Download - EHR Scribes
EHR ScribesA Post-Implementation Strategy
Ann Murphy, MD -- Charles Kitzman CIO – Michaela MangasShasta Community Health Center, Redding CA
Fast facts….• 30 FT Provider FQHC • Live on since May 2007• 130,000 encounters annually • Multiple services• Primary Care• Pediatrics• Primary Care Neuropsychiatry• Urgent Care• Homeless Van• Various Specialties – Rheumatology, Podiatry, Neurology, etc
and a partridge in a pear tree…..
Live on EHR….so what’s the problem?
Pilfered from thisisindexed.com
Weighing the resultsGood stuff
• Legible charts• ePrescribing• Solid lab interfaces• Flexible platform
Eh? • Enhancement process• Individual practices• Reduced access/capacity• Flexible platform
2 areas to address….
Documentation/Quality
• Organizational undercoding• Data capture could be
better• Pt. Satisfaction surveys
were critical of EHR processes
Productivity
• Very gradual decline in productivity• Increase in billable hours• Clinician burnout• Difficult recruitment• Primary care less popular
than $pecialty care
Big on ideas, short on cash….
Score!
Grantor
3rd party Evaluator
4 month evaluation period**Probably too short but more about that later
Scribing Goes Way Back!!Applying old methodologies to newer processes
Early on….setting the table• Clinician interest was quite low• Trust/Control Issues• Our method of “selling” the idea was flawed• “Barnum & Bailey – Get ‘em in the Tent” approach• Learned quickly that familiarity is best
• Had to develop Training/Assessment Process• Michaela was a big help – ER experience• System/Clinical parts – Set guardrails
• Develop standards for scribe candidates• College educated – Interest in medicine• “JV Residency”
Scribe Profiles
Recruitment and Training Process
Risks• CPOE numbers could be impacted• Clinicians could be left “stranded” if they don’t
have a scribe• Gender issues may interfere with care• Learning/Training curve might negatively impact
access• Scribes might be traumatized by our patients
Sample Group & Criteria
Control Group
Surprises
Clinician Testimonials
• “Saves at least an hour of work.”• “I enjoy the ability to focus on my patients.”• “My notes are actually better and contain
more data.”• “It makes a difference in how my day goes.”• “I sure miss my scribe when she’s out sick!”
Case studies• First Case – MD
Veteran Clinician
• Documentation – Initial E/M coding 90% Chief Complaint 90% W/Scribe showed Moderate improvement.
• Improved timeliness of notes• +108 Encounter over the same period the year prior• 1.09 Enc/Ttl Hours 1.32 Enc/Ttl Hours
Case studies• Second Case– FNP
With Practice 5 years
• Documentation – Initial E/M coding 45% Chief Complaint 75%• W/Scribe showed good excellent improvement.
• Decrease in getting notes done day of visit
• Access - +2 encounters over same period year prior• 1.23 Enc/Ttl hours 1.42 Enc/Ttl hours
Case studies• Second Case– MD
Approaching Retirement
• Documentation – It’s Better to actually show you.
Conclusions
Conclusions
?
Clinician/Scribe Perspective
Questions