From a physician’s perspective, the digital health revolution crashed on the shores of the electronic health record. Navigated using hundreds of keystrokes through a frequently arcane interface, the EHR increased the physician’s administrative burden. While today in-house medical scribes perform searching and documentation in the health record, this solution is costly and diminishes patient-physician communication. Fortunately, in the ferment of the digital health transformation a new solution is available: the virtual scribes of Skywriter MD.
Visiting the Family Physician
Let’s visit a family physician in her office. Dr. Jones’ waiting room is frequently full of patients. In order to avoid after-hours documentation, she performs her EHR searches and documentation while interviewing her patients. Aware that a subtle to overt distancing can develop between her and her patient depending on the position of the screen, her computer has been positioned so she can look at – and attentively listen to – her patient while periodically making small turns to work on the EHR.
While focused on the screen, Dr. Jones worries she may miss the patient’s facial expression or a quick glance at their spouse that could reveal underlying social factors impacting the medical condition. Strain is evident as Dr. Jones splits her focus between accurately documenting the visit and understanding the patient’s complaints as well as their impact on family and work.
While some of her patients present with straightforward problems or for follow-up visits, others present with complex histories that may ultimately represent the beginning of their most trying life challenge. Regardless of the intensity of the visit, she knows working on the EHR work during the patient interview must be as efficient at possible. Her primary focus should be to understand the symptoms and their impact, which will serve as the foundation of diagnosis and care.
In order to improve EHR use and documentation during the patient interview, over 1 in 5 physicians have turned to in-house medical scribes (Physicians Practice). Certified through the American College of Medical Scribe Specialists, scribes assist the physician by searching for laboratory results, radiological studies, or consultation reports. They also document the clinical history and examination. While in-house scribes are a viable model for reducing the administrative burden and increasing physician satisfaction, a less expensive and less intrusive solution has been developed.
The Virtual Scribes of Skywriter MD
Tracy Rue, CEO and Founder of Skywriter MD, was inspired to think differently about the conflict between the patient evaluation and EHR utilization. During his previous clinical and administrative healthcare roles, including an EHR implementation, Rue witnessed how the EHR increased the physician’s documentation burden and contributed to physician burnout.
Rue conceived of taking the scribe out of the patient room and placing them in a remote location. These “virtual scribes” would provide EHR assistance at a non-intrusive digital distance. Formed in Jan 2015, Skywriter MD launched its platform in September of 2015, which has since been adopted by practices in six states.
Rue clearly states his goal in founding the service:
“The service was born to help providers shift focus back to the patient in order to improve both physician and patient satisfaction.”
To understand how Skywriter MD works, let’s consider how Dr. Jones could incorporate it into her practice. After registering as a solo practitioner and receiving an introduction to the service she was ready for her first patient. At the beginning of a visit, Dr. Jones would inform the patient that a virtual scribe, referred to as a “skywriter,” would be listening in on the conversation and that the audio connection could be muted at any time.
The skywriter, one of a small team covering her practice, would log into the visit through the secure web-based HIPPA compliant Skywriter MD platform. In addition to listening in on the visit, the skywriter would share the physician’s EHR screen. At any time, Dr. Jones could request the results of laboratory or radiology study and would see the report found by the skywriter. As needed, she could also visualize the skywriter’s documentation and suggest modifications.
Over time, her skywriter team would learn her preferences and would be able to anticipate her needs. Steadily, they would become an integral part of her practice. In addition, the team approach would provide her practice with continuous coverage.
The Benefits of Virtual Scribes
Skywriter MD is focused on measuring the return on investment to determine if the company is meeting its goals. Amanda Slocum, Skywriter MD’s Sales and Marketing Director, reports:
“We continuously strive to collect and evaluate ROI metrics in order to show our clients the value Skywriter MD can bring to their practice. Our clients have seen improved documentation quality, which leads to higher reimbursement, reduction in overhead and the ability to increase their patient load.”
Skywriter MD Founder and CEO Tracy Rue notes additional benefits:
“Skywriter MD helps physicians shift their focus back to the patient, while still meeting the intense documentation requirements associated with Meaningful Use, Accountable Care, and other regulations that have evolved over the past decade.”
What is Dr. Jones likely to find following adoption of virtual scribes into her practice? In addition to significantly decreasing her data search and entry, not having a scribe in the patient room has created a more comfortable environment when discussing sensitive issues. Most importantly, by delegating EHR navigation and documentation she more fully assumes the role of the physician: building a trusting relationship with her patients, understanding their symptoms and concerns, communicating her empathy, presenting her clinical impressions and recommendations, and conveying that she will be there for them.
Dr. Jones decided to incorporate virtual scribes into her practice. While still very busy, she now travels home at a more reasonable hour and occasionally reflects on her new team and the lightening of her burden. She more frequently arrives home with a smile.