“My interaction with the patient in the exam room has been lost and replaced with large amounts of data entry on my part. I click away, staring at the screen and barely have time to make eye contact with my patient. This is the greatest loss, in my opinion.”
- A GP’s anguished comments to The Physician’s Foundation1
Physicians religiously feed the EHR, but lose out on patient relationships. One primary care study tallied only 1.2 hours/day spent with patients while not simultaneously working in the EHR. But they spent 4.1 hours/day typing progress notes and orders2.
When the keyboard sabotages patient relationships, 79% of physicians say the most satisfying factor in their medical practice is lost1.
Pulling the physician’s gaze away from the screen and back to the patient requires another way to run the EHR; quite simply, using a competent assistant.
The right assistant makes the technology transparent. As the physician engages the patient, performs the exam, and makes MEAT decisions, the assistant hangs on every word of the conversation and the physician’s commentary.
The assistant logs the context, medical details, and orders in EHR templates, in real-time. The physician can later review, update, and approve the encounter with about 80% less time on patient progress notes and orders.
The physician can then use their time with patients to provide greater care and improve outcomes. As one physician said when sharing their results with a researcher, “The bulk of the time should really be on the assessment and plan, and I really feel like we're having . . . very effective conversations about that3.”
The EHR can fade to the background.
Virtual assistants or “scribes” deliver an even more compelling solution. “Virtual” just means “not in the room.” They’re in a secured office using proven technology, scribing the encounter to the physician’s specifications.
After greeting the patient and getting approval for the assistant to join by audio, the physician calls the scribe with an earpiece or speakerphone. Using a laptop or tablet, the doctor views the scribe’s “virtual desktop” in the EHR. The physician can request and view history and data, such as labs, without moving attention from the patient.
The physician develops confidence in a well-prepared assistant and gains freedom from the streamlined process. By not having a third person in the small exam room, the patient feels comfortable and not crowded.
Scribes bring competency to their role from nursing or PA experience. Our training is honed from extensive experience serving physicians. Schooled in exactly how the physician likes to work, one of two scribes is always available to them. Physician and scribe meet briefly for a few minutes each day to review changes to notes and clarify procedures. The doctor gives the scribe feedback on how they can perform better for their needs.
The physician gets their patient relationships back, along with critical care delivery improvements, which include:
A more deliberate understanding of the complete patient reduces missed details, providing a more complete analysis and thorough diagnosis. The patient gets the professional attention they deserve and personal contact creates trust in the physician’s advice and compliance with treatment recommendations5. Using a virtual scribe to remove the EHR from the patient experience gives the physician time to deliver better care4.
1. “2016 Survey of America’s Physicians – Practice Patterns & Perspectives.” The Physician’s Foundation.
2. “Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine.” Health Affairs, 2017 Apr 1: 36(4) 655-662.
3. Yan, C., Rose, S., Rothberg, M.B. et al. “Physician, Scribe, and Patient Perspectives on Clinical Scribes in Primary Care.” J Gen Intern Med (2016) 31: 990.
4. Makoul, G., Zick, A., & Green, M. “An Evidence-based Perspective on Greetings in Medical Encounters.” Arch Intern Med. 2007;167:1172–6.
5. Sheppard, V.B., Zambrana, R.E. & O’Malley, A.S. “Providing Health Care to Low-income Women: A Matter of Trust.” Family Practice 2004; 21: 484–491.
