Scribing at Kaiser Permanente Through ScribeAmerica
Hey! My name is Ryan Leonard and I've been involved in multiple community efforts throughout my life. I enjoy helping people and I want to make others happy. When I was a toddler, I recall pretending to be a doctor and helping others feel better. My mother was patient enough to let me take her blood pressure, check her heartrate and eyes. I had no idea what I was doing but I kind of felt like I was helping her like my doctor helped me. I wasn't really sure what I wanted to do in college but then I recalled that joy I felt as a kid when I was pretending to help others with a specialized skillset. So, I started working at Amazon to build up a work portfolio and shortly after, I started volunteering at Kaiser Permanente. The truly wonderful people I met in the Surgery Prep room recommended that I try out scribing, which is why I'm at where I am now. I've been scribing unassisted since the start of January 2024.
Kaiser and ScribeAmerica Background
https://healthy.kaiserpermanente.org/oregon-washington/facilities/kaiser-permanente-westside-medical-center-303481
The Importance of ScribingScribes help with physician health charting, which alleviates physician workload so that physicians can spend more time being a physician rather than charting. Scribes help reduce physician burnout. Lastly, scribes also help keep track of information for providers, allowing for better care and patient experience.
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Kaiser Permanente (or KP) was founded in 1945 by Henry J. Kaiser and Sidney Garfield. Henry was an entrepreneur who had run Kaiser Shipyards which served to supply cargo ships during the war. Henry, being an entrepreneur, had a hospital established for his shipyard’s employees. After WWII was finished though, most of Kaiser’s shipyards closed and with it the Kaiser hospital lost most of its members. To survive a large number of members were needed and KP couldn’t promise to pay at first nor patients. 6-7 out of 45 physicians opted to stay despite the unfamiliarity. They would also be experimenting with salaried physicians versus the usual pay-per-visit.
ScribeAmerica was founded in 2003 by Michael Murphy and Luis Moreno. They established SA with the goal of providing trained scribes to medical practices to help increase physician productivity. SA offers rigorous, thorough training to scribes to ensure the success of their program. Additionally, SA understands that most scribes are also students, so they allow for significant scheduling flexibility. |
Why Scribing?
For me, I loved the idea of familiarizing myself with medical terminology and being in an environment where I could see the healthcare process up close. I applied because I thought I'd enjoy the fast-paced environment. I continue to choose this work because I am now significantly invested in helping my providers and their patients. I often look forward to my shifts. I did not often look forward to my shifts at Amazon.
Responsibilities
I am assigned to a physician for each of my shifts, each of whom have different preferences. It is part of my job to familiarize myself with these preferences so that the providers I work with feel well-supported. When I arrive on-site, we are generally given multiple patients, some of whom we might have to perform chart review for. Past medical charts provide an extensive overview of a patient's medical history. If there is pertinent information, I document it in the patient's chart for their current visit.
After this, I follow the physician into the room and notate the patient's explanation of their current symptoms and the timeline along which they developed. I also listen to the physician's physical exam and initial plan to help the patient, and notate this, too.
I then keep track of upcoming results such as electrocardiograms, X-rays and other results for the provider. If a patient receives one of these, I prompt my physician for their interpretation and input that into the patient's chart. I also notate any additional consults for the physician as well as medical updates.
After this, I follow the physician into the room and notate the patient's explanation of their current symptoms and the timeline along which they developed. I also listen to the physician's physical exam and initial plan to help the patient, and notate this, too.
I then keep track of upcoming results such as electrocardiograms, X-rays and other results for the provider. If a patient receives one of these, I prompt my physician for their interpretation and input that into the patient's chart. I also notate any additional consults for the physician as well as medical updates.
I made this to help keep track of patient charting. HPI is the History of Present Illness, or why a patient is presenting to the medical facility. ROS is the Review of Systems, which is a subjective review of the patient's reported systems. The PE is the Physical Exam, or the physician's objective findings such as tenderness to palpation (touch). The MDM is the physician's Medical Decision Making, or their plan for the patient.
EKGs are electrocardiograms, which are a record of electrical signals from the heart. XRs are X-rays. DISPO is disposition, or whether or not the patient is stable and able to go home.
EKGs are electrocardiograms, which are a record of electrical signals from the heart. XRs are X-rays. DISPO is disposition, or whether or not the patient is stable and able to go home.
Plan of Action
KP and SA both strive to ensure that diverse needs are met and that individuals are not judged based on individual differences. Additionally, they ensure that under privileged individuals are still able to access health care. They strive to ensure personalized healthcare. Thus, my goals are as follows:
- Continue to create accurate charts, as reviewed by physicians, for patients.
-Continue to create to ensure good workflow for providers to alleviate workload.
-Assist in the healthcare process in any way that I can, as my training and qualifications permit.
I chose these goals because I want to continue to ensure that I do my job to the best of my ability. When I perform well on my job, I am helping others.
I ensure that I accurately and consistently communicate with the provider I am assisting throughout my shift. I strive to work as part of a team in providing assistance of patients. While I cannot directly help patients, I am content with knowing that my work will help providers perform more efficiently.
When and if I am asked a question that I cannot answer in the ED, I ensure that patients are directed to someone who is qualified to answer them. I am not a physician, but I can ensure that the physician is aware of any questions that a patient might have so they can answer them.
- Continue to create accurate charts, as reviewed by physicians, for patients.
-Continue to create to ensure good workflow for providers to alleviate workload.
-Assist in the healthcare process in any way that I can, as my training and qualifications permit.
I chose these goals because I want to continue to ensure that I do my job to the best of my ability. When I perform well on my job, I am helping others.
I ensure that I accurately and consistently communicate with the provider I am assisting throughout my shift. I strive to work as part of a team in providing assistance of patients. While I cannot directly help patients, I am content with knowing that my work will help providers perform more efficiently.
When and if I am asked a question that I cannot answer in the ED, I ensure that patients are directed to someone who is qualified to answer them. I am not a physician, but I can ensure that the physician is aware of any questions that a patient might have so they can answer them.
Who, What, Where and When? How did it go?
I will continue to scribe to the best of my ability and improve in any place that might be seen either by myself or another party as deficient. I have already done this by reviewing past charts prior to my shift so that I can continue to improve into the future. I have familiarized myself with a greater degree of medical terminology and which symptoms and conditions are paired together, so that I might create more fluent charts. I have developed a system for tracking patient information (which is thrown away at the end of each shift) to assist my provider in keeping track of results.
A significant part of my job as a scribe is to write thorough HPIs. Here is a sample (this is not from a real patient):
X is a 37-year-old male with a past medical history of Paroxysmal Afib, AoA, CHF, CAD, CABG, CKD stage 3 (kidney disease), who presents to the ED for chest pain. Today at 1400, patient began to experience intermittent pain on the right side of his chest. He describes his pain as a pressure and says that "it feels like something is weighing down on me." He reports that his episodes last approximately a minute. He does not know how many episodes he had but he says that it was at least a dozen or so times. His chest pain is exacerbated by exercise and relieved with rest. Patient denies radiation of his pain. Associated with his chest pain is shortness of breath and upper left quadrant abdominal pain. He notes that he has experienced similar episodes in the past. Patient endorses swelling in legs and nausea. He also denies fever, chills, vomiting, diarrhea, cough and swelling or pain in any other part of his body. Of note, patient has been feeling stressed lately due to his work as a lawyer.
Patient does not report any other symptoms or concerns at this time.
Another part of my job as a scribe is to write preliminary medical decision making based on what the physician tells the patient after examination, which is then reviewed by the physician. Here is a sample (this is not from a real patient):
X is a 37-year-old male with a past medical history of Paroxysmal Afib, AoA, CHF, CAD, CABG, CKD stage 3 (kidney disease), who presents to the ED for chest pain. Patient is visibly stressed upon examination. Patient's vitals are notable for Tachycardia. Exam is notable for mild upper left quadrant abdominal pain to palpation and an irregularly irregular heartrate. Exam is otherwise unremarkable. Differentials include but are certainly not limited to CHF, ACS, MI and pancreatitis. Given patient's past history of Afib and current EKG, which shows Afib, will consult cardiology to see if cardioversion is necessary. Patient has required cardioversion in the past. Will obtain full set of labs. Will get Chest XR and repeat EKG, then reassess.
X is a 37-year-old male with a past medical history of Paroxysmal Afib, AoA, CHF, CAD, CABG, CKD stage 3 (kidney disease), who presents to the ED for chest pain. Today at 1400, patient began to experience intermittent pain on the right side of his chest. He describes his pain as a pressure and says that "it feels like something is weighing down on me." He reports that his episodes last approximately a minute. He does not know how many episodes he had but he says that it was at least a dozen or so times. His chest pain is exacerbated by exercise and relieved with rest. Patient denies radiation of his pain. Associated with his chest pain is shortness of breath and upper left quadrant abdominal pain. He notes that he has experienced similar episodes in the past. Patient endorses swelling in legs and nausea. He also denies fever, chills, vomiting, diarrhea, cough and swelling or pain in any other part of his body. Of note, patient has been feeling stressed lately due to his work as a lawyer.
Patient does not report any other symptoms or concerns at this time.
Another part of my job as a scribe is to write preliminary medical decision making based on what the physician tells the patient after examination, which is then reviewed by the physician. Here is a sample (this is not from a real patient):
X is a 37-year-old male with a past medical history of Paroxysmal Afib, AoA, CHF, CAD, CABG, CKD stage 3 (kidney disease), who presents to the ED for chest pain. Patient is visibly stressed upon examination. Patient's vitals are notable for Tachycardia. Exam is notable for mild upper left quadrant abdominal pain to palpation and an irregularly irregular heartrate. Exam is otherwise unremarkable. Differentials include but are certainly not limited to CHF, ACS, MI and pancreatitis. Given patient's past history of Afib and current EKG, which shows Afib, will consult cardiology to see if cardioversion is necessary. Patient has required cardioversion in the past. Will obtain full set of labs. Will get Chest XR and repeat EKG, then reassess.
Reflection
I feel like I've gained significant experience from my time as a scribe. I've familiarized myself with tons of medical terminology and sets of symptoms. I've also learned a lot about how physicians make decisions. I also feel like my mood has improved significantly since I started scribing. I wasn't very sure if I wanted to pursue medicine initially, but I can pretty safely say that I want to, now.
My community partner has gained a fairly dedicated scribe, who hopes to continue to improve in the coming months.
I hope that the charts I help create will continue to help physicians with future medical decision making for individuals seeking medical aid.
My community partner has gained a fairly dedicated scribe, who hopes to continue to improve in the coming months.
I hope that the charts I help create will continue to help physicians with future medical decision making for individuals seeking medical aid.