# Scribes and EMR?  Good or Bad? Ok or Not?



## dcrossman (Mar 18, 2013)

Anyone know where I could find documentation on if, when, and how we can use Scribes for EMR?  My provider wants to employ one and I don't have much information on them.  I'm hesitant because I recall hearing a little bit about them years ago when EMR first started coming on, but it wasn't very reassuring at the time.

If any of you could point me to some articles or resources I would appreciate it.  Also- if any of you utilize a scribe in your office could you tell me about your experience?  I'm hoping for a little more information before I give him my "opinion".


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## mhstrauss (Mar 18, 2013)

dcrossman said:


> Anyone know where I could find documentation on if, when, and how we can use Scribes for EMR?  My provider wants to employ one and I don't have much information on them.  I'm hesitant because I recall hearing a little bit about them years ago when EMR first started coming on, but it wasn't very reassuring at the time.
> 
> If any of you could point me to some articles or resources I would appreciate it.  Also- if any of you utilize a scribe in your office could you tell me about your experience?  I'm hoping for a little more information before I give him my "opinion".




I would recommend starting with your MAC.  If yours happens to be Novitas, here is the link to their page on scribe services:

https://www.novitas-solutions.com/bulletins/partb/news081611.html


A couple of our surgeons have started using PA's and NP's to scribe into our EMR for them.  The biggest challenge we have had is getting both the performing doc and the scribe to sign the docoment.  The "quicktext" feature available in our EMR (Centricity) has made adding the required statements easier; we set up a few for all of the docs and extenders that scribe, so they just have to type a couple letters instead of the entire statement.

In my opinion, this can be a good thing for the docs, if they have someone they trust, since most of them (or ours, at least LOL) are really not liking having to personally type into the EMR.

Hope this helps!


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## AprilSueMadison (Mar 19, 2013)

Our doctors couldn't get the hang of managing the computer, documentation and the patient.  We already use MAs to enter the information the doctor says so we've explained to them what a scribe is and how it relates to their job and have implemented that at our practice.  The scribe signs the bottom of the document stating they scribed the information and the doctor signs later after reviewing and approving the documentation.


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## jimbo1231 (Mar 19, 2013)

*Scribes*

Scribing actually has really taken off in Emergency Medicine. There are some boom companies that specialize in Emergency Medicine Scribing, and now other specialties especially any that require E&M documentation are moving to Scribes. One of you mentioned that mid-levels do some scribing for their practice. I would tread carefully on that if the mid-levels are also seeing patients. This can become a compliance issue if it isn't clear who is providing the service and who is scribing.

Jim


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## mhstrauss (Mar 21, 2013)

jimbo1231 said:


> Scribing actually has really taken off in Emergency Medicine. There are some boom companies that specialize in Emergency Medicine Scribing, and now other specialties especially any that require E&M documentation are moving to Scribes. One of you mentioned that mid-levels do some scribing for their practice. I would tread carefully on that if the mid-levels are also seeing patients. This can become a compliance issue if it isn't clear who is providing the service and who is scribing.
> 
> Jim



Jim, you are completely right!  This was actually a big issue for us, because our mid-levels do have their own schedules and that caused a bit of confusion.  I did have to meet with them all and show them the guidelines, and the importance of documenting appropriately for the role they were filling for each particular encounter, but I've been checking the records and they seem to have it all down pat now.


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## jimbo1231 (Mar 25, 2013)

*Thank You*

MH,

It's kind of funny that the latest in technology has resulted in a comeback of one of the world's oldest professions. Maybe the Abacus will make a comeback.
I ran into a situation recently where medical students were doing the Scribing. And again due to signature limitations of the EHR or user confusion, it was not clear to the auditors who was doing what.
In the mid 90s I did consulting for an Oncology practice that was in deep doodoo with CMS (HCFA at the time, I think). They used nurse employees of the practice as Scribes. As often happens, a disgruntled nurse left the practice and went right to whoever people went to in those days (pre CERT, RAC and OIG not that active) and the practice wound up in a world of hurt.
But the Scribing boom has been around now for nearly a decade without any major disasters that I've read about, and as has been mentioned CMS and the carriers recognize it and provide guidelines.
I have a presentation I did on Scribes for a local AAPC chapter in Philly if you or anyone out there would like to see it send me your E.

Jim Strafford CEDC  MCS-P


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## DORAZIO73 (Mar 26, 2013)

Jim, 
I would like a copy my email is dorazio73@aol.com.
Thank you.


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## ford04 (Mar 26, 2013)

*Scribes*

I would also like a copy. My email is ford04@srmc.org.
Thanks so much,
Anne Ford CPC


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## dcrossman (Mar 27, 2013)

I would love a copy of that!  Thank you by the way- to all of you for your responses!  
dcrossman@bangorobgyn.com

Thanks again!


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## jtb57chevy (Mar 28, 2013)

Jim, I'd love to have a copy of your presentation too!
terri.blevins@kdmc.kdhs.us

Thanks!

Terri Blevins, CPC


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## l8n (Mar 29, 2013)

I would also like a copy. jeanine.layton@dmas.virginia.gov

Thanks


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## ford04 (Apr 2, 2013)

*Scribes good or bad?*

My thought has always been a scribe cannot accurately document as well as a provider can for the service he/she provides.

I'm currently dealing with orthopedic surgeons who have requested a scribe. Has anyone had experience with this? Any feedback would be appreciated. 

Thanks...


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## jimbo1231 (Apr 22, 2013)

*Presentation*

Just wondering if those who requested the Scribe Presentation, received it. I sent it under Straffcon or jimbo1231 so I could attach the presentation. AAPC approved it for I think 1.5 CEUs, if anyone if interested in having me present at a Chapter Meeting.
Any questions?

Jim Strafford


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## maddismom (Apr 23, 2013)

Would love to have a copy also.  Thank you so much.  kaylenebrady@msn.com


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## jimbo1231 (Apr 24, 2013)

*Theoretically, yes*

Hi,

In theory the provider should be the best documenter of their own services. But in practice. particularly with ED and other high volume E&M providersthey have not been ideal documenters. Eds have lost a great deal of revenue due to lack of documentation of E&M elements and procedures. The quality has improved over the years, but in recent years the introduction of EM/EHRs has affected physician productivity. Remember the Scribe does not cocument, they should only be the recorder of provider documentation. There have been concerns that Scribes might not accurately record physician documentation, but no recent cases or litigation that i know of. Plus the physician is required to attest to the Scribe recording of documentation.
I'm guessing they surgeons want a Scribe for their E&M services? That could help. I haven't heard of Scribes being in the operating room. Think that would present some challenges. Although Scribes are present for minor surgeries in the ED, I'm pro-scribe...but I don't see them in the operating room!

Jim


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## jimbo1231 (Apr 24, 2013)

*oops*

I meant document...not cocument...that somehow sounds obscene....


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## jimbo1231 (Apr 24, 2013)

*will send you one later*

Can you drop me an E when you receive it?

Thank You,

Jim


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## jdunnahoe (Jun 12, 2013)

Jim - I would really appreciate a copy of your presentation regarding scribes. 
jdunnahoe@oncologyconsultants.com


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## dferree37 (Nov 15, 2013)

Jim I would also appreciate a copy.  dhunt@sidium.com

Thank you!


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## espforu (Nov 19, 2013)

mhstrauss said:


> I would recommend starting with your MAC.  If yours happens to be Novitas, here is the link to their page on scribe services:
> 
> https://www.novitas-solutions.com/bulletins/partb/news081611.html
> 
> ...



Megan,  You mentioned Centricity.  Who is doing the coding?  Is the providers utilizing the scribes for this and the coding or is this another process.

I am very interested in this and I realize this is a little off topic, but we are trying to find a process of implementing coders rather than the providers coding.  Especially with ICD-10.

If you have some thoughts my email is kespinosa@healthcareswfl.org

Thanks,


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## adccouch (Nov 19, 2013)

Jim - I would like a copy of your presentation.  my email is adccouch7@yahoo.com.

thanks
arica


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## Denise01 (Jan 16, 2014)

*using scribes*

I would love to have a copy of this presentation. pls email dalexander92a@bellsouth.net


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## aangita (Mar 18, 2014)

If the offer still stands, I would like to have a copy of the scribe presentation as well: andreena@nauc.net


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## astephens (Mar 24, 2014)

I'd like a copy if is not too late.


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## jimbo1231 (Mar 25, 2014)

*Copy of Presentation*

I've lost track of who I've sent a copy to so far. If you haven't received one could you request privately.
I saw an interesting article on Linkedin. It was the first really negative article I've seen on the Scribe phenomenon. It was an anonymous(not crazy about that) Scribe working for a major Scribe company. Basically he was saying he felt pressured by the Attending to for example document a 4 element HPI or a social history even when the provider didn't do it. I found the social history reference kind of odd since they can usually be found somewhere on any chart (smoker?). But I had wondered about this potential when Scribing first took off a decade ago. Add to it that these companies employ young, impressionable students working for big shot docs, and it would seem the risk might be there. 
My contribution to the Linked in dialog was that Scribing is somewhat regulated now and the good companies invest in training. But it does seem when you add a third party into the documentation process the potential for problems is there. Guess time will tell.


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## dianna@salinapediatriccare.com (Aug 20, 2014)

Hi Jim,

Would you send a copy of your presentation on scribes.

My email is dgray@srhc.com

Thank you !


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## nkoons (Aug 27, 2014)

Jim,

    We are just starting with EHR and we have been discussing scribes. Could I please have a copy of your presentation? My email is nkoons@jaycountyhospital.com.

Thank you,

Nikki Koons 
CPC


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## cynthiabrown (Mar 17, 2015)

pls send me a copy   browncynthia62@yahoo.com


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## sawhitt (May 11, 2015)

I would like a copy please.
Sawhitt4@gmail.com


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