Abstract
BackgroundScribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice.MethodsSix faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations.ResultsMedian time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35–22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13–4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22–2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes.ConclusionsWorking with a scribe in an academic internal medicine practice was associated with more timely documentation.
Highlights
Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality
We sought to assess the impact of scribes in primary care on clinical efficiency measures and clinical quality (e.g. EHR note quality, rate of immunization and current medication review, and completion of preventative health recommendations) [37]
In this study, we found that scribed visits were associated with more timely closure of clinic encounters and increased clarity and completeness in history of present illness (HPI) documentation at an academic general internal medicine practice
Summary
Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. Scribes have been found to increase productivity and efficiency in emergency departments and subspecialty clinics [23, 25, 26, 29,30,31,32,33,34]. Four previous studies in primary care have found that scribes improved physician productivity, timely chart completion, and EHR note quality [33,34,35,36]. We sought to assess the impact of scribes in primary care on clinical efficiency measures (e.g., number of visits per clinic session) and clinical quality (e.g. EHR note quality, rate of immunization and current medication review, and completion of preventative health recommendations) [37]
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