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Team Documentation Case Report: The Vancouver Clinic

Physicians at The Vancouver Clinic (TVC) in Vancouver, WA, noticed that they were struggling to keep up with their increasing charting burden. To help the providers spend more time with patients and less time with charts, the practice decided to give scribes a try.

After testing different team documentation models, the clinic formed an agreement with a local scribing company. The company uses recent college graduates who are pursuing careers in medicine. This model worked well and is still in place. TVC has been impressed by the scientific training and vocabulary of these scribes and have found that they require little additional training.

The clinic studied different models to pay for the scribes. Physicians who used a scribe added one contact-hour to their seven-contact-hour workday, which covered the additional cost of the scribe. The clinic also found that adding a scribe and the corresponding clinic-hour per day for seven physicians is equivalent to adding one more full-time physician and extends the care that The Vancouver Clinic doctors can provide.

To be eligible to hire a scribe at The Vancouver Clinic, physicians must have worked at the clinic for at least six months learning the electronic health record (EHR) and must be busy enough to fill their added contact-hour each day to offset the cost of the scribe. Even with the added contact-hour, the reduced charting burden saves the physicians time each day—data showed that by using a scribe, physicians added one contact-hour but removed two charting-hours, resulting in physicians needing to work one fewer hour each day.

The scribes are welcomed by most patients. The purpose of the scribe was explained to patients during initial visits. The scribes wear scrubs and name tags like other members of the team. Patients have the option to decline the scribe, but this rarely occurs. An initial patient survey revealed that half of patients thought their visit was substantially better with the scribe in the room, while the other half felt neutral about the scribe. Only rarely did the survey show that the patient would have preferred a private conversation with the physician but was afraid to speak up. It is now at the discretion of the physician to ask the patient if there is something he or she would prefer to discuss without the scribe present if physician senses the patient may be uncomfortable; the physician may also ask the scribe to leave if he or she believes this is what the patient will prefer.

Scribing is used successfully at The Vancouver Clinic by a wide range of specialties, including primary care providers, urologists, ENTs, rheumatologists, and orthopedic surgeons. Approximately 60 physicians now use scribes and the number keeps growing. Working with scribes has increased physician satisfaction with their work. With the added support, physicians are able to take on last-minute patients without feeling burned out and overwhelmed by a heavy charting workload. Practitioners have remarked, “I feel like I have my life back,” and, “I feel like I'm a real doctor again.” The improved physician experiences is a selling-point for recruiting new providers to TVC.

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