Electronic medical records (EMRs) have increased the workload for doctors greatly. It has become much more time consuming to keep up with documentation, and increasingly difficult for doctors to take care of patients in an efficient manner.

“I was seeing fewer patients, and struggling having to do records later on in the evening or on weekends,” said J.D. Fuller, MD, a bariatric surgeon at the Surgical Clinic of Central Arkansas, Little Rock, who is medical director of MedOptim (formerly ScribeNow) formed in January 2012. “Using a scribe has allowed me to get it done in real time throughout the work day, decreased my workload and allowed me to focus on my patients again. It definitely improved my stress levels. My patients are a lot more satisfied now. It does improve patient satisfaction to see the doctor actually spending time with them again instead of looking into a computer screen.”

The cost of using a scribe is a concern for many doctors. But without help, physicians may have to cut back on the number of patients they can see when using EMRs, which causes a decline in revenues.

“When you get a scribe in place, it allows you to see several more patients per day and it allows you to bill for those services appropriately,” Fuller said. “So, we found having a scribe in place easily pays for itself every day and is actually profitable for the clinic. That is why it is working.”

There is more than one way to provide scribe services. Some doctors choose to have the scribe in the room with patients, and patients typically don’t find that very distracting. It usually works out nicely.

“Most of our doctors, however, chose to use our remote monitoring technique where the scribe is in the office, but not physically in the room with the patient,” Fuller said. “The scribe is listening to the physician during the encounter and documenting appropriately based upon the physician’s examination findings. That provides real time documentation, but maintains patient privacy.”

MedOptim has an extensive training program which includes multiple courses both in the classroom and online followed by extensive testing. Then there is a several week period of on-the-job training where they are mentored by the company’s most experienced scribes. Once done with basic training, they are paired up with the doctor and learn specific terminology and preferences required.

Initially scribes were primarily used in emergency rooms, but Fuller said they have found the biggest demand comes from clinics, especially busy family practices.

“One thing we did not anticipate was that we would actually be improving patient access to care,” Fuller said. “Now that doctors can see more patients throughout the day, doctors are now able to schedule more patients and we have been able to improve healthcare in Arkansas. In one clinic where we work, we started providing scribe services to the doctor and after a while also to several nurse practitioners (NPs).”

Some healthcare providers use nurses to input the EMRs. But Fuller said they believe nurses are much more effectively used performing nursing functions instead of scribe duties.

“From a cost standpoint, you are better off using a scribe,” Fuller said. “Let nurses be nurses. Let doctors be doctors. And we will take care of the documentation.”

MedOptim offers several different programs. The most common one is to provide real-time EMR documentation by medical scribes, but the company also works closely with billing professionals such as medical coders. Fuller said this improved level of “coding awareness” in the clinic helps to improve coding accuracy as services are billed appropriately.

There are no startup costs associated with training, equipment purchases, or software.

“We use your existing EMR system and provide all the scribe specific equipment,” Fuller said. “Payroll taxes and all associated costs for the scribe are paid by us. We charge daily for our services and usually doctors will find it to make good financial sense immediately. We do have a contract that has a one-year term, but there is a 30-day out clause for either party. We contract with each provider, but it is easy to terminate the services if it doesn’t work out for some reason. We have found most of our doctors who have tried it love it.”

Michael Murphy, MD, CEO of ScribeAmerica, said the use of scribes is expected to increase.

“As the EMR, federal, and insurance regulations continue to impact physician productivity, the need for assisted documentation will grow,” Murphy said. “At the end of the day, medical scribes are going to be the standard in healthcare and they will be part of the team: a physician, nurse, tech and a medical scribe.”

The use of scribes may allow physicians to practice longer before retiring. A study published in The Journal of the American Medical Association in October 2012 said that nearly 46 percent of physicians had at least one symptom of burnout. The highest rates were found in internal medicine, family medicine and emergency departments where scribes are more likely to be used.