10/21/2014. Improving EHR Navigation with the Use of Scribes. Charles H. Mann, MD FACS. Improving EHR Navigation with the Use of Scribes

Improving EHR

Navigation with the Use

of Scribes

October 22, 2014 | 12:30–1:30 p.m., EDT

© 2014 The Carolinas Center for Medical Excellence

Charles H. Mann, MD, FACS

Charles H. Mann, MD FACS

• Practicing otolaryngology in the Triangle area since 1982 • President of Mann Ear, Nose

and Throat Clinic • Using electronic medical

records for documentation as part of specialty practice for over 15 years.

• Member of the Senior Advisory Council of Radysans Inc.

Improving EHR Navigation with the

Use of Scribes

History of Development

– Doctors used to do everything in office with hand-written charts, then supplemented with electronic dictation – Evolution of medical records reversed the doctor/patient

relationship

– We found that no EHR preserved the doctor/patient relationship

– TEAMWORK is the solution  Scribes or medical assistants  Front desk and ancillary services

Improving EHR Navigation with the Use of Scribes - The Process

• The record follows the outline of the typical doctor visit: – Pre-check-in and Front Desk

– Triage – Summary Sheet – History Taking

– Documentation of physical examination – Medical decision-making

– Diagnosis – Assessment – Plan of action

– Doctor’s comments at the end

• The data are accumulated, then go to a person to finalize processing and billing

Less Time in the Exam Room Saves

Money*

• It takes an estimated 2 minutes to complete a paper chart

• Using EHRs, without team assistance, chart completions average 3.5 minutes per patient • This would mean a practice may see a reduction of

patient flow by 1/3

• If your average reimbursement is $86, this would be a decrease of $963 per week, or $3852.80 per month

* ‘Using Medical Scribes in the Office’ AHIMA.org

Using Scribes Versus Clinic Staff

which is generally an additional cost to the provider • These charges can range from an hourly rate to a

charge per record for this service

• Hiring medical assistants (MAs) to work alongside the provider as the scribe will save on cost

• MAs become familiar with the physician’s practice style and can assist in the exam and procedures

Tried and True Practices

• Mann ENT has been using a home-grown EMR for 15 years • We use MAs as scribes and

have found that this allows for better physician and patient interaction

Our Proven Method

• Utilize your patient portal and web registrations whenever possible

• Our web registration is given to all new patients to fill out online. This is linked directly to our EHR and aids in the speed of triage

• We also utilize our website by incorporating paper

documents for download for those patients who prefer

complete paper documents prior to arrival. This aids in the speed of check-in and triage

Utilize Your EHR to Provide All

Details

• Using the indication and note fields to ensure the flow for the patients is always beneficial

• Asking the reason for the visit and making special notes can aid clinic prep and improve patient flow

Importance of the Front Desk

• To ensure data accuracy, have the front desk staff enter as much information before the patient is seen

• This includes demographics, insurance, occupation, and pharmacy

Have Your EHR Work for You

• When triaging your patients, the EHR should help guide the staff to ask the right questions

Have Your EHR Work for You

• Templates can aid the staff in asking the right questions for the chief complaint

• If a template is built correctly, it will also save time in the room

Details to be Done at Triage

• Review all medications • Patient’s allergies

• Significant medical conditions • Patient’s vitals with BMI

calculated

• Load the appropriate template • Pull up any needed scans

and/or reports

Two Ways to Go from Here

Paper Tablet

Providers Who Prefer Paper

the clipboard to understand the reason for the visit and ensure all needed reports are available

• Materials Printed: – Reports – Summary Report – Last Visit

Summary Sheet Holds Vital Pieces of Information

Utilizing a Tablet

• The provider can open the current exam and

review triage for the

visit reason • The provider has the

opportunity to view reports and chart before entering the room

• This is an excellent way to page through

all reports and

previous visits at a glance

• The physician can manage all aspects of the patient’s care from here

Quality Face Time with the Patient

more at ease if the provider is giving them their undivided attention

The Visit

• The provider goes in the room prepared

• The MA will enter the exam room with the provider • With the MA at the computer, the provider is free to

give the patient undivided attention

• The MA is there to aid the provider and to make the necessary notes in the chart

• This keeps the exam workflow at the provider’s discretion not the EHR’s

Equipment and Programs Utilized

• A slave monitor can aid in visualizing scans and reports for the patient

• With qualified staff in the room, the e-prescribe can be easily utilized

• Labs can be ordered on the spot and sent to the lab of your choice

Equipment and Programs Utilized

visit is essential

• Pictures of scans, the patient, and photos from a procedure will help in tracking changes in the patient’s health

While the Provider Explains the

Next Plan of Care

• MA can order requested tests and/or surgery

Completing the Charges

choose the procedure and note the findings

• As the provider discusses the findings and diagnosis, the MA is entering it in the chart

• The visit is now ready for billing

Completing the Visit

• Comments for the visit in the

provider’s words personalize the visit

• Comments may be added in multiple ways

– Dictated into an iPad, or phone with Google Speak

– MA typing into the chart as the provider speaks with the patient – Voice recognition

Finally

• The provider is free to leave the room when exam is finished

• The MA will then review any orders from the provider • The MA can then exit the patient to check-out • The chart is now complete

Checks and Balances

• Our correctionists will review charts for completion and any errors

• The office note is then faxed to the primary care physician and referring physicians within 24 hours • Our Billing Team reviews the charges and enters the

claim

• Medical Records team does audits quarterly

In Summary

• We’ve developed our own program that models the typical doctor visit and the important function here is TEAMWORK

• The scribe is important, but only one part of the team

• The goal is a positive experience for the patient and a positive experience for the doctor

Questions

Marnivia Spencer Health Care Quality Consultant

919-461-5665

[email protected]

References

• ‘Hate Dealing with an EHR’ by Neil Chesanow • ‘Using Medical Scribes in the Office’ AHIMA.org • AAOA

• DbChart, Creator and Senior Medical Advisor • Radysans EHR, Senior Medical Advisor

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