Virtual Medical Scribes: Telescribes & Remote Scribes

Virtual medical scribes are filling an important role in healthcare by documenting the physician-patient encounter remotely. In-person scribes and virtual medical scribes reduce the physician’s workload. This workload has increased due to the implementation of electronic health records, which force doctors to spend much of their time typing on a computer during a patient’s visit. A virtual medical scribe is also known as a telescribe, virtual scribe, or remote medical scribe. In this article you will learn what is a medical scribe and how telescribes differ from in-person physician scribes. You will also learn the different types of virtual scribes. The benefits and challenges of using remote medical scribes are discussed as well. Finally, we look at several virtual scribe companies providing remote medical scribing services.

Electronic health records are widely used in hospitals and among office-based physicians. Although the implementation of EHRs seems to have many benefits such as improved documention quality, cost reduction, and enhanced patient safety, EHRs add demands to a physician’s time mainly by increasing clerical workload. This can result in increased physician stress and burnout.

Medical scribes are a solution to this documentation burden and are a very important part of healthcare teams. According to the American Health Information Management Association, a clinical scribe is a person who has a core responsibility to capture accurate and detailed documentation of doctor-patient encounters in a timely manner in EHRs . Hospital scribes provide insurmountable support to clinicians by alleviating the documentation burden. This has allowed the clinicians to focus on patient-centered care, which has resulted in increased patient satisfaction, increased provider productivity, provider job satisfaction and decreased burnout. These results explain why medical scribes are in high demand and why a more flexible and accessible alternative to live scribing, such as virtual medical scribing has been created to meet the demand.

Difference between in-person medical scribes and virtual medical scribes

An in-person medical scribe works onsite, meaning they are in the same location as the healthcare provider often at emergency departments in hospitals. The ER scribe follows the doctor to the examination room and documents the encounter on EHRs in real-time.

Remote medical scribes work off-site. Virtual scribes can be located either at their homes or at company designated offices. They document patient-provider encounters directly on electronic health records of medical practices or hospitals, via a HIPAA-secure computer connection. There are different types of virtual medical scribes.

Types of Virtual Medical Scribes

Video virtual Clinical scribes

The virtual clinical scribe and provider are connected through a tablet or laptop via a secure app, the electronic device can be set on a counter, or transported on a mobile cart. They are able to communicate audibly, and the video allows the scribe to respond to non-verbal cues as if he or she was in the room with the provider, this allows real-time documentation of the encounter in the EHR. An example of this is TeleScribe Video from ScribeAmerica.

Audio only virtual healthcare scribes

The physician calls the telescribe over a HIPAA-secure landline or mobile phone before seeing the patient. The provider is equipped with a light wireless earpiece connected to the HIPAA-secure line. The earpiece has a microphone that allows the scribe to hear, capture, and document the encounter in the EHR. The physician and remote medical scribe are continuously connected, allowing the clinician to move from patient to patient without stopping at the computer station to document. Some providers and patients prefer this option as they feel it is less intrusive during the patient visit. Examples of this are the TeleScribe Audio from ScribeAmerica and ScribeLink from Aquity.

These types of virtual scribes provide real-time documentation in EHRs using their own accounts. Once the encounter is over, the scribe prompts the physician for any missing information required to complete the medical chart, such as physical exam details, differential diagnoses, orders, and treatments. These virtual healthcare scribes are also able to review past visits, monitor returned labs, and radiology results in order to assist the provider and ensure an efficient workflow.

Recorded encounters remote Medical scribes

This type of remote scribe does not document in real-time. Instead, the providers record their patient encounters with mobile apps or other recording options. Then the audio files are securely submitted for scribing. The scribe listens to the encounters and extracts the required information for direct input into the EHR. Providers subsequently log in to their EHR to review and sign the completed documents. These types of scribes are not able to ask for missing information to optimize the documentation since they are not connected with the provider in real-time. Examples include Athreon’s virtual medical scribe service and Aquity’s ScribeAssist.

Benefits of Virtual Scribing for Remote Medical Scribes

The person working remotely has a medical scribe enjoys many benefits. These positions are great for people who need to work from home. However, some companies may require the scribe to go to an office to work as a virtual scribe.

  • Flexible scheduling
  • Ability to work from home
  • Less money spent on gas, car maintenance, and eliminating commutes.
  • The opportunity to gain clinical exposure by working with multiple providers
  • Work with several different practices and specialties
  • Gain exposure to the systems and processes of several different hospitals
  • Earn an income while gaining clinical experience for medical school
  • Gain a greater understanding of the medical field
  • Opportunities to receive letters of recommendation

What are the benefits of telescribing for physicians?

The many benefits of medical scribing to the physician are detailed in this article. There are also benefits specific to remote medical scribes as seen below.

  • Telescribes provide documentation solutions for practices located in remote or rural areas where it may be difficult to hire qualified physical scribes.
  • Reduced cost when compared to live/in-house scribes.
  • Ability to be called as needed, flexible availability.
  • Virtual scribe companies have a team approach where several scribes are familiar with the physician workflow and documentation preferences, this ensures uninterrupted coverage, regardless of illness, breaks, and other absences.
  • Telescribe scribe companies plan for natural scribe attrition and replacement with internal training and shadowing, therefore a provider doesn’t have to worry about scribe turnover.
  • Reduced scheduling problems. Since several scribes are available and are familiar with the physician workflow and preferences, the need for 1:1 coordination of scribe-provider schedules is virtually eliminated.
  • Ability to cover multiple locations on the same day.
  • Ability to be more discreet/ less intrusive. Telescribes reduce patient anxiety by not being present in the exam room.

What are the challenges of remote telescribing?

In order for telescribing to be successful, reliable and secure, a HIPAA compliant connection must be guaranteed at all times. Remote scribing companies implement and manage this connection. However, if you are a healthcare provider implementing remote scribes in your office, make sure you have an appropriate consultation with your EHR provider, internet connection provider and your IT department to ensure HIPAA compliance.

Internet outages can cause a challenge in virtual scribing, therefore it’s very important to ensure a reliable and stable connection. Without the internet there is no way to connect remotely to an EHR, leading to disruption of documentation input and workflow. This can happen in hospitals, the company designated virtual scribes offices, and more frequently at home locations. In case of an outage, solutions to overcome this problem include taking or recording notes of the encounter and then adding them to the EHR when the connection is re-established. However, in scenarios such as emergency departments, providers may be required to document the encounters themselves, due to the urgency for chart completion for proper patient disposition.

Not being able to hear the entire encounter. Since clinical scribes are not present in the examination room while the encounter takes place they rely on the provider to ensure the patients are close enough to the communication device and their voice is being clearly heard. This challenge can be easily overcome by asking the provider to either tell the patient to talk louder or by the provider repeating what the patient said.