Question Virtual Scribe

mdfech

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In a record that I am reviewing the office had noted that they have a virtual scribe. Has anyone heard of an office doing this?! Concerns that stick out to me immediately is this being recorded and is the patient aware, and if it is recorded do they have consent. I have just never run into this in all my years as a nurse. Can anyone shine any light on this?
Thanks,
Misty
 

csperoni

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Using virtual scribes can be 100% compliant, provided it is being properly used. There are many companies that offer this service, and they do it in a variety of different ways. Typically, it is not recorded, but there is someone on the other end of a microphone who is not present in the room listening in on everything. I think some even do it with AI, so it's a computer program (like a smart dictation) listening, not a human. Any reputable company providing this service will be HIPAA compliant.
I will say personally from a patient standpoint, if a scribe is being used, I would vastly prefer an in-person scribe. To me, it just seems creepy that there's an open microphone either on the computer, or a phone line and someone or something, somewhere else in the world is listening in. Depending on exactly how embarrassing my reason for the visit is, my level of comfort with that process could vary.
I'm not certain about informing the patient. For example, if a physician uses a transcription program or person, the patient does not need to consent to this. The company providing the service (if not an employee) needs to have a business contract with the health care provider. Some providers or companies might have internal policies to inform the patient, but it is likely not required by law.
From a coding standpoint, as long as it is signed by the clinician, it doesn't really matter who or how the information is there.
 

mdfech

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Using virtual scribes can be 100% compliant, provided it is being properly used. There are many companies that offer this service, and they do it in a variety of different ways. Typically, it is not recorded, but there is someone on the other end of a microphone who is not present in the room listening in on everything. I think some even do it with AI, so it's a computer program (like a smart dictation) listening, not a human. Any reputable company providing this service will be HIPAA compliant.
I will say personally from a patient standpoint, if a scribe is being used, I would vastly prefer an in-person scribe. To me, it just seems creepy that there's an open microphone either on the computer, or a phone line and someone or something, somewhere else in the world is listening in. Depending on exactly how embarrassing my reason for the visit is, my level of comfort with that process could vary.
I'm not certain about informing the patient. For example, if a physician uses a transcription program or person, the patient does not need to consent to this. The company providing the service (if not an employee) needs to have a business contract with the health care provider. Some providers or companies might have internal policies to inform the patient, but it is likely not required by law.
From a coding standpoint, as long as it is signed by the clinician, it doesn't really matter who or how the information is there.
I get the in-person scribe thing and they do not need to be consented for it. To me it could raise a lot of issues and I could see things from a patient perspective as you have said, depending on the reason for visit, would not want to talk about my issues and have someone I can't interact with transcribing. I had just never heard of a virtual scribe before.
 

csperoni

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I get the in-person scribe thing and they do not need to be consented for it. To me it could raise a lot of issues and I could see things from a patient perspective as you have said, depending on the reason for visit, would not want to talk about my issues and have someone I can't interact with transcribing. I had just never heard of a virtual scribe before.
During the pandemic, there has definitely been an uptick in the use of virtual scribes as so many things have gone remote. An in-person scribe is another potential exposure to everyone involved.
 
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