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In March of 2020, I had planned a trip to Peru. I had been hearing various murmurs from throughout the healthcare industry that there was some new disease beginning to circulate. However, there had been no real formal action to attempt to prepare for this new disease. I had been working as a medical scribe in the emergency department at the time, and to my knowledge there had been no significant moves towards limiting access. On March 15, already in Peru, I awoke and checked the US embassy website to find that the US was being put into lockdown; no one was going to be allowed in or out of the country. For the next two weeks, I was trapped in this foreign country, and was only able to leave when the US State Department flew a rescue mission down to retrieve those of us stuck in the country.

When I returned to US soil, the landscape of healthcare had changed dramatically. Where the position of the scribe had originally been one to accompany the doctor as a shadow to all visits, we now were isolated at home, using a cobbled-together network of phone calls, unique hospital applications, and sometimes scribe intuition to perform our duties and help the physicians with their workflow. Physicians, however, found the role of the scribe indispensable, and often tried to keep us in the department for as long as possible, and brought us back into the department as soon as they were able.

Why were the scribes viewed as so indispensable to the providers? Scribes do not necessarily have a medical background, they are not necessarily knowledgeable about the medical pathways providers use, they legally do not have the authority to sign physician notes. So why do so many physicians maintain the need for scribes as such a vital component of healthcare?

The scribing profession is ancient, with scribes around 3,200 BCE in ancient Mesopotamia, copying down cuneiform onto various tablets to denote resources, such as grain, cattle, or other precious resources. [1]On the surface, this appears fairly mundane. Keeping track of such resources, however, is often of vital importance; without these records, a ruler might not know how much of a given resource there was. This tradition continued for millennia, with scribes taking the important records for posterity and ensuring that these records could be enshrined by the act of writing.

However, times have changed since ancient times. While the scribe in healthcare might not be tracking the bushels of rice put away for storage in case of a particularly bad harvest, scribes nonetheless continue that tradition of maintaining important records, in this case, records of a patient’s healthcare. Without these records, the details of these important encounters might not be recorded correctly, which will lead to worse patient outcomes.

In addition to the need to record the patient-physician interaction, there also comes the benefit of provider satisfaction. According to some studies, half of physicians experience burnout due to growing clerical load.[2]This can be due to a number of factors, including additional stressors from electronic medical records, ensuring quality documentation for the purposes of insurance reimbursement, and administrative tasks. In many of these roles, the process of documentation of a patient encounter appears to be a contributing factor to physician burnout.

So, given this increased need for administrative assistance, it makes sense that physicians would turn to a tried-and-true way to document since ancient times. By bringing a dedicated scribe into their medical practice, physicians spend less time on administrative tasks such as documentation, and more time with patients. These physicians see job satisfaction improve across the board, while not impacting the patient experience. These are huge benefits, all by bringing on a single staff member into one’s practice.[3]

However, with the onset of the COVID-19 pandemic, we do now have to grapple with bringing on these scribes into the medical environment. In traditional scribing, a scribe would accompany the physician to each patient room to record the encounter, document the history and physical examination, and then create the encounter document in the electronic health record. A well-trained scribe would know what questions to ask a provider and often be an additional set of ears and eyes on the patient’s charts to notify them of documentation needs. But, given the increased strain on the healthcare system, including need for N95 masks, personal protective equipment, and social distancing, the needs of the provider for documentation purposes must be balanced against the risks of exposing staff to this novel virus, and potentially increasing the spread of this virus.

To solve this problem, we here at Simply Speak are working on an innovative plan for physicians. In order to off-load these administrative and documentation tasks from the provider, we have developed an artificial intelligence scribing technology that can perform the same task as a well-trained medical scribe. Our goal is to capture that patient-provider encounter in the same way that your standard medical scribe would, and improve documentation efficiency for providers so that they can focus on what really matters: the patient.  Now, during the rollout of the SARS-CoV-2 vaccine in the United States, it is more important than ever to provide quality documentation on all patient encounters while encouraging social distancing.  By providing a tool to providers to ease their workload, I believe that we can continue to improve the physician experience and let providers focus on what they were trained to do: provide care to their patients.

[1] The World’s Oldest Writing

[2] Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017

[3] Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial

Sources Cited

Editors, T. (n.d.). The World’s Oldest Writing. Retrieved from https://www.archaeology.org/issues/213-1605/features/4326-cuneiform-the-world-s-oldest-writing

Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., . . . Lin, S. (2017). Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial. The Annals of Family Medicine, 15(5), 427-433. doi:10.1370/afm.2122

Shanafelt, T. D., West, C. P., Sinsky, C., Trockel, M., Tutty, M., Satele, D. V., . . . Dyrbye, L. N. (2019). Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. Mayo Clinic Proceedings, 94(9), 1681-1694. doi:10.1016/j.mayocp.2018.10.023

Matthew is the Head of Clinical Information at Simply Speak. He is responsible for the development and quality assurance of the clinical notes created by the Artificial Intelligence (AI) software, in addition to recruiting and training of quality assurance testers.  Matthew has over 10+ years of experience in various Electronic Health Record systems, workflows design, process improvement, revenue cycle, and physician adoption. He has previously worked in Emergency Medicine, Psychiatry, Primary Care, and other fields.

 

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