What Can a Scribe Do for You?

 

Evidence suggests that documentation support provided by scribes can help relieve physician burnout and increase practice productivity.

Fam Pract Manag. 2020 Nov-Dec;27(6):17-22.

Author disclosures: no relevant financial affiliations disclosed.

Although electronic health records (EHRs) were originally hailed as a means to improve clinical productivity, quality of care, and patient outcomes, the widespread use of EHRs has had the unintended effect of dramatically increasing the administrative burden on physicians. In fact, primary care physicians spend about half of their workdays on the computer during and after clinics.1 According to some estimates, every hour of direct patient care requires two hours of EHR work, and many physicians spend one to two hours a night on charting.1,2 Additionally, physician burnout rates in family medicine are well above 50%, and many physicians indicate that complicated EHR systems are a strong contributor to burnout.1,3

For physicians who are frustrated by cumbersome EHR systems and increasing documentation requirements, documentation support is one possible solution. Models of documentation support include the following:

  • Speech recognition software, which converts spoken notes to digital text saved in the EHR system. Emerging technology includes software that “listens” to the physician-patient interaction in the exam room and adds notes to the EHR automatically.

  • Scribes, which the Joint Commission defines as an unlicensed, certified, or licensed individual who enters information into the EHR or chart at the direction of a physician or licensed independent practitioner.4 Scribe services may be virtual — the documenter is not physically present for the physician-patient interaction and documentation is completed either in real time or after the visit — or in person. In-person scribe services typically are provided by care team members such as medical assistants (MA), advanced practice providers (APP), technicians, or medical scribes provided by an outsourced vendor.

This article reviews some of the available evidence on the effectiveness of in-person scribes and presents the outcomes of two different scribing models. While our focus in this discussion is primarily on in-person scribing services, we also provide a brief review of virtual services, given the impact of the COVID-19 pandemic on the clinic environment.

KEY POINTS

  • Complicated EHR systems and time spent in front of the computer contribute to physician burnout. Scribes can help relieve the administrative burden.

  • The two primary implementation models for integrating scribes into a practice are in-house development and utilization of an outsourced vendor.

  • Both models of implementation for in-person scribes result in increased patient volume and physician and provider satisfaction.

SUMMARY OF EVIDENCE ON THE BENEFITS OF SCRIBES

The literature on scribes shows improvement in some metrics and no change in

ABOUT THE AUTHORS

show all author info

Dr. Lyon is associate vice chair for clinical affairs for the Department of Family Medicine at the University of Colorado School of Medicine and associate program director for the University of Colorado Family Medicine Residency in Denver....

Dr. Holmstrom is the medical director of clinical informatics for the Department of Family Medicine at the University of Colorado School of Medicine and a physician informaticist for the University of Colorado Health System.

Mary McDaniel is a clinical nurse educator for ambulatory services with oversight over seven primary care practices; the Center for Dependency, Addiction, and Rehabilitation (CeDAR); Lone Tree Medical Center; and Boulder Health Center.

Dr. Serlin is associate professor and associate chair for clinical programs for the Department of Family Medicine at the University of Michigan in Ann Arbor and the ambulatory care clinical chief of family medicine for Michigan Medicine.

Author disclosures: no relevant financial affiliations disclosed.

References

show all references

1. Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med. 2017;15(5):419–426....

2. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialities. Ann Intern Med. 2016;165(11):753–760.

3. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general U.S. working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600–1613.

4. Documentation assistance provided by scribes. The Joint Commission. April 16, 2020. Accessed Oct. 13, 2020. https://www.jointcommission.org/en/standards/standard-faqs/nursing-care-center/record-of-care-treatment-and-services-rc/000002210/

5. Zallman L, Finnegan K, Roll D, Todaro M, Oneiz R, Sayah A. Impact of medical scribes in primary care on productivity, face-to-face time, and patient comfort. J Am Board Fam Med. 2018;31(4):612–619.

6. Gidwani R, Nguyen C, Kofoed A, et al. Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. Ann Fam Med. 2017;15(5):427–433.

7. Shultz CG, Holmstrom HL. The use of medical scribes in health care settings: a systematic review and future directions. J Am Board Fam Med. 2015;28(3):371–381.

8. Danak SU, Guetterman TC, Plegue MA, et al. Influence of scribes on patient-physician communication in primary care encounters: mixed methods study. JMIR Med Inform. 2019;7(3):e14797.

9. Sattler A, Rydel T, Nguyen C, Lin S. One year of family physicians’ observations on working with medical scribes. J Am Board Fam Med. 2018;31(1):49–56.

10. Odenheimer S, Goyal D, Jones VG, Rosenblum R, Ho L, Chan AS. Patient acceptance of remote scribing powered by Google Glass in outpatient dermatology: cross-sectional study. J Med Internet Res. 2018;20(6):e10762.

11. Smith PC, Lyon C, English AF, Conry C. Practice transformation under the University of Colorado’s primary care redesign model. Ann Fam Med. 2019;17(Suppl 1):S24–S32.

12. Lyon C, English AF, Smith PC. A team-based care model that improves job satisfaction. Fam Pract Manag. 2018;25(2):6–11.

 
 

Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact fpmserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now