When they’re documenting a patient visit in the EHR, John Bender, a family physician in Fort Collins, Colo., and Maley Birdwell, his scribe, have it down to a science.
At the start of each patient visit, Bender walks into the exam room and introduces himself. He then sits down at the computer and angles the monitor so his patient can see the EHR on the screen. Then, about five minutes into the visit, Birdwell enters the exam room — without introduction. Bender simply gets up from his chair, walks away from the computer and engages more closely with the patient. As his scribe, Birdwell slides into Bender’s chair at the computer to take over documenting the patient encounter in the EHR.
Birdwell has worked at the practice for years as a medical assistant and as Bender’s scribe for about two-and-a-half years. That means patients who have been coming to the practice already know her and need no introduction. If new patients ask why she’s in the exam room, she explains that she’s documenting their care in the EHR.
Bender said the EHR is a “definite improvement over paper-based patient documentation” because it enables care transitions. Still, the need to document the patient visit in the EHR during office visits was cutting into his face time with patients, he said.
The decision to work with a scribe came down to two realities: Physicians at his practice need to generate about $360 an hour to keep in business — which means that spending minutes toggling between screens on the computer wasn’t the best use of his time — and he wasn’t able to truly connect with patients if his eyes were on the computer screen and he was focused on typing.
During the patient visit, Bender communicates the physical exam, medical decision-making, and care plan out loud so that Birdwell can document the entire visit in the EHR. Then Bender steps out of the room, and Birdwell takes over. He trusts that she’ll input the care plan, order any necessary x-rays or flu shots, and review everything with the patient so that they understand.
Trust is key, said Bender. And so is Birdwell’s training as a medical assistant. Of course, it also helps that he and Birdwell have worked together for years. She knows exactly how he wants the documentation to appear in the EHR, said Bender.
Because he’s not documenting the encounter in the EHR, Bender can focus his attention on his patients, he said. Before working with Birdwell as his scribe, he might have wasted a few minutes of the 15-minute patient visit toggling through screens in the EHR.
What patients remember about the visit is they’re able to have face time with him, said Bender.
While Birdwell logs into the EHR using his user name and password, Bender views all of the documentation and makes any necessary changes to the patient record before it’s considered final. Within the patient record, Birdwell is recognized as the scribe.
Most patients are comfortable having a scribe in the room, said Bender. Longstanding patients, in particular, appreciate that Birdwell is in the room. In fact, when she’s there in the room, patients feel like they’re getting “extra care,” he said.