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

Abstract

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.

Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis

“…Five studies were randomized controlled trials, [15][16][17][18][19] 23 studies were prospective nonrandomized studies, 10 studies were retrospective, [43][44][45][46][47][48][49][50][51][52] and 1 study had both prospective and retrospective components. 53 All studies were published between 2010 and 2020. Most studies were conducted in the United States, [15][16][17][18]21,23,24,[26][27][28][29][30][32][33][34][35][36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52][53] with ...…”

“…Most studies were conducted in the United States, [15][16][17][18]21,23,24,[26][27][28][29][30][32][33][34][35][36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52][53] with 4 conducted in Australia 19,22,25,42 and 2 performed in Canada. 20,31 Nineteen studies were conducted in EDs, 17,19,20,[22][23][24][25][26][27]31,36,38,[42]<...>…”

“…The sensitivity analysis with only prospective studies found similar results (mean difference 3.93 minutes; 95% CI -2.48 to 10.33 minutes). In 7 studies taking place in a clinic setting, 18,29,37,41,48,51,53 length of stay was shortened from 32.06 to 26.32 minutes with a scribe (mean difference 5.74 minutes; 95% CI 0.42 to 11.05 minutes) (Figure E2, available online at http://www.annemergmed. com).…”

Physician Stress and Burnout

“…42 Furthermore, the use of scribes does not decrease patient satisfaction. 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.…”

Safe use of the EHR by medical scribes: a qualitative study

“… 3 , 6–10 , 14 , 16 Since their review included only papers published through 2017 and a good deal of research has been done since then, we updated their literature search, finding additional relevant papers with results similar to those in prior studies: The increase in provider satisfaction and productivity has been further verified. 17–28 In addition, studies of scribes have found other positive outcomes, such as increasing the joy of practicing. 24 It is therefore reasonable, after reviewing these studies, to conclude that the use of medical scribes can have a positive impact on provider workflow, provider and patient satisfaction, and on organizational finances.…”