EHR’s Impact on Productivity: What’s a Provider to Do?

Brian Anderson

Brian Anderson , MD

Board Member

Published October 17, 2016

The majority of hospitals have implemented an electronic health record (EHR), thanks in large part to the federal government’s meaningful use program. But not everyone is happy about it.

Three out of four physicians believe EHRs increase practice costs, outweighing any efficiency savings. And seven out of 10 think EHRs reduce their productivity, according to Deloitte’s 2016 Survey of U.S. Physicians.

Many also feel that entering information into the EHR system is difficult and time-consuming and creates a barrier between physicians and patients.

This leaves physicians with two choices. They can spend time outside of a patient visit completing the patient’s chart, which means longer hours. Or, they can efficiently document the encounter while the patient is in the room, which impacts care quality, the patient experience, and throughput.

Finally, both hospitals and physicians feel they have received no return on investment on their EHR, according to a 2014 Physicians Practice Technology Survey.

Since EHRs are here to stay, how do hospitals and providers deal with the burden of documentation and productivity issues?

Medical Scribes as a Solution

Increasingly, hospitals and physicians are mitigating their EHR challenges with the use of medical scribes. The 2014 Tech Survey found that approximately 21 percent of physicians now use medical scribes to help chart physician-patient encounters in real-time in the EHR, freeing physicians from performing data entry and enabling them to fully interact with the patient.

After one Vituity hospital site implemented an EHR, the ED struggled with productivity as providers put in long hours on data entry. When the hospital launched a scribe program, productivity improved and doctors could now focus on patient care. One emergency physician called the scribe program a "game changer."

Physicians now had more time to spend with patients and no longer had to spend time after their shifts (sometimes up to three or four hours of unreimbursed time) catching up on data entry.

Some of the metrics a scribe program can help move are:
  • Patients per hour: Documentation and clerical tasks can take upwards of 30 percent of a doctor’s shift time. Scribes may allow doctors to see more patients per shift because they alleviate this burden and can help hospitals achieve and sometimes exceed pre-EHR productivity levels.
  • Door-to-doctor time: With less time spent charting, providers can see patients sooner, reducing their time in the waiting room. Accordingly, this also decreases left without being seen (LWBS) rates.
  • Undocumented services: Scribes are completely focused on the patient chart, ensuring that no elements are missed.
  • Patient satisfaction: With a scribe in the room, patients have the undivided attention of their doctors. They feel they are receiving higher quality care, which leads to a better patient experience.
  • Physician satisfaction: Scribes alleviate physician frustration with the EHR, improving physician satisfaction, retention, and even recruiting efforts.

Are There Downsides to a Scribe Program?

Despite the many benefits of scribes, cost is an important consideration. For low productivity EDs, there may be financial and productivity benefits to employing scribes, since an effective scribe program can potentially enable it to treat more patients each day, increasing revenue.

However, for a hospital that already sees a high volume of patients and documents well, a scribe program may simply allow it to get back to pre-EHR levels of productivity, without an associated increase in revenue.

The scribe program helped the department achieve its goal of returning to pre-EHR productivity levels. For example, at another CEP site, the highly productive ED was seeing 2.5 – 3 patients per hour before it implemented an EHR. After implementation, the ED launched a scribe program to get back to pre-EHR levels of productivity in order to remain financially viable.

Although bringing on scribes was more cost-effective for the ED than adding more expensive provider hours, scribes still cost the hospital more than $500,000 last year without an associated revenue increase.

So, it’s important to examine the additional cost of starting and maintaining a scribe program in relation to the corresponding financial benefits your hospital expects to realize.

Finding the Right Fit

If you determine that the benefits of utilizing medical scribes outweigh the drawbacks, do your homework before starting a program. Decide whether you want to develop a homegrown program or work with a scribe training and management company. If you do work with an outside provider of scribe services, be sure to find out about the company’s hiring process and training programs.

At Vituity, our scribes work in EDs, inpatient departments, and outpatient settings. We provide training in medical terminology and medical documentation as well as the EMR or documentation system specific to each hospital client.

A scribe program isn’t a magic bullet for an ED that is struggling with significant operational or financial issues. But for an ED experiencing EHR-related productivity challenges, looking to reduce its length of stay, or struggling with a high percentage of LWBS rates, a scribe program may be a worthwhile investment.

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