Presentation on theme: "EHR Scribes A Post-Implementation Strategy Ann Murphy, MD -- Charles Kitzman CIO – Michaela Mangas Shasta Community Health Center, Redding CA."— Presentation transcript:
EHR Scribes A Post-Implementation Strategy Ann Murphy, MD -- Charles Kitzman CIO – Michaela Mangas Shasta 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 results Good 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
Score! Grantor 3 rd 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”
Recruitment and Training Process Lead Scribe Works with Clinician Outline Preferences Document workflow Dev Training Tools Query for Common Dx – Meds - Ordering Train New Scribe Candidate Learns System Clinical Homework “Scribrary” Sample Visits Train w/Clinician Shadow Lead Scribe Handoff See 1 - Do 1 Go live
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
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.