More and more we're hearing from clients that want to train staff to do the newest thing in the medical scribe world: work remotely. We've heard stories of undergraduate students, medical assistants, and nurses all starting to do this newfangled role. Whereas an in-person scribe follows a provider around, crafting notes based on what they see and hear, remote medical scribes view the encounter through a camera (or sometimes just a microphone) placed in the patient's room. Now, the first thing I thought was, is this legal? Yes, it can be. Any internet providing service to a healthcare facility has to be healthcare compliant, meaning it's encrypted to protected patient data. So the internet that the device is using to stream is ok to use. But then patients need to agree to be recorded as well so that this doesn't infringe on their privacy (you cannot record patient interactions without consent). There are some distinct advantages and disadvantages to this system. One advantage is that the patient may feel more comfortable having only one person other than themselves in the room (the provider!). One disadvantage, is that this can be expensive. Mounted cameras with good microphones and streaming capabilities can be a couple thousand dollars a piece, so the usual provider has 2-3 dedicated rooms, so that's 5,000-10,000 dollars to install the cameras. And then the internet server may need to be upgraded to account for the extra bandwidth being used, which is another several thousand dollars. But maybe, this new system will allow them to save money to make up for these costs. Not all patient encounters are equally difficult to document. Pediatric well child checks and routine physicals in healthy patients can be largely written from a template in most clinics. Maybe remote scribes allow a provider to only pay for services (for a particular patient) when they feel they need it...? In any case, the future is coming, and MSTS is here to help any organization that may be interested in training staff to write medical notes remotely. 

Healthcare providers have enough on their plate. According to The Physicians Foundation, 80% of providers feel that they are working at their maximum capacity or are overextended. Corresponding to that, 78% of physicians often or always have feelings of burnout. Now, medical scribes can be used for a variety of reasons, but provider burnout is probably at the top of that list. The average physician spends 11-12 hours on documentation outside of work per week. By adding a medical scribe to a practice, clinicians can significantly reduce the amount of time that they spend on a computer after work. But not just any scribe will do that. Believe it or not, they need to have some training. That's where MSTS comes in. Do you have a great medical assistant or nurse already working with you in clinic? Get them some training in documentation of the medical note so they can help take some of the work off your plate!

https://physiciansfoundation.org/research-insights/the-physicians-foundation-2018-physician-survey/

Despite the now widespread use of medical scribes, there are few studies out there that objectively measure the results of their use. A literature review out of the Journal of  the American Board of Family Medicine identified five studies from 2000 to 2014 analyzing the impacts on clinical practice of using a scribe. 

The results were as follows:

• 2/3 of showed no effect on patient satisfaction. There is a belief out there that the use of scribes will improve patient satisfaction because of the increased attention given to the patient, but in our experience, providers don't change who they are--they continue to practice in a similar way, but they get home earlier with all of their documentation done. That is a good segue to the next finding.
• 2/2 reported improved clinician satisfaction. Medical scribes can greatly relieve the symptoms of burnout that some providers may be experiencing from the overwhelming number of things they are expected to do.
• 2/2 reported an increase in RVUs per hour. RVUs, or relative value units, are numeric values assigned to each chart that quantifies how much the provider is reimbursed. Therefore, an increase in RVUs per hour suggests that either the documentation was better and thereby warranted more RVUs or the provider saw more patients per hour, on average. In any case, the use of scribes can be a net neutral expense if they increase patient volumes or charting quality.

These were the biggest takeaways from the article and we wanted to highlight some of them because they help provide some objective information about using scribes in a clinical practice that is naive to them. 

The full article can be found here: https://www.jabfm.org/content/28/3/371

We recently updated our physical exam training to include a brief discussion and demonstration of some of the most common neurological tests performed outside of basic motor and sensory function. These tests include pronator drift, Romberg's, finger-to-nose, heel-to-shin, gait and tandem gait. It may be unnecessary for some medical scribes, but those going to medical school or physician-assistant school may find it informative. It is required in the emergency department scribe training course, but optional in the primary care scribe training course. Enjoy!

We were recently asked why Medical Scribe Training Systems is not a certified academic partner of the MSCAT and its providing organization, the American College of Medical Scribe Specialists (ACMSS). Our answer? Essentially, we choose not to pay for something without utility.  The American College of Medical Scribe Specialists (ACMSS) was created as a branch from Scribe America and is not an accredited licensing program, so it has no impact upon healthcare services. Although Scribe America is probably the largest medical scribe company in the US, we have our own training philosophy. Our courses include lectures, readings and activities to understand basic medical terminology, physical examinations, HPI terminology, labs, medications, and more! We know that memorizing every detail in any scribe training courses is unrealistic, but just like most medical school curricula, we believe that a solid theoretical understanding of clinical medicine will lay the foundation for what is eventually a far greater medical scribe, and can serve as reference material long-term. So essentially, being "certified" by the Medical Scribe Certification and Aptitude Test bears little clinical significance, is not required to become a medical scribe, and does not correlate to the clinical competency of a medical scribe.

Meaningful use is a big deal for primary care physicians and it's important for scribes to have an understanding of what meaningful use is, what the rationale for it is, and how it affects clinical practice. Medical Scribe Training Systems just released a five minute lecture detailing the objectives and implications of meaningful use for the primary care scribe. 

We have overhauled our previous physical exam training videos and just introduced the first of three detailed instructional videos about the physical exam. This first video includes an overview of the general, HEENT and neck exams including topics like:

• Extraocular movements and pupillary reflexes
• Conjunctival injection and icterus
• Oropharyngeal erythema and exudate
• Findings suggestive of otitis media and otitis externa
• The anterior and posterior cervical triangles and lymphadenopathy
• Carotid palpation and auscultation
• Cervical range of motion and meningismus

In his recent editorial in the October edition of the Journal of Family Practice, Dr. John Hickner (MD, MSc) notes that many doctors fail to adequately document three portions of the medical note: history of present illness (HPI), assessment and plan.

Dr. Hickner was kind enough to chat with us at the American Academy of Family Practice Conference that ended yesterday. Like us, he wants medical notes to tell the story underlying the patient's present visit; not just a checklist of symptoms. The emphasis of quantity over quality by the healthcare system and electronic medical records (EMRs) has eroded the quality of the HPI. During our conversation at the conference, he acknowledged that scribes may have a role in solving the dearth of quality documentation by some medical doctors. You can read his full article on the Journal of Family Practice website. And again, it was a pleasure chatting with Dr. Hickner at the conference.

Medical Scribe Training Systems will be at the American Academy of Family Practice (AAFP) in Washington D.C. Thursday October 23 through Saturday October 25. This is your chance to ask us any questions about the logistics of having and training a scribe. We will be located in the Technology Pavilion in between eClinicalWorks, e-MD and Cerner. Come check us out!