The Iowa Clinic, which is based in West Des Moines, implemented its EHR system about 13 years ago. A lot of physicians at the clinic have done well with utilizing the EMR. But at the same time, “you put the physician in the place of being a court reporter instead of just going in and being the physician,” Dr. Christina Taylor, an internist and the chief quality officer and director of the population health, quality analytics and care management team at The Iowa Clinic, said in a phone interview.
The physicians still have a mountain of documentation work to handle. Some were taking work home and charting from 8:00 to 11:00 p.m., while others were staying late or coming in on the weekends.
“We had a number of people who were at a breaking point,” Taylor added.
So the West Des Moines organization began looking at solutions. It tried out a model where nurses could handle some of the documentation. It also turned to ScribeAmerica, a company offering medical scribes to hospitals. While The Iowa Clinic liked ScribeAmerica’s service, it found that the scribes were often young people who only worked with the company for a short period of time. There weren’t enough scribes to fill the clinic’s needs.
Eventually, the organization came across IKS Health and its Scribble tool, which is an asynchronous virtual scribe service. The first five or six providers started using the tool in the fall of 2017, and the next five or six doctors came on in January 2018. The number of providers using Scribble is now in the low- to mid-20s — or about 10 percent of the clinic, Taylor said. They’re in various departments, including internal medicine, family medicine, ENT and podiatry. Today, The Iowa Clinic continues to bring on additional providers to use Scribble.
Once implemented, here’s how Scribble works: The IKS team starts by reading each provider’s previous patient notes to learn about their specific documentation style. Essentially, this is IKS doing its background homework on the doctor.
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Next, each provider’s exam room is equipped with a microphone and the Scribble application is installed on their desktop computer. When a patient enters the room, the doctor obtains their verbal consent for the visit to be recorded. The visit then proceeds as normal. Taylor noted that if a patient wants to speak about something without the recording device on, the doctor can easily pause it or turn it off. After the patient leaves, the physician can end the recording and can type any additional information into the HIPAA-compliant application.
The recording is immediately encrypted and sent to the IKS clinical team in India. There is not any personal health information connected to the recording, and the IKS team doesn’t see or know who the patient is. They play the audio and create the note per the doctor’s preferred documentation style. It is then sent back to the clinic as a note that is fully integrated into The Iowa Clinic’s EMR system.
The next day, it’s ready for the provider at The Iowa Clinic to review. If everything is to the doctor’s liking, he or she can sign it. If not, the physician can make changes before OK’ing the note.
Thus far, The Iowa Clinic is reaping multiple benefits from using Scribble. Physicians are happy with it, Taylor said. She noted that “the biggest ROI is time.” When surveyed, the clinic’s doctors said they’re saving anywhere from less than 30 minutes per day to five hours per day.
Others said they’ve been able to see more patients. Taylor herself said that until she started using Scribble, she generally wasn’t able to see new patients.
Photo: sturti, Getty Images
