![]() There are significant practice variations that can affect the quality of scribe work and ultimately patient care ( 4, 5): They also may affect how patients interact with providers. Interposed between a provider and an EHR, a scribe is uniquely positioned to affect not only how and what information is captured, but also how providers think about and seek information during an encounter. Simply by virtue of their presence, scribes-silent though they may be-make the patient encounter more complex. Under pressure to treat more patients while completing time-intensive electronic health record (EHR) documentation, physicians and licensed independent practitioners have increasingly turned to medical scribes for documentation assistance during patient encounters.( 2) In this sense, the use of scribes can be viewed as a workaround or unintended consequence of EHR use.( 3) What safety aspects should health care organizations consider when implementing and evaluating a scribe program? Background 2019 7(3):e14797.Scribes have supported physicians for thousands of years.( 1) However, little is known about how today's use of medical scribes may affect patient safety. Influence of scribes on patient-physician communication in primary care encounters: mixed methods study. Danak SU, Guetterman TC, Plegue MA, et al. The use of medical scribes in health care settings: a systematic review and future directions. One year of family physicians’ observations on working with medical scribes. Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. Impact of medical scribes in primary care on productivity, face-to-face time, and patient comfort. Zallman L, Finnegan K, Roll D, Todaro M, Oneiz R, Sayah A. Changes in burnout and satisfaction with work-life balance in physicians and the general U.S. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Arndt BG, Beasley JW, Watkinson MD, et al. Patients report high levels of satisfaction with their care, regardless of whether a scribe is present in the exam room. ![]() Scribes do not appear to change the patient experience. 5 Physician satisfaction increased when scribe support went beyond documentation to include assisting with clinical procedures, paperwork, and writing letters. In another study investigating how scribes affect physician attitude and behavior, most of the physicians’ negative comments were related to clinic operational inefficiencies (e.g., workflows and administrative tasks), and not the scribing support itself. 4 The use of scribes also improved the time it took to close charts 32.6% of charts drafted by scribes were closed at 48 hours, while 28.5% of charts drafted by physicians were closed at 48 hours. Another study found that scribes improved all aspects of physician satisfaction, including time spent charting, time spent with patients, and chart quality and accuracy. However, the proportion of the clinic's charts still open at the end of the day did not change significantly compared to the pre-scribe period. 3 In addition, physicians’ time spent facing patients increased by 57% and time spent facing the computer decreased by 27%. In a study of a combined family medicine and internal medicine clinic that implemented in-person scribes, the clinic saw a 10.5% increase in work relative value units (RVUs) and an 8.8% increase in patients seen per hour. Here’s what the available literature shows: 1,2ĭocumentation support through the use of scribes is increasingly touted as a way to alleviate these problems. Primary care physicians spend about half their workday on the computer during and after clinic, and many physicians indicate that EHRs are a strong contributor to burnout.
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