Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort

Zallman, Leah; Finnegan, Karen; Roll, David; Todaro, Martina; Oneiz, Rawan; Sayah, Assaad

doi:10.3122/jabfm.2018.04.170325

Cited by 34 publications

(56 citation statements)

References 24 publications

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“…When scribes were present, physicians spent more time in the encounter looking at the patient as opposed to the computer, a finding that was marginally significant. This is consistent with other similar findings in the literature [16]. Patients noticed that that their physician was the professional using the computer more frequently in nonscribed encounters as compared to scribed encounters (93% vs 52.6%), but this factor too had little impact on patients’ perceptions of the encounter.…”

Section: Discussionsupporting

confidence: 92%

Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study

Danak¹,

Guetterman²,

Plegue³

et al. 2019

JMIR Med Inform

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Background With the increasing adoption of electronic health record (EHR) systems, documentation-related burdens have been increasing for health care providers. Recent estimates indicate that primary care providers spend about one-half of their workdays interacting with the EHR, of which about half is focused on clerical tasks. To reduce documentation burdens associated with the EHR, health care systems and physician practices are increasingly implementing medical scribes to assist providers with real-time documentation. Scribes are typically unlicensed paraprofessionals who assist health care providers by documenting notes electronically under the direction of a licensed practitioner or physician in real time. Despite the promise of scribes, few studies have investigated their effect on clinical encounters, particularly with regard to patient-provider communication. Objective The purpose of this quasi-experimental pilot study was to understand how scribes affect patient-physician communication in primary care clinical encounters. Methods We employed a convergent mixed methods design and included a sample of three physician-scribe pairs and 34 patients. Patients’ clinical encounters were randomly assigned to a scribe or nonscribe group. We conducted patient surveys focused on perceptions of patient-provider communication and satisfaction with encounters, video recorded clinical encounters, and conducted physician interviews about their experiences with scribes. Results Overall, the survey results revealed that patients across both arms reported very high satisfaction of communication with their physician, their physician’s use of the EHR, and their care, with very little variability. Video recording analysis supported patient survey data by demonstrating high measures of communication among physicians in both scribed and nonscribed encounters. Furthermore, video recordings revealed that the presence of scribes had very little effect on the clinical encounter. Conclusions From the patient’s perspective, scribes are an acceptable addition to clinical encounters. Although they do not have much impact on patients’ perceptions of satisfaction and their impact on the clinical encounter itself was minimal, their potential to reduce documentation-related burden on physicians is valuable. Physicians noted important issues related to scribes, including important considerations for implementing scribe programs, the role of scribes in patient interactions, how physicians work with scribes, characteristics of good scribes, and the role of scribes in physician workflow.

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Section: Discussionsupporting

confidence: 92%

Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study

Danak¹,

Guetterman²,

Plegue³

et al. 2019

JMIR Med Inform

View full text Add to dashboard Cite

show abstract

“…43 One recent study found that the use of scribes in primary care increased the number and intensity of patients seen per hour, increased patient-facing time, increased total physician-patient interaction time, decreased the time physicians spent interacting with a computer, and decreased the after-hours time spent in EMR documentation. 44 Other physician-driven changes in EMR processes may improve usability, patient safety, and physician job satisfaction, and decrease physician burnout. 45 In a paper entitled, "The Electronic Elephant in the Room," Philip Kroth and colleagues describe findings of structured interviews on the impact of EMR use on physicians (with the majority reporting EHR proficiency but also regularly spending "excessive" time at home documenting patient details in electronic charts).…”

Section: Clinical Significancementioning

confidence: 99%

Physician Stress and Burnout

Yates¹

2020

The American Journal of Medicine

218

188

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Tens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low-quality objective data. The psychological and physical impact on physicians and other providers is quite clear, however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to "Please put on your own oxygen mask first before assisting others." Unfortunately, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail the causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.

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“…Scribes have been shown to improve physician satisfaction, charting efficiency, productivity, and face-to-face communication with patients. [24][25][26][27][28] However, some have suggested that using scribes results in lost nuance and cognitive processing time, 29 and relatively little is known about the safety and accuracy of scriberelated documentation. 30 Moreover, scribes may not always be financially feasible.…”

Section: Background and Significancementioning

confidence: 99%

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

et al. 2020

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Objective To evaluate informatics-enabled quality improvement (QI) strategies for promoting time spent on face-to-face communication between ophthalmologists and patients. Methods This prospective study involved deploying QI strategies during implementation of an enterprise-wide vendor electronic health record (EHR) in an outpatient academic ophthalmology department. Strategies included developing single sign-on capabilities, activating mobile- and tablet-based applications, EHR personalization training, creating novel workflows for team-based orders, and promoting problem-based charting to reduce documentation burden. Timing data were collected during 648 outpatient encounters. Outcomes included total time spent by the attending ophthalmologist on the patient, time spent on documentation, time spent on examination, and time spent talking with the patient. Metrics related to documentation efficiency, use of personalization features, use of team-based orders, and note length were also measured from the EHR efficiency portal and compared with averages for ophthalmologists nationwide using the same EHR. Results Time spent on exclusive face-to-face communication with patients initially decreased with EHR implementation (2.9 to 2.3 minutes, p = 0.005) but returned to the paper baseline by 6 months (2.8 minutes, p = 0.99). Observed participants outperformed national averages of ophthalmologists using the same vendor system on documentation time per appointment, number of customized note templates, number of customized order lists, utilization of team-based orders, note length, and time spent after-hours on EHR use. Conclusion Informatics-enabled QI interventions can promote patient-centeredness and face-to-face communication in high-volume outpatient ophthalmology encounters. By employing an array of interventions, time spent exclusively talking with the patient returned to levels equivalent to paper charts by 6 months after EHR implementation. This was achieved without requiring EHR redesign, use of scribes, or excessive after-hours work. Documentation efficiency can be achieved using interventions promoting personalization and team-based workflows. Given their efficacy in preserving face-to-face physician–patient interactions, these strategies may help alleviate risk of physician burnout.

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Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort

Cited by 34 publications

References 24 publications

Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study

Influence of Scribes on Patient-Physician Communication in Primary Care Encounters: Mixed Methods Study

Physician Stress and Burnout

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

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