Primary care scribes: writing a new story for safety net clinics

Abstract

The spread of electronic health records systems (EHRs) poses challenges for both patient and provider care experience. Limited research suggests that scribes offer potential benefits to productivity and clinician satisfaction in emergency health and specialty settings. We conducted this evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR 2011–2014. The scribe programme trained and managed scribes for 51 providers (25% participation) from 5 of 12 San Francisco Health Network primary care clinics. We evaluated the programme using four measures. Providers reported spending less time out of clinic completing notes after sessions with scribes versus sessions without scribes (14.0 min vs 30.2 min, p<0.01). The rate of incomplete EHR notes at 72 hours was not significantly different for clinics using and not using scribes (16.9% vs 16.7%, p=0.4). Mean visit length using EHR-recorded provider cycle time was shorter for sessions with scribes (24.0 min), compared with sessions without scribes (26.4 min, p<0.01). Patients at clinics using scribes were as likely to recommend their provider (74.5%), compared with patients at clinics not using scribes (74.3%). Limitations of our evaluation include selection bias and possible confounding by clinic- and provider-level factors. In a safety net primary care system, trained volunteer scribes were associated with improved clinician efficiency and experience and no difference in patient satisfaction.

The Impact of Medical Scribes on Patient Satisfaction in an Academic Otolaryngology Clinic

“…While there is currently no published data in an Otolaryngology setting, our results are consistent with those of other studies from the ED and other clinic settings. [8][9][10][11][12][13][14] However, one study in the ED reported a quantitative increase in patient reported satisfaction after implementation of a scribe program, 15 as has a small study in an inflammatory bowel disease clinic. 16 Only one study by Martel et al found a small but significant decrease in patient satisfaction after scribes were introduced in multiple clinics in a safety net hospital.…”

Clinical scribes and their association with patient experience in the otolaryngology clinic

“…Although patients have reported positive attitudes toward scribes and perceived improvement of provider-patient interactions, [10][11][12] no studies have found a quantitative difference in patient's satisfaction with providers. 11,[13][14][15][16][17] Conclusions are further limited by heterogeneity in the methodology for assessing patient satisfaction in all of these studies, including many studies that created their own surveys and metrics.…”

“…14,16,19 There has been mixed evidence on the timeliness of note and chart completion in the setting of outpatient scribe utilization. 13,17 Several studies have reported an increase in time spent in direct patient care when scribes were present. 16,19 The hypothesis of this study was that presence of a scribe would positively impact patient satisfaction with their visit in the otolaryngology outpatient clinic.…”

“…Total work relative value units, a measure of physician productivity used to determine Medicare reimbursement, increased after implementation of a scribe program . Other studies have found decreased visit length and a resulting increase in the number of patients seen per hour and per day . Multiple studies have reported reduced documentation time .…”

“…Multiple studies have reported reduced documentation time . There has been mixed evidence on the timeliness of note and chart completion in the setting of outpatient scribe utilization . Several studies have reported an increase in time spent in direct patient care when scribes were present …”