The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions

Abstract

Background: 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.Methods: 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.Results: 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.Conclusions: 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. (J Am Board Fam Med 2015;28:371-381.)

Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial

“…Two systematic reviews found, using data from observational studies, that scribes may improve revenue, patient and physician satisfaction, productivity, efficiency, and the quality of patient-physician interactions. 24,25 There has been no randomized controlled study of scribes, and few studies have been undertaken in the primary care setting. Given that most office visits are to primary care physicians, 26 research in this setting is particularly warranted.…”

Re: The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions

“…1 We agree that 1 potential benefit of medical scribes is improved documentation of a patient's medical complexity. The stakes for improved documentation are growing notably higher as more patients are enrolled in health plans that factor medical complexity into their reimbursement models.…”

Transforming Nephrology

“…This has been a rapidly growing trend, and although there were approximately 20,000 scribes employed in the United States in 2014, this number is expected to reach 100,000 by 2020 (8). Available evidence suggests that scribes may improve physician satisfaction, productivity, and efficiency and that the additional practice costs may be offset by gains in revenue (9). Scribes could also be effectively implemented within the dialysis unit to lessen the burden of documentation and maximize face to face time with patients.…”