Scribes find their place in emergency rooms


Helix Scribe Solutions officially has stepped out into the open.

In 2014, Grand Rapids-based physician group Emergency Care Specialists was looking to contract a medical scribe company.

A subsection of the 2009 American Recovery and Reinvestment Act required the adoption and proven “meaningful use” of electronic medical records by 2014. Providers who didn't meet those requirements risked losing their Medicaid and Medicare reimbursement levels. The hiring of medical scribes, trained professionals who document patient-physician meetings during medical exams, would ease some of the difficulties of converting from paper to electronic medical records.

Yet, the organization was struggling to find cost-effective contracted scribes services. So, it built its own.

“They wanted a high-quality program that fit what Emergency Care Specialists and (ECS partner) Spectrum Health are about,” said Ryan Cook, Helix Scribe Solutions executive director. “We’ve got enough pieces of the puzzle here that we can build whatever we want and thought we’d have a better training and outcomes if we did it ourselves — plus, we have a much greater level of control.”

When Emergency Care Specialists’ first wave of trained scribes started their hospital work in May 2015, there were only five working scribes. Now, Helix Scribe boasts more than 100 scribes working in Spectrum Health System hospitals, including Blodgett, Butterworth and Helen DeVos Children’s Hospital.

“West Michigan has some talented young people, and we’re now accessing that pool,” Cook said.

A typical applicant to Helix Scribe Solutions is a college undergrad studying pre-med. If accepted, they receive about 80 hours of free training, provided at Scribe Academy, in conjunction with Grand Valley State University. Trainees take a course designed and taught by GVSU professors to prepare them for the rigors of working as a medical scribe.

The Scribe Academy is a four-to-five-week course offered about three to four times a year, with each class comprising between 30 and 40 students. Potential scribes have signed on for at least an 18-month commitment with Helix Scribe. Upon graduating, scribes undergo another 40 hours of training with one of Helix’s 11 senior scribes in a real-world environment.

Chief Scribe Michael Knox said the scribes do five clinical training shifts with a “progressing autonomy” in each shift. In the first shift, a trainee shadows the senior scribe as they document the physician’s encounters with patients. By the third shift, the trainee is transcribing and shadowing the senior scribe on a one-to-one ratio. And by the fifth, the trainee is on his or her own, with the senior scribe on hand to put out any fires.

“Most of our scribes are in the pre-health field, and they already have a decent amount of scientific background,” Knox said. “But a lot of the training is in learning the medical background, terminology, ins and outs of the emergency department itself, what the different scrubs mean, what a triage nurse does. We put a lot of value on ensuring they are comfortable with everything going on in the emergency department.”

Additionally, student scribes receive real-world experience Knox said translates as they continue their medical school educations. Cook said on average, a medical scribe receives 500-1,000 hours working in an emergency department.

“The medical world is a foreign language, but working as a scribe, you’re thrust into it,” Knox said. “It’s like going into Paris and learning how to get from Point A to B all by yourself.

“As a shadow, it’s always kind of awkward to be there and not have a role, but as a medical scribe, you’re supposed to be there, supposed to be right at a patient’s bedside documenting what happens. It gives you a sense of confidence, and while you’re still sort of bottom of the totem, you’re a part of the team.”

After two years of operating under the Emergency Care Specialists umbrella, Helix Scribe Solutions officially launched this past month. The startup looks toward expanding its services outside the purview of emergency departments and offering primary care scribe services. The emergency department scribes will continue as a part-time option tailored for students' class schedules, while primary care scribes will work a full-time, Monday through Friday schedule.

Helix Scribe Solutions also is looking to expand its footprint beyond the Grand Rapids metro area, with trial programs underway at Zeeland Hospital, and is intent on drawing in pre-med students from Hope College and Ferris State University.

With the inaugural class of scribes set to conclude their 18-month commitment soon, Helix is completing a study on how the company has affected the efficiency of emergency department physicians. A 2013 study conducted by Beaumont Health Systems in Troy found that following the implementation of computerized physician order entry, emergency room patients’ wait times from walking in the door to being admitted or discharged jumped from 231 minutes to 237 minutes. After introducing a scribe program, average wait times decreased to 185 minutes.

Cook said the initial returns on the current study have shown doctors at hospitals deploying Helix scribes are seeing more patients per hour and physicians are spending less time completing paperwork after their shifts, reducing overtime costs.

“We’re already lowering staffing costs per patient, and anecdotally, we’ve heard from doctors who were ready to quit medicine (with the EMD mandate), but this gave them a renewed energy,” Cook said. “It’s nice to be able to see that we’re having positive impact here.”

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