving the profession. The Physicians Foundation found that roughly eight in 10 doctors had reported feelings of burnout. Nearly half of doctors are looking to change career paths.
Rolling back the federal electronic health records mandate won’t stop doctors and hospitals from incorporating health information technology into their practices and facilities. Instead, it will allow them — not the government — to decide how to balance patient care and technology use. In theory, clinicians will use technology to improve their ability to deliver high-quality patient care — rather than using technology simply to satisfy the government.
Doctors choose their profession because they want to heal people, not fill out paperwork. It’s time for the government to get out of the way and let physicians actually practice medicine.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is “The False Promise of Single-Payer Health Care” (Encounter 2018). @sallypipes.
Posted: January 16, 2019 – 12:13 PM
Sally Pipes, for the Inquirer
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Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing, Medical Transcription, Scribe Services, and AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #MedicalTranscription #AzaleaHealthEHR #RevenueCycleManagement #MDSofKansas #MedicalBillingService #MedicalScribes
As physicians look for ways to reduce the clerical load associated with EHR data entry, they are increasingly turning to medical scribes.
Scribes help physicians with EHR navigation, retrieval of diagnostic results, documentation and coding. This allows the physician to free up time for patient care.
Yet while the use of scribes is growing, the position remains minimally regulated. There are no requirements for certification, for instance. Any certification received by scribes is voluntary, and the minimum qualification to work as a scribe is a high school diploma.
Here are 17 things to know about scribes.
Basic duties and numbers
1. Scribes typically go with the provider into the exam room and document the patient’s encounter with the provider. The provider may also dictate the patient encounter to the scribe, and the scribe gathers data for the physician such as nursing notes, prior records, labs and radiology results, according to the American College of Emergency Physicians.
2. “Medical scribes do the bulk of documentation for the provider, says Michael Murphy, MD, cofounder and CEO of ScribeAmerica, which provides scribes to hospitals and medical practices. “They’re tracking down labs, they’re notifying of delays, they’re helping in scheduling appointments. They’re basically handling 80 to 90 percent of the ancillary duties for providers.”
4. As of April 2015, at least 22 companies supplied scribes across 44 states, according to the Journal of the American Medical Association. The largest company is ScribeAmerica, with more than 5,000 scribes in more than 570 healthcare facilities across 44 states.
Benefits
5. A study published last year by the National Center for Biotechnology Information found physician productivity in a cardiology clinic was 10 percent higher when scribes were used. The study compared the productivity during routine clinic visits of 10 cardiologists using scribes versus 15 cardiologists without scribes. According to the study, physicians with scribes saw 9.6 percent more patients per hour than physicians without scribes. Physician productivity in a cardiology clinic, overall, was 10 percent higher for physicians with scribes.
6. This same study showed physicians with scribes generated an additional revenue of $24,257 by producing clinical notes that were coded at a higher level. Total additional revenue generated was $1.4 million at a cost of roughly $99,000 for the employed scribes.
7. Additionally, another study showed correlation between a scribes system and thousands of dollars in savings per patient. The study compared standard visits (20-minute follow-up and 40-minute new patient) to a scribe system (15-minute follow-up and 30-minute new patient) in a cardiology clinic. Direct and indirect revenue combined resulted in $2,500 more per patient with the use of scribes.
8. While the use of scribes has resulted in increased productivity and a revenue boost, evidence also suggests scribes may improve clinician satisfaction, as well as patient-clinician interactions, according to a study published in the Journal of the American Board of Family Medicine.
The authors identified five peer-reviewed studies from 2000-2014 assessing the effect of medical scribes on healthcare productivity, quality and outcomes. Three studies assessed the use of scribes in an emergency department, one assessed the use of scribes in a cardiology clinic and one assessed the use of scribes in a urology clinic. Two of the studies reported scribes improved clinician satisfaction, and one study reported improved patient-clinician interactions.
9. Dr. Murphy says scribes are helping alleviate productivity challenges associated with EHRs, but they are also helping providers through the transition to ICD-10 —the 10th version of the World Health Organization’s medical classification system that took effect Oct. 1, 2015.
Regulations
10. CMS does not provide official guidelines on the use of scribes, but has responded to direct inquiries about using scribes, according to the American College of Emergency Physicians.
11. CMS does not bar non-physician providers, such as physician assistants, nurse practitioners and clinical nurse specialists, from using scribes.
12. A scribe does not need to be employed by the hospital they work at, according to the American College of Emergency Physicians. Hospitals may use scribes to bridge volume gaps, enabling a smaller number of physicians to treat a greater volume of patients, says Dr. Murphy.
13. The provider must add and sign an addendum to the scribe’s note when the scribe makes an entry on a paper medical record and correction is needed, rather than cross out or alter what the scribe has written, according to the American College of Emergency Physicians.
14. The Joint Commission does not endorse or prohibit the use of scribes. The Joint Commission permits scribes to document the previously determined physician’s dictation and/or activities, but does not permit scribes to act independently, with the exception of obtaining past family social history and a review of systems, a technique providers use to get the patient’s medical history.
Education and training
15. As of January 2016, the average pay for a medical scribe is roughly $12 an hour, or $29,595 annually, according to PayScale. The Bureau of Labor Statistics does not provide salary information specific to medical scribes. However it does provide data for medical transcriptionists. According the bureau’s latest numbers available, from May 2014, the average pay for a medical transcriptionist is $17.11 an hour.
16. The general minimum qualification for medical scribes is a high school diploma, although some pre-med students work in medical scribe positions to gain experience from shadowing physicians, according to an article published by U.S. News & World Report.
17. Scribes are not required to go through a certification process. However, there are organizations, mostly scribe service vendors, that train and certify scribes, one of which is the American College of Medical Scribe Specialists. Read more…
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. Medical Scribe Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement #MDSofKansas #medicalbillingservice
Certified Medical Scribe Support Can Alleviate Physician EHR Burnout Concerns; Certify Today
CONTACT: Kristin Hagen
President/CEO, American College of Medical Scribe Specialists
(657) 888-2158
ORANGE, CA., July 6, 2016. According to a new analysis by the Mayo Clinic and American Medical Association researchers of a nationwide survey of physicians, computerized provider order entry and electronic health record use are a major source of burnout for physicians. The study found that physicians who used EHRs and CPOE had greater rates of burnout than those who did not, an issue that Certified Medical Scribe Specialists (CMSS) have been shown to help alleviate.
“This study makes it clear that physicians are frustrated with the drop in productivity resulting from electronic health record use and the time takes away from true, face-to-face interactions with patients,” said ACMSS Executive Director Kristin Hagen. “The revolution in our healthcare system toward value-based, individualized medical care and treatment cannot happen if the EHRs meant to help facilitate these changes are a major source of physician dissatisfaction. Certified Medical Scribe Specialists assist practices and clinicians in real time, assisting innovative workflow and efficiencies, providing necessary tools and resources.”
A study published last fall in ClinicoEconomics and Outcomes Research found that physician productivity in a cardiology clinic was 10% higher for physicians using medical scribes. This improved productivity resulted in 84 additional new and 423 additional follow-up patients seen in one year. That study also found that the physicians using medical scribes finished most or all of their work during clinic hours and they did not have to spend additional time to complete documentation after their standard working hours.
“The clinical documentation and practice efficiencies certified scribes provide have been shown to ease the clerical burdens of CPOE and EHRs, and give physicians back the time and attention they need focus on their patients,” Hagen said. “Providers need to ensure that they use certified medical scribes, meeting CMS requirements, revolutionizing clinical care and creating sustainable outcomes together.”
The ACMSS certification program meets current and proposed CMS certification requirements toward use of electronic health records. ACMSS works in compliance with CMS to meet national goals and initiatives of Meaningful Use, Merit-Based Payment Incentive System (MIPS) and Medicare Access and CHIP Reauthorization Act (MACRA). Certified medical scribes also meet the “qualified people” standard in Certified Electronic Health Record Technology (CEHRT). If not the clinicians themselves entering the data, eligible personnel must be certified, meeting the CEHRT Meaningful Use (MU) Personnel standard.
The ACMSS certification program meets current and proposed CMS certification requirements toward use of EHRs through its Medical Scribe Certification & Aptitude Test (MSCAT). ACMSS provides specialty certifications in vascular medicine, dermatology, oncology, primary care, internal medicine, emergency medicine and general patient care, enabling access to all across the specialities. ACMSS enables same-day certification for practices to meet Meaningful Use attestations, presently at 2%, and offers ongoing webinars to assist prospective individuals with key information about ACMSS, regulations, and innovations to meet healthcare goals through Volume Certification Packages.
Building integrative systems design for prevention and disease reversal for patient care most heavily impact family practice, primary care, and urgent care, followed by all the specialities. MIPS and MACRA allow the current traditional healthcare system and providers to focus on their much-needed goals today in independent practices of working to assist patients in disease reversal and prevention toward wellness.
The American College of Medical Scribe Specialists offers five separate pathways for Certified Medical Scribe Specialists. Please contact ACMSS directly atsupport@theacmss.org or 657-888-2158 if you have any questions regarding the ACMSS program and/or materials.
About ACMSS
The American College of Medical Scribe Specialists is the nation’s only nonprofit professional society representing more than 17,000 Medical Scribes in over 1,700 medical institutions. ACMSS partners with academic institutions, non-profit partners, and medical scribe corporations to offer both education-to-certification and employment-to-certification pathways. ACMSS advances the needs of the medical scribe industry through certification, public advocacy, and continuing education. To learn more about ACMSS, please visit: theacmss.org
Certified Medical Scribe Specialists (CMSS) credentials and certification are enabled via the Medical Scribe Certification & Aptitude Test (MSCAT), recognized by CMS, meeting the Personnel Measure of Eligible Personnel of “who” may document in the EHR.
Medical Document Services of Kansas, LLC (MDS) is a Wichita, Kansas healthcare document service specializing in Medical Billing and RCM, Medical Transcription, Pre-Certs with AzaleaHealth EHR. We provide efficient, accurate, affordable quality services for hospitals, clinics, and facilities of all sizes. Call 866-777-7264 today, or visit our website for more information. We have education programs in Medical Scribe Specialists. #medicaltranscription #azaleahealthEHR #revenuecyclemanagement #MDSofKansas #medicalbillingservice