Patient Time

“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

The Barrier to Patient Care


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.

EHR Respite


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 Scribe


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.

Valued Outcomes


Valued Outcomes

The physician gets their patient relationships back, along with critical care delivery improvements, which include:

  • Quality – Personal attention to patients enables better sensing of their needs
  • Accuracy – Completely capturing physical exam results and MEAT in the EHR means properly documenting the encounter
  • Compliance – Improved clinical documentation helps provide solid patient risk scores and billing to the highest correct amount
  • Focus – It assesses the complete problem list and delivers appropriate screening and counseling standards
  • Schedule Flexibility – It allows a physician to spend more time with a patient when necessary
  • Press-Ganey Scores – More eye contact and attention improves the patient’s satisfaction with care
  • 15-20% Time Saved – This means less time typing progress notes and orders (from 80%)

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.

References:

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.

Randall Davis

Meet the Author

Randall Davis - Senior Director Client Operations

Randall's entire career in complex systems has been solving practical problems in service development and operations. Through two decades in software engineering, finance and healthcare he deployed critical infrastructure for process performance and reliability on a collapsing cost curve. Since 2013, Randall has dramatically improved healthcare revenue efficiency through technology and process innovation.

Patient Time