She even navigates to different parts of the record to retrieve information for Weiss upon request. For example, in addition to completing all relevant documentation, the scribe listens to the doctor’s verbal instructions and then orders tests, initiates referrals, messages relevant office staff to obtain prior authorizations and checks off boxes in the EHR for quality measures. Jonathan Weiss, MD, internist in Monticello, New York, has used a domestic virtual scribe for the last four years and says his scribe does just about everything except take vital signs, draw blood, perform electrocardiograms and administer vaccines. Hight’s still assessing whether it makes financial sense for the nurse practitioner (who bills under her own national provider identifier rather than incident-to a physician) to continue. The other physician who participated in the pilot continues to use a virtual scribe. She also usually does not take work home at night or on weekends. Greater efficiencies enable Hight to see six or seven additional patients a day without putting in extra hours. “My hands are not on the keyboard and I’m looking directly at the patient,” says Hight. Hight says the pilot was a huge success, prompting her to continue working with the scribe, a dentist in India. RIPCPC partnered with an outsourced virtual scribe vendor to launch the two-month pilot program that included Hight, one other physician, and one nurse practitioner. Scribes are someone who works offsite or in a different area of the practice (i.e., not in the exam room) to document important aspects of the encounter so the physician or other provider can focus on providing patient care and working more efficiently. “When I heard about virtual scribes, I thought, ‘Well that’s a good idea,’ ” she recalls. When the Rhode Island Primary Care Physicians Corporation (RIPCPC), an independent practice association to which her practice belongs, approached her about piloting a virtual scribe program - and said it would pay for the first two months of participation - she jumped at the opportunity. Her work-life balance also took a hit as she began to spend Saturday mornings finishing her notes from the previous week. “When our practice started using an EHR, I began to feel a distance between myself and my patients because I was constantly staring at the computer,” she says.

Ellen Hight, M.D., a family medicine physician in East Greenwich, Rhode Island, says the electronic health record (EHR) completely changed her practice, and not necessarily in a good way.

Virtual scribe