Scribes A Very Ancient And Very Modern And

Scribes A Very Ancient And Very Modern And Booming Field

Scribes in Ancient Times • Profession over 5000 years old • First appeared in ancient Egypt and Persia as record keepers who recorded deeds, royal proclamations, laws etc. • Became so prominent that Scribes were exempt from paying taxes in ancient Persia (no longer a perk)

Scribes in Scripture • Jeremiah 8: 8 speaks of “The pens of Scribes” (They had pens? ) • Ezra 7: 6 was called “A ready Scribe of the Law of Moses • By Jesus's time Scribes were such part of the religious establishment that Jesus criticized them many times for getting caught up in petty legal technicalities(Sound like modern Lawyers!)

Scribes Save Civilization! • In the book “How the Irish Saved Civilization", Irish Monk-Scribes are credited with documenting much of the history and literature of ancient civilization that otherwise would have been lost during the Dark Ages.

What Killed Ancient Scribing Something called The Printing Press

Fast Forward to the 1970 s • A study in “The Annals of Emergency Medicine” in the late 1970 s discussed Scribes who • Shadow Physicians • Act as “human tape recorders’ • Increased Physician Efficiency • Improved Chart Documentation

Moving on to the 90 s • Scribing remains rare • My first encounter with Scribes was a consult for a large Oncology Practice in Milwaukee • Practice used Nurses employed by practice also as Scribes for hospital services (99231 -33) • Major Issue was Nurses didn’t accurately record physician services • Result: Major Issues with OIG and CMS

The Scribe Boom 2005 -Current • Dozens of Scribe Services from single practice to large national services (EMSS. Scribe America etc. ) • Thousands of Scribes employed • Scribe America doubled in size between 20092012 • Nearly 3000 Scribes employed by Scribe America alone • Google Scribes and you will see as many hits as traditionally found when Googling coding

Why the Boom? • “ The implementation or electronic medical records (EMRs) in many emergency departments has required a physician learning curve. As a result, EMRs actually increase chart documentation time. Interacting with a computer terminal instead of a patient is not an efficient use of a physician’s time, thus the need for Scribes. ” Luis Moreno MD CEO of Scribe America

What? • That’s right! The implementation of the most advanced ( and government incented) technology in medical records has resulted in a boom in one of the world’s oldest professions! • What’s next The return of 8 tracks and Beta Max? (Probably not)

Other Reasons for Boom Documentation/Coding • Documentation guideline Requirement's for History/Physical/ Medical Decision Making Documentation • Proper Documentation of Procedures • Complete Medical Record Guidelines (Signatures, Attestations, diagnoses etc) • Increased government/payor scrutiny (RACS, CMS, OIG etc. , etc. )

Other Reasons for Boom Practice Management • Need to increase provider clinical time vs. administrative time • Need to improve practice efficiency • Improved patient throughput • Decreased overcrowding • Improved patient experience • Improved provider work quality

More Industry Quotes • “A recent article from the Society of Emergency Medicine demonstrated that the addition of a Scribe results in an additional 24 RVUs during a ten hour shift’ Luis Moreno MD • “Every minute spent on documentation and not seeing patient’s costs a practice $18” Rick Bukata MD in an article for The Annals of Emergency Medicine

A Client of My Company • “Our providers have the time and capacity to see significantly more patients since we established our Scribe Service. Although difficult to measure, the Scribes have had an immense impact on the constant interruptions and stresses that go with a busy ED. ” Richard Schwab MD, Director of Emergency Medicine, Holy Name Hospital, Teaneck, New Jersey • Dr. Schwab established his own Scribe Service several years ago after the implementation of an EMR.

What Scribes Do Basics • Shadow providers and record chart elements that result in History/Physical/MDM elements • Document labs ordered, diagnostics, consults with other providers, procedures. In other words all important MDM elements for coders • Follow up with providers on chart completion • Scribes strictly record from physician instruction. Like coders cannot interpret or assume something was done • Scribed charts must include documentation that charts was scribed, scribe authentication, and physician attestation

What Scribes Do Increased role in practice • Take Elements of history such Family/Social/PMH • Track down test results etc. • Generally assist providers

Scribe Work Setting • • If an Emergency Department Fast Moving On feet for several hours Ability to Do input to EMRs Not for squeamish at site of blood and other bodily fluids

Scribe Training • • • Anatomy Medical Terminology Medical Record Documentation Sound Familiar? But typically not much coding training Should be more of that….

Scribe Background • Many Scribes are medical students • Also EMTs, Mid- Level students, nurse students • Occasionally coding or medical records background

Scribing as a Profession for a Coding Background or Training • Is there a better way to learn coding than to actually be involved in the chart documentation? • However Scribe companies tend to hire medical students etc • Average pay is less than average coding pay • Many Scribe jobs are part time • Scribe companies often don’t have career paths since they expect to turnover students as they graduate medical programs

Summary • Scribing is a boom field • Offers entry level employment in a challenged economy • Cannot be off shored (but it’s been tried) • An ideal job for recently trained or certified coder who needs experience to get a coding job • Scribe companies need to recognize coding training is as appropriate for Scribing as being a medical student

Future of Scribing • EMRs and EHRs are becoming more user friendly • Provider resistance is decreasing • Scribing could become a challenged field in 510 years • But it has been around for 5000 and 10 recent boom years so I wouldn’t bet on it going away

Measures of Scribe Impact Decreased Chart Deficiencies Decreased Incomplete/Sent Back Charts Increase in RVUs per visit/hour/shift More clinical time resulting in improved patient flow • Patient satisfaction • Provider Satisfaction • •