In surveys Massachusetts General Physicians Organization conducted of its physicians, the healthcare organization found that 46 percent exhibited some degree of burnout. When asked what contributed to that burnout, they blamed the administrative burden added to the work of patient care.

THE PROBLEM

Chief among those administrative burdens was documenting in the electronic health record. Many physicians were spending two hours or more after each clinical session documenting in the EHR.

As a result, they were missing family events and staying up late at night typing clinical notes. And in the office, they were too burdened to add new patients to their panels or focus on improving care and outcomes of their existing patients.

In short, they were losing the joy of practicing medicine, and Massachusetts General Physicians Organization needed a way to relieve the burden of documenting ambulatory clinical encounters, said Dr. David Y. Ting, chief medical information officer and a practicing physician at the organization.

PROPOSAL

The organization already had a relationship with vendor IKS Health, which had demonstrated success in allowing physicians to delegate and centralize clinical tasks – in that case, transferring medications from the legacy EHR to the current Epic system.

Building on the vendor's clinical delegation abilities, Massachusetts General Physicians Organization engaged IKS Health to implement its virtual scribe technology, dubbed Scribble. Scribble provides a hybrid technical-human system where a physician uses a secure device to obtain an encrypted audio recording of the patient encounter, with the patient's consent.

The recording is accessed by an IKS Health physician partner, who then synthesizes a complete, concise clinical note in the EHR, ready for the Mass Gen physician to review, edit if necessary, and sign. In addition, IKS Health coders review the documentation and provide billing and coding guidance.

"The workflow releases our physicians to focus on – and even enjoy – the patient-doctor interaction, rather than fret over how they would document complicated histories and detailed exams," Ting said. "And in contrast to live-scribe solutions that require placing an additional person in the exam room, the Scribble solution suffers neither from the need to expand the size of exam rooms nor the hassle of managing and scheduling hundreds of additional staff with the accompanied high rates of turnover."

MARKETPLACE

There are many scribe technology vendors on the market. These vendors include iScribeMD, Physicians Angels, Scribe America, Scribe Healthcare Technologies, Scribe Technology Solutions and Skywriter MD.

MEETING THE CHALLENGE

Currently, around 200 physicians at Massachusetts General Physicians Organization use Scribble, representing about 90 percent of the primary care team and about 10 percent of the total clinical team.

"We rolled Scribble out to our primary care and medicine-pediatrics teams first, with the notion of gaining experience with a general specialty that could then be applied across other specialties, where our current focus lies," Ting explained. "We also chose primary care because they were among the most burned-out of our physicians."

"Patients note that our doctors are more attentive to them, and less distracted by the computer in the exam room."

Dr. David Y. Ting, Massachusetts General Physicians Organization

The organization began by attaching omnidirectional microphones to exam room workstations and worked with information systems to vet and add the Scribble recorder to the hospital's suite of clinical applications.

Eventually, it worked with IKS Health to develop and transition to an Android app that is deployed on inexpensive single-purpose tablets, encrypted and managed by the organization's enterprise mobility management service. The switch to a mobility solution has meant that Scribble is now available anywhere doctors go.

"For implementation, we standardized the patient consent and clinical workflows, and created training videos and in-person training sessions to ensure our physicians and staff were fully versed in how to integrate this new approach into office workflow and culture," Ting said.

"We also worked with our business transformation team to create a standard implementation timeline that gives our physicians several weeks to gradually transition from traditional documentation and coding to a fully scribed model," he added.

Integration with the Epic EHR was a light lift, Ting explained, as the organization's hospital already had security templates for inpatient and ambulatory scribes, and IKS Health's physician partners enter their data directly into approved coded and free-text fields in the EHR. Scribble is EHR agnostic: the physicians organization has partner organizations on different platforms that also use Scribble.

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