1. Introduction Proposed Workflow Methods Conclusions Click headings to further view content A Novel Approach to Documentation: Telescribes Justin Worthing, MS2; Rajneesh Gulati, MD; Joseph Habboushe, MD, MBA; Robert Femia, MD, MBA, FACEP; Tina Wu, MD, MBA New York University School of Medicine, Bellevue Hospital The work of ED physicians is complex, with increasing patient volumes, rapidly changing electronic health records, and growing documentation regulations. The medical scribe aims to address these problems, while improving quality of care, physician workflow efficiency, job satisfaction, and reimbursement rates. Despite these advantages, facilities remain resistant to adopting a scribe program for several reasons, including new costs, the addition of ED personnel, and incorporation of a new role within an established workflow. Looking to minimize these challenges, we propose modified telescribes utilizing a pre-established, highly qualified volunteer program. The workflow consists of providers connecting to telescribes via audio/video from secure mobile devices, allowing for real time documentation. Providers reap the benefits of note drafting and volunteers gain valuable education and experience only obtainable through close collaboration with ED providers. Results Survey 1: 88 attendings (Response Rate (RR) =29%) and 59 residents (RR=39%) employing yes/no, multiple choice, and Likert scale questions to assess receptivity to scribes and telescribes; no supplemental information was provided. Survey 2: Evaluated hospital volunteers’ (within Project Healthcare and PAVERS programs) desire to participate (n=50; RR=44%). Survey 3: Gauged patient responses (n=12) to both scribes and telescribes services using a Likert scale after a brief explanation of the services. Use of the telescribe would be primarily via audio or video using a secure mobile device (i.e., phone, iPad, android tablet, Google Glass etc). 1.Before evaluating your patient, connect to your scribe. 2.Identify your patient and you keep the scribe on the line. 3.Once entering the patient’s room and completing your introduction, it will be important to let the patient know your telescribe assistant will be present virtually to assist you in your management and expedite his or her care. 4.Documentation is performed in real-time and ideally, a typed note draft will be completed by the time the physician returns to the computer to place orders. T The ultimate goal is several scribes located remotely that can be with a provider virtually, again, in real-time, documenting in the system. This will provide multiple providers with near instant access to a scribe and lead to fewer physical bodies in the ED compared to a traditional scribe model. Survey 1: 84% of providers never used a traditional scribe or telescribe, while 85% indicated a desire to work with them. Furthermore, 95% agreed that learning to use a scribe would benefit them in the future and 75% agreed to adjust workflow to accommodate a scribe. Despite willingness to use a traditional scribe, 45% indicated they would not use the telescribe service (free-text rationales related to inconvenience). Survey 2: 95% hospital volunteer respondents were interested in the scribe position. Survey 3: Zero patients were uncomfortable with presence of a scribe and 16% and 25% were uncomfortable with an audio or video scribe, respectively. Our results indicate patients and providers are more comfortable with a traditional scribe model and implementation of a telescribe model requires addressing workflow and privacy concerns of provider and patient. In order to move forward with this project, several steps must be taken, including: further development of telescribe workflow and exploration of responsibilities outside of documentation that will increase provider efficiency and patient flow (i.e. using scribes to monitor return of labs and diagnostics, placement of consults, or other non-clinical responsibilities); education of providers of newly established workflow, including benefits and drawbacks of the telescribe implementation; provider assessment and instruction of proper use of the telescribe service; development of training program for volunteers to adequately prepare for the telescribe role; compare in-house telescribe service to that offered by national companies (e.g. ScribeAmerica). Source of telescribes? We propose using the pre-established volunteer programs at NYU/Bellevue, including Project Healthcare and Patient Advocacy Volunteer in Emergency Research Services (PAVERS). References

2. 1 st Survey: 84% of providers never used a traditional scribe or telescribe, while 85% indicated a desire to work with them. Furthermore, 95% agreed that learning to use a scribe would benefit them in the future and 75% agreed to adjust workflow to accommodate a scribe. Despite willingness to use a traditional scribe, 45% indicated they would not use the telescribe service (free-text rationales related to inconvenience). 2 nd Survey: 95% hospital volunteer respondents were interested in the scribe position. 3 rd Survey: Zero patients were uncomfortable with presence of a scribe and 16% and 25% were uncomfortable with an audio or video scribe, respectively. A Novel Approach to Documentation: Telescribes Justin Worthing; Rajneesh Gulati, MD; Joseph Habboushe, MD, MBA; Robert Femia, MD, MBA, FACEP; Tina Wu, MD, MBA New York University School of Medicine, Bellevue Hospital Results

3. A Novel Approach to Documentation: Telescribes Justin Worthing; Rajneesh Gulati, MD; Joseph Habboushe, MD, MBA; Robert Femia, MD, MBA, FACEP; Tina Wu, MD, MBA New York University School of Medicine, Bellevue Hospital "EMR Cuts Into Resident Education Productivity, Can Scribes Help?" ScribeAmerica. Web. 15 July 2015. "Scribe Resources FAQ." Medical Scribe FAQ. Web. 13 July 2015. "Scribes in Academic Medicine." ScribeAmerica. Web. 16 July 2015. "Use of Scribes, an Information Paper." (1 June 2011). American College of Emergency Physicians, 1 June 2011. Web. 15 July 2. Watson, Sarah. "The Scribe Industry Blog." The Scribe Industry Blog. 18 Feb. 2015. Web. 13 Aug. 2015. Westgate, Aubrey. "Medical Scribes: Pros and Cons." Medical Scribes: Pros and Cons. 2 Apr. 2015. Web. 14 July 2015. References