If they opt in, they are required to see one additional patient per session (i.e., every four hours). Physicians at UW Health have the option of working with a virtual scribe. This is true whether it’s a small practice or a large academic medical center.” “With virtual scribes, physicians can stay connected to the patient. They went to school to practice medicine and make a difference,” says Williams. “Providers didn’t go to school to document. I could not go back to the way I was doing things before.”Īt UW Health, an integrated health system of the University of Wisconsin-Madison serving more than 700,000 patients each year in the Upper Midwest, working with virtual scribes was part of a deliberate effort to reduce physician burnout, says Christine Williams, director of health information management. “If it was taken away from me, I would quit my job. “Working with a remote scribe has been the single most work-changing thing I’ve done in 15 years,” he says. In addition, his medical assistant is not tied to the computer and can engage patients more directly. Previously, he would have stayed until 8 p.m. Weiss is also able to see an additional three or four patients per day without extending his hours. Ten minutes after my last patient, I’m in the car and headed home.” In the majority of cases, I can legitimately obtain a higher E/M (evaluation and management) level because my notes are so robust. “During a 15-minute established patient visit, I can produce an incredibly well-documented note, get all the tests ordered and stay on schedule. “To me, virtual scribing is one of the holy grails of making medicine tolerable again,” says Weiss. She even navigates to different parts of the record to retrieve information for Weiss upon request. For example, in addition to completing all relevant documentation, the scribe listens to the doctor’s verbal instructions and then orders tests, initiates referrals, messages relevant office staff to obtain prior authorizations and checks off boxes in the EHR for quality measures. Jonathan Weiss, MD, internist in Monticello, New York, has used a domestic virtual scribe for the last four years and says his scribe does just about everything except take vital signs, draw blood, perform electrocardiograms and administer vaccines. Hight’s still assessing whether it makes financial sense for the nurse practitioner (who bills under her own national provider identifier rather than incident-to a physician) to continue.
The other physician who participated in the pilot continues to use a virtual scribe. She also usually does not take work home at night or on weekends. Greater efficiencies enable Hight to see six or seven additional patients a day without putting in extra hours. “My hands are not on the keyboard and I’m looking directly at the patient,” says Hight. Hight says the pilot was a huge success, prompting her to continue working with the scribe, a dentist in India. RIPCPC partnered with an outsourced virtual scribe vendor to launch the two-month pilot program that included Hight, one other physician, and one nurse practitioner. “When I heard about virtual scribes, I thought, ‘Well that’s a good idea,’ ” she recalls. When the Rhode Island Primary Care Physicians Corporation (RIPCPC), an independent practice association to which her practice belongs, approached her about piloting a virtual scribe program - and said it would pay for the first two months of participation - she jumped at the opportunity. Her work-life balance also took a hit as she began to spend Saturday mornings finishing her notes from the previous week. “When our practice started using an EHR, I began to feel a distance between myself and my patients because I was constantly staring at the computer,” she says. Scribes are someone who works offsite or in a different area of the practice (i.e., not in the exam room) to document important aspects of the encounter so the physician or other provider can focus on providing patient care and working more efficiently.Įllen Hight, M.D., a family medicine physician in East Greenwich, Rhode Island, says the electronic health record (EHR) completely changed her practice, and not necessarily in a good way.
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