EHR Scribes

1. EHR Scribes A Post-Implementation Strategy Ann Murphy, MD -- Charles Kitzman CIO – Michaela Mangas Shasta Community Health Center, Redding CA

2. 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…..

3. Live on EHR….so what’s the problem? Pilfered from thisisindexed.com

4. Weighing the results Good stuff Eh? Enhancement process Individual practices Reduced access/capacity Flexible platform • Legible charts • ePrescribing • Solid lab interfaces • Flexible platform

5. 2 areas to address…. Documentation/Quality Productivity Very gradual decline in productivity Increase in billable hours Clinician burnout Difficult recruitment Primary care less popular than $pecialty care • Organizational undercoding • Data capture could be better • Pt. Satisfaction surveys were critical of EHR processes

6. Big on ideas, short on cash….

7. Score! Grantor 3rd party Evaluator 4 month evaluation period* *Probably too short but more about that later

8. Scribing Goes Way Back!! Applying old methodologies to newer processes

9. 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”

10. Scribe Profiles

11. Recruitment and Training Process

12. 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

14. Sample Group & Criteria

15. Control Group

16. Surprises

17. “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!” Clinician Testimonials

18. Case studies • First Case – MDVeteran 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

19. Case studies • Second Case– FNPWith 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

20. Case studies • Second Case– MD Approaching Retirement • Documentation – It’s Better to actually show you.

23. Conclusions

24. Conclusions ?

25. Clinician/Scribe Perspective

26. Questions