Use Of Medical Scribes Research Articles

The Role of Scribes in Orthopaedics.

The rapid increase in the use of electronic medical records (EMRs) has led to some unintended consequences that negatively affect physicians and their patients. The use of medical scribes may serve as a possible solution to some of the EMR-related concerns. Research has demonstrated an overall positive impact of having scribes on both physician and patient well-being, safety, and satisfaction. Adaptation of advances in technology, including remote and asynchronous scribing, use of face-mounted devices, voice recognition software, and applications of artificial intelligence may address some of the barriers to more traditional in-person scribes.

Medical Record Closure Practices of Physicians Before and After the Use of Medical Scribes

This study uses electronic health record data to evaluate medical record closure outcomes before and after the use of medical scribes at a large academic medical center.

Translating ethnographic data into knowledge, skills, and attitude statements for medical scribes: a modified Delphi approach.

While the use of medical scribes is rapidly increasing, there are not widely accepted standards for their training and duties. Because they use electronic health record systems to support providers, inadequately trained scribes can increase patient safety related risks. This paper describes the development of desired core knowledge, skills, and attitudes (KSAs) for scribes that provide the curricular framework for standardized scribe training. A research team used a sequential mixed qualitative methods approach. First, a rapid ethnographic study of scribe activities was performed at 5 varied health care organizations in the United States to gather qualitative data about knowledge, skills, and attitudes. The team's analysis generated preliminary KSA related themes, which were further refined during a consensus conference of subject-matter experts. This was followed by a modified Delphi study to finalize the KSA lists. The team identified 90 descriptions of scribe-related KSAs and subsequently refined, categorized, and prioritized them for training development purposes. Three lists were ultimately defined as: (1) Hands-On Learning KSA list with 47 items amenable to simulation training, (2) Didactic KSA list consisting of 32 items appropriate for didactic lecture teaching, and (3) Prerequisite KSA list consisting of 11 items centered around items scribes should learn prior to being hired or soon after being hired. We utilized a sequential mixed qualitative methodology to successfully develop lists of core medical scribe KSAs, which can be incorporated into scribe training programs.

The Use of Medical Scribes in Primary Care Settings: A Literature Synthesis.

Background:Clerical burdens have strained primary care providers already facing a shifting health care landscape and workforce shortages. These pressures may cause burnout and job dissatisfaction, with negative implications for patient care. Medical scribes, who perform real-time electronic health record documentation, have been posited as a solution to relieve clerical burdens, thus improving provider satisfaction and other outcomes.Objective:The purpose of this study is to identify and synthesize the published research on medical scribe utilization in primary care and safety net settings.Research Design:We conducted a review of the literature to identify outcomes studies published between 2010 and 2020 assessing medical scribe utilization in primary care settings. Searches were conducted in PubMed and supplemented by a review of the gray literature. Articles for inclusion were reviewed by the study authors and synthesized based on study characteristics, medical scribe tasks, and reported outcomes.Results:We identified 21 publications for inclusion, including 5 that examined scribes in health care safety net settings. Scribe utilization was consistently reported as being associated with improved productivity and efficiency, provider experience, and documentation quality. Findings for patient experience were mixed.Conclusions:Published studies indicate scribe utilization in primary care may improve productivity, clinic and provider efficiencies, and provider experience without diminishing the patient experience. Further large-scale research is needed to validate the reliability of study findings and assess additional outcomes, including how scribes enhance providers’ ability to advance health equity.

Professional fission in medical routines: medical scribes and physicians in two US hospital departments

Abstract In this study we argue that professionalism imposed from above can result in a type of fission, leading to the ambiguous emergence of new occupations. Our case focuses on the US’ federally mandated use of electronic health records and the increased use of medical scribes. Data include observations of 571 patient encounters across 48 scribe shifts, and 12 interviews with medical scribes and physicians in the ophthalmology and digestive health departments of a community hospital. We found substantial differences in scribes’ roles based on the pre-existing routines within each department, and that scribes developed agency in the interface between the electronic health record and the physicians’ work. Our study contributes to work on occupations as negotiated orders by drawing attention to external influences, the importance of considering differences across professional task routines, and the personal interactions between professional and technical workers.

The Impact of Medical Scribes on Relative Value Units in a Pediatric Primary Care Practice

Our study assessed the impact of adding medical scribes to an academic pediatric primary practice by measuring the relationship between work relative value units (wRVUs) and use of the medical scribe. This is a retrospective comparative study on the effect of medical scribes on average wRVUs per patient encounter. wRVUs were abstracted from procedure codes in the billing system. Six clinicians performed 2277 patient visits included in the study over 2 different time periods during 2017 and 2018. The first period was without the use of medical scribes and the second period included scribes. Average clinician wRVU production per visit increased by 7.68% (P < .001) with medical scribes over the previous period without them. This study shows that scribes contribute to improving the wRVU per visit in a primary pediatric practice. This finding is consistent with other research showing that scribes help increase volume and improve wRVUs for specialists who perform complex procedures.

Effect of Medical Scribes on Outpatient Oncology Visits at a Multidisciplinary Cancer Center.

The use of medical scribes has emerged as a strategy to increase clinic workflow efficiency and reduce physician burnout. While oncology clinics may be ideally suited to scribe integration because of the high burden of documentation, oncology-specific scribe research has been limited. The objective of this study was to determine the effect of scribe integration on clinic workflow efficiency and physician satisfaction and quality of life in outpatient oncology clinics. We conducted a retrospective, concurrent qualitative and quantitative analysis of patient visit durations and survey data for 129 attending physicians affiliated with an academic hospital's cancer center between January 2017 and January 2019. Thirty-three physicians were paired with scribes in each physician's individual clinic or clinics. In terms of clinic efficiency, physicians with scribes had a 12.1% decrease in their overall average patient visit duration compared with their own time before receiving a scribe (P < .0001) and spent significantly less time completing charts at the end of the day (P = .04). Compared with their peers, oncologists with scribes showed a 10%-20% decrease in the duration of all patient visits. Scribes also contributed to patient care, as shown by 90% of physicians surveyed who strongly agreed that they spent less time at the computer and more time with patients; 100% of physicians surveyed strongly agreed that scribes improved their quality of life. The integration of medical scribes into oncology clinics across several oncologic disciplines has the potential to reduce burnout through increasing physician satisfaction and quality of life, improving patient care, and streamlining clinic workflow.

Evaluation of the Use of Medical Scribes in VAMC Emergency Departments and Specialty Care Clinics

Evaluation of the Use of Medical Scribes in VAMC Emergency Departments and Specialty Care Clinics

Does Use of Medical Scribes Affect Time Efficiency in a GI Ambulatory Clinic Setting?: Presidential Poster Award

Does Use of Medical Scribes Affect Time Efficiency in a GI Ambulatory Clinic Setting?: Presidential Poster Award

Medical Scribes: The Future for Medical Data Input in Emergency Departments

Despite their widespread use, electronic medical records have created frustrations for physicians, especially those working in busy hospital emergency departments. After a brief discussion of the causes of the problems, a potential solution—the use of medical scribes—is presented. The extant literature regarding results obtained following the implementation of medical scribes in emergency departments is reviewed and some conclusions regarding the future of this phenomenon are presented. The future looks quite bright for use of medical scribes in hospitals’ emergency departments.

Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience

Widespread adoption of electronic health records (EHRs) in medical care has resulted in increased physician documentation workload and decreased interaction with patients. Despite the increasing use of medical scribes for EHR documentation assistance, few methodologically rigorous studies have examined the use of medical scribes in primary care. To evaluate the association of use of medical scribes with primary care physician (PCP) workflow and patient experience. This 12-month crossover study with 2 sequences and 4 periods was conducted from July 1, 2016, to June 30, 2017, in 2 medical center facilities within an integrated health care system and included 18 of 24 eligible PCPs. The PCPs were randomly assigned to start the first 3-month period with or without scribes and then alternated exposure status every 3 months for 1 year, thereby serving as their own controls. The PCPs completed a 6-question survey at the end of each study period. Patients of participating PCPs were surveyed after scribed clinic visits. PCP-reported perceptions of documentation burden and visit interactions, objective measures of time spent on EHR activity and required for closing encounters, and patient-reported perceptions of visit quality. Of the 18 participating PCPs, 10 were women, 12 were internal medicine physicians, and 6 were family practice physicians. The PCPs graduated from medical school a mean (SD) of 13.7 (6.5) years before the study start date. Compared with nonscribed periods, scribed periods were associated with less self-reported after-hours EHR documentation (<1 hour daily during week: adjusted odds ratio [aOR], 18.0 [95% CI, 4.7-69.0]; <1 hour daily during weekend: aOR, 8.7; 95% CI, 2.7-28.7). Scribed periods were also associated with higher likelihood of PCP-reported spending more than 75% of the visit interacting with the patient (aOR, 295.0; 95% CI, 19.7 to >900) and less than 25% of the visit on a computer (aOR, 31.5; 95% CI, 7.3-136.4). Encounter documentation was more likely to be completed by the end of the next business day during scribed periods (aOR, 2.8; 95% CI, 1.2-7.1). A total of 450 of 735 patients (61.2%) reported that scribes had a positive bearing on their visits; only 2.4% reported a negative bearing. Medical scribes were associated with decreased physician EHR documentation burden, improved work efficiency, and improved visit interactions. Our results support the use of medical scribes as one strategy for improving physician workflow and visit quality in primary care.

Use of Medical Scribes to Reduce Documentation Burden

Use of Medical Scribes to Reduce Documentation Burden

Can Use of Medical Scribes Bring Efficiency in a Busy GI Lab?

Introduction: Electronic Medical Record (EMR) Systems markedly improve the quality and productivity of clinicians in the Healthcare system, however the use of EMR can be burdensome and decrease the physician engagement to the patient. In recent years use of medical scribes has been studied in the hospital setting and has been shown to improve physician satisfaction and increase revenues and productivity. The purpose of this study is to evaluate if use of a medical scribe in a GI lab can increase productivity and time-related efficiencies. Methods: Retrospective chart review was conducted on all the upper GI endoscopies and colonoscopies done in the last 12 months in a tertiary care hospital. Pre-operative (Preop), time in room, procedure time and recovery time was calculated on each procedure. These times were then compared between the providers who worked with a scribe and those who did not. Results: 866 procedures were done by the providers without using a medical scribe and 278 were done with the use of medical scribe. Mean preop time for procedures with a scribe was 40.94 min compared to 45.60 min without the use of scribe. Similarly, differences were seen in time in room (25.20 min vs 33.46 min, P=0.06) and procedure time (10.99 min vs 22.07 min, P=0.05) among the two groups showing the use of a medical scribe is time-efficient. The recovery time of patients was greater in procedures in which a medical scribe was utilized, but the results were not statistically significant. Secondly, the medical scribe has no impact on recovery time.Table: Table. Mean times in each interval for patients without a scribe and those with a scribeConclusion: Studies in the past discussed the use of medical scribes in emergency settings, clinic settings, and cardiology and urology clinics. As per literature review, this is the first study done on the utilization of medical scribes in the GI lab. Given increasing workload of both screening and emergent procedures on gastroenterologists, the use of medical scribes can increase physician satisfaction, productivity and most importantly can increase hospital revenue by having more procedures done in same duration of time.

Use of Simulation Based on an Electronic Health Records Environment to Evaluate the Structure and Accuracy of Notes Generated by Medical Scribes: Proof-of-Concept Study.

BackgroundThe increasing adoption of electronic health records (EHRs) has been associated with a number of unintended negative consequences with provider efficiency and job satisfaction. To address this, there has been a dramatic increase in the use of medical scribes to perform many of the required EHR functions. Despite this rapid growth, little has been published on the training or assessment tools to appraise the safety and efficacy of scribe-related EHR activities. Given the number of reports documenting that other professional groups suffer from a number of performance errors in EHR interface and data gathering, scribes likely face similar challenges. This highlights the need for new assessment tools for medical scribes.ObjectiveThe objective of this study was to develop a virtual video-based simulation to demonstrate and quantify the variability and accuracy of scribes’ transcribed notes in the EHR.MethodsFrom a pool of 8 scribes in one department, a total of 5 female scribes, intent on pursuing careers in health care, with at least 6 months of experience were recruited for our simulation study. We created three simulated patient-provider scenarios. Each scenario contained a corresponding medical record in our simulation instance of our EHR. For each scenario, we video-recorded a standardized patient-provider encounter. Five scribes with at least 6 months of experience both with our EHR and in the specialty of the simulated cases were recruited. Each scribe watched the simulated encounter and transcribed notes into a simulated EHR environment. Transcribed notes were evaluated for interscribe variability and compared with a gold standard for accuracy.ResultsAll scribes completed all simulated cases. There was significant interscribe variability in note structure and content. Overall, only 26% of all data elements were unique to the scribe writing them. The term data element was used to define the individual pieces of data that scribes perceived from the simulation. Note length was determined by counting the number of words varied by 31%, 37%, and 57% between longest and shortest note between the three cases, and word economy ranged between 23% and 71%. Overall, there was a wide inter- and intrascribe variation in accuracy for each section of the notes with ranges from 50% to 76%, resulting in an overall positive predictive value for each note between 38% and 81%.ConclusionsWe created a high-fidelity, video-based EHR simulation, capable of assessing multiple performance indicators in medical scribes. In this cohort, we demonstrate significant variability both in terms of structure and accuracy in clinical documentation. This form of simulation can provide a valuable tool for future development of scribe curriculum and assessment of competency.

LO55: A pilot evaluation of medical scribes in a Canadian emergency department

Introduction: Improving emergency department productivity has been a priority across Canada. In the United States, medical scribes have been utilized to increase the number of patients seen per hour (PPH) per physician; however, it is not well known if these outcomes can be translated to Canada. The purpose of this pilot evaluation was to (a) establish proof-of-concept of medical scribes in Canada and (b) gain experience in scribe implementation so as to inform future directions for the use of scribes in Canada. It was hypothesized that use of medical scribes would result in a greater PPH per physician. Methods: We conducted a four-month pilot evaluation of medical scribes in the emergency department of the Queensway-Carleton Hospital in Ottawa, Ontario. Eleven scribes were utilized in the study ranging in age from 18 to 23 years old. Following scribe training and an initial two-month acclimation period for both scribes and physicians, data collection began January 2015. Twenty-two full or part time emergency physicians were followed in this study, who received shifts with and without a scribe over the next four months. Physician work hours as well as the number of patients seen by each physician on each shift was documented. From these metrics, PPH per physician was calculated for each shift. Across the four months, the average PPH was determined for each physician during shifts with a scribe and shifts without a scribe. Two-tailed paired-samples t-tests (α=0.05) were used to compare mean (SD) PPH within physicians based on presence or absence of a scribe. Results: A total of 463 physician hours were documented without use of a scribe and 693.75 physician hours were documented with use of a scribe. Across all 22 physicians in the study, 18 (81.8%) demonstrated a greater PPH with use of a scribe. Overall, PPH per physician was significantly greater (12.9%) during shifts with a scribe (mean 2.81, SD 0.78) compared to shifts without a scribe (mean 2.49, SD 0.60) (p=0.006). Sensitivity analyses revealed that PPH per physician during shifts without a scribe during the study period were similar to the year prior, before scribes were introduced to the hospital (p=0.315). Conclusion: Use of medical scribes resulted in an increased PPH per physician in our hospital. While these results were from an evaluation at a single centre, they support broader implementation and evaluation of scribes in more centres across Canada.

Examining the Utilization of Medical Scribes in a Hospital Emergency Department Environment

This paper reports results from an original research project studying the use of medical scribes in emergency departments (EDs) including analysis of more than one full year of archival data as well as observations and interviews in the ED that were conducted over a one and one-half year period. This paper also reports results from additional studies that have been completed since this research project. Ultimately, this research revealed there can be a significant impact of scribes on the overall number of patients seen, i.e. a 10.3% increase in the number of patients seen per hour. This appears to be in direct opposition to the use of non-medical scribes under the same conditions [1]. Since this original research was completed the use of medical scribes has rapidly grown. In 2014 over twelve medical scribe companies employed more than 15,000 staff in a greater than $125 million annual market [2].

The Evolving Role of Medical Scribe: Variation and Implications for Organizational Effectiveness and Safety.

Increasing use of medical scribes is an unintended consequence of electronic health record adoption in the U.S. The role of scribe is not universally defined, leading to variations in scribe training and operations, as well as questions about scribe efficiency, effectiveness, and safety. Studies published since 2009 have primarily focused on the financial aspects of scribe use, but no published studies have taken an organizational view of this phenomenon. This paper describes stakeholder perspectives on scribes working in outpatient settings within an urban tertiary academic medical center. It places factors associated with of scribe systems within an eight-dimension sociotechnical framework for evaluating health information technology, and discusses key aspects of those perspectives.

Integration of Medical Scribes in the Primary Care Setting: Improving Satisfaction.

There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes.

The use of medical scribes in health care settings: a systematic review and future directions.

Electronic health records (EHRs) hold promise to improve productivity, quality, and outcomes; however, using EHRs can be cumbersome, disruptive to workflow, and off-putting to patients and clinicians. One proposed solution to this problem is the use of medical scribes. The purpose of this systematic review is to summarize the literature investigating the effect of medical scribes on health care productivity, quality, and outcomes. Implications for future research are discussed. A keyword search of the Cochrane Library, OvidSP Medline database, and Embase database from January 2000 through September 2014 was performed using the terms scribe or scribes in the title or abstract. To ensure no potentially eligible articles were missed, a second search was done using Google Scholar. English-language, peer-reviewed studies assessing the effect of medical scribes on health care productivity, quality, and outcomes were retained. Identified studies were assessed and the findings reported. Five studies were identified. Three studies assessed scribe use in an emergency department, 1 in a cardiology clinic, and 1 in a urology clinic. Two of 3 studies reported scribes had no effect on patient satisfaction; 2 of 2 reported improved clinician satisfaction; 2 of 3 reported an increase in the number of patients; 2 of 2 reported an increase in the number of relative value units per hour; 1 of 1 reported increased revenue; 3 of 4 reported improved time-related efficiencies; and 1 of 1 reported improved patient-clinician interactions. Available evidence suggests medical scribes may improve clinician satisfaction, productivity, time-related efficiencies, revenue, and patient-clinician interactions. Because the number of studies is small, and because each study suffered important limitations, confidence in the reliability of the evidence is significantly constrained. Given the nascent state of the science, methodologically rigorous and sufficiently powered studies are greatly needed.