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Dome - Eyes on the Patient, Not the Screen

Dome November 2014

Eyes on the Patient, Not the Screen

Date: November 6, 2014

Scribes document in Epic while providers focus on care.


Emergency Department scribe Brenton Elliott helps physician Ian Warrington record information about a patient at Sibley Memorial Hospital.
Emergency Department scribe Brenton Elliott helps physician Ian Warrington record information about a patient at Sibley Memorial Hospital.

Last summer’s smooth Epic rollout in the Emergency Department at The Johns Hopkins Hospital can be attributed to preparation, practice—and, in part, to scribes.  

As they screened incoming patients, physicians stationed at the Emergency Department entrance didn’t have to document in the new electronic medical system at the same time. Instead, they were able to devote their full attention to patients while a trained scribe entered data into a laptop computer. 

A scribing pilot program has proved a boon for physicians assigned to evaluate patients through the Emergency Department’s high-volume “up-front process,” says Peter Hill, clinical director of the Emergency Department. Scribes “are incredibly helpful,” says Hill, who plans to increase their use. “You can focus on interacting with the patients, caring for them, making decisions and taking their medical history.”  

An estimated 12,000 scribes are documenting work performed by physicians in hospitals and clinics across the country. Whether trained in the workplace or a professional scribing program, scribes must meet standards for training and competence specific to their workplace according to guidelines set by the Joint Commission and the Centers for Medicare & Medicaid Services.  

Michael Boland, ophthalmologist and director of information technology for the Wilmer Eye Institute at Johns Hopkins, has helped to incorporate scribes into the work flow at numerous Wilmer practices. “Scribes are really useful for providers in high-volume settings, where spending a couple of minutes with 50 to 60 patients a day translates into two hours a day at the computer,” he says.

The extra cost of using scribes can be made up by improved provider efficiency, Boland says. “You just need to add a few more patients a day to make this work out.”

Learning to work with a scribe takes time, says Mustapha Saheed, assistant clinical director of the Emergency Department. “You have to get used to having someone in the exam room typing what you say, and you also have to learn to vocalize parts of your exam and assessment. But ultimately, the more you work with scribes, the better the efficiency gains.”

 Anticipating the demands of Epic on providers, The Johns Hopkins Hospital and the school of medicine have established policies for hiring and using scribes. “We’re prepared to support the use of scribes for clinical services,” says Martha Weiner, senior director of the Office of Billing Quality Assurance for the school of medicine. Guidelines prohibit scribes from providing any form of treatment. Physicians are required to review and sign off on documentation entered by scribes. 

Elsewhere in the Johns Hopkins Health System, orthopaedic surgeon Uma Srikumaran works with a scribe in two outpatient offices. Scribes eased the Epic rollout across Suburban Hospital in July and are used extensively by Sibley Memorial Hospital’s emergency physicians.

“From the very beginning of our patient encounter to the time the patients are discharged, the scribes help navigate and expedite patient flow through the ED,” says Nadia Eltaki, a Sibley emergency physician. “They are an invaluable part of patient flow and allow us to be more efficient in meeting the needs of our patients.” 

—Stephanie Shapiro

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