EHR ScribesA Post-Implementation Strategy

Ann Murphy, MD -- Charles Kitzman CIO – Michaela MangasShasta Community Health Center, Redding CA

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…..

Live on EHR….so what’s the problem?

Pilfered from thisisindexed.com

Weighing the resultsGood stuff

• Legible charts• ePrescribing• Solid lab interfaces• Flexible platform

Eh? • Enhancement process• Individual practices• Reduced access/capacity• Flexible platform

2 areas to address….

Documentation/Quality

• Organizational undercoding• Data capture could be

better• Pt. Satisfaction surveys

were critical of EHR processes

Productivity

• Very gradual decline in productivity• Increase in billable hours• Clinician burnout• Difficult recruitment• Primary care less popular

than $pecialty care

Big on ideas, short on cash….

Score!

Grantor

3rd party Evaluator

4 month evaluation period**Probably too short but more about that later

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

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”

Scribe Profiles

Recruitment and Training Process

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

Sample Group & Criteria

Control Group

Surprises

Clinician Testimonials

• “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!”

Case studies• First Case – MD

Veteran 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

Case studies• Second Case– FNP

With 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

Case studies• Second Case– MD

Approaching Retirement

• Documentation – It’s Better to actually show you.

Conclusions

Conclusions

?

Clinician/Scribe Perspective

Questions