Implementation of a Virtual Asynchronous Scribe Program to Reduce Physician Burnout

Abstract

Goal: Administrative burden is one of many potential root causes of physician burnout. Scribe documentation assistance can reduce this burden. However, traditional in-person scribe services are challenged by consistent staffing because the model requires the physical presence of a scribe and limits the team to a single individual. In addition, in-person scribes cannot provide the flexible support required for virtual care encounters, which can now pivot geographically and temporally. To respond to these challenges, our health network implemented an asynchronous virtual scribe model and evaluated the program's impact on clinician perceptions of burnout across multiple outpatient specialties. Methods: Using a mixed-methods, pre-/postdesign, this evaluation measured the impact of an asynchronous virtual scribe program on physician burnout. Physicians were given the Professional Fulfillment Index tool (to self-assess their mental state) and free-text comment surveys before virtual scribe initiation and again at 3-, 6-, and 12-month intervals after program implementation. Descriptive statistics of survey results and qualitative review of free-text entries were analyzed for themes of facilitation and barriers to virtual scribe use. Principal Findings: Of 50 physician participants in this study, 42 (84%) completed the preintervention survey and 15 (36%) completed all 4 surveys; 25 participants (50%) discontinued scribe use after 12 months. Burnout levels—as defined by dread, exhaustion, lack of enthusiasm, decrease in empathy, and decrease in colleague connection—all trended toward improvement during this study. Importantly, quality, time savings, burnout, and productivity moved in positive directions as well. Practical Application: The cost burden to physicians and the COVID-19 pandemic inhibited the continued use of asynchronous virtual medical scribes. Nevertheless, those who continued in the program have reported positive outcomes, which indicates that the service can be a viable and effective tool to reduce physician burnout.

The Role of Scribes in Orthopaedics

“…Alternatively, clinics can also implement asynchronous virtual scribe services for documentation into the EHR 37 . Advantages of an asynchronous scribe service include limited physician interaction with the EHR, especially when compared with voice recognition dictation tools, and cost savings related to more efficient use of the scribe's time.…”

“…Advantages of an asynchronous scribe service include limited physician interaction with the EHR, especially when compared with voice recognition dictation tools, and cost savings related to more efficient use of the scribe's time. Disadvantages include inconsistent timing of note return, which may affect billing, variability in quality of notes, and a greater need for subsequent editing 37 . These shortcomings can be potentially addressed with prior contractual arrangements to have the scribed note returned the same day, minimizing the negative impact on patient care and billing.…”

Interventions to Reduce Electronic Health Record-Related Burnout: A Systematic Review

“…The study setting in the retrieved articles included academic or research hospitals , 20,21,25,30,32,33,38,39,45,46,51,57,59,62,63 general internal medicine, 24,26,41,48,50,53,57,60 oncology, 23,27,29,43,54 family medicine, 35,52,56,61 urology, 36,47 general surgery, 34 dermatology, 44 and radiology practices, 42 large health networks and systems, 28,37,40,49,55 and community hospitals. 22,31 Outcome Measures Fourteen studies measured the baseline burnout or wellness level of the participants as well as the outcomes of the interventions.…”

“…22,31 Outcome Measures Fourteen studies measured the baseline burnout or wellness level of the participants as well as the outcomes of the interventions. These included the Mini Z survey, 30,38,46,48 Maslach burnout inventory, 50,57,61 professional fulfillment index, 31,48,51,59 American Medical Association Steps Forward Survey 26,48 Copenhagen burnout inventory, 44 and physician work life study study, 45 and the Stanford Physician Wellness Survey. 42,45 For intervention satisfaction, written surveys [20][21][22][23][24][25]28,29,[32][33][34][35][36][37]40,41,43,[47][48][49]52,53,55,56,60,63 was most often used, followed by Net Promoter Score (NPS), 39,45,57,62 and the Technology Acceptance This article is protected by copyright.…”

“…Interventions to reduce EHR-related clinician burnout were in three broad groups: (1) employment of scribes (48%), 23,[26][27][28]31,[34][35][36]41,44,[46][47][48][49][50][51][52][53]56,59,60 (2) EHR training (36%), 20,25,29,30,33,[37][38][39][40]42,43,45,55,57,58,61 and (3) EHR modifications (25%) [20][21][22]24,32,39,54,57,58,62,63 (►Table 3). Four studies combined both EHR training and modifications into one intervention (9%; ►Fig.…”