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Saturday Nov 14, 2020

Are scribes effective?

Primary care physicians spend about half their workday on the computer during and after clinic, and many physicians indicate that EHRs are a strong contributor to burnout.1,2

Documentation support through the use of scribes is increasingly touted as a way to alleviate these problems. But are scribes effective?

Here’s what the available literature shows:

Increased productivity. In a study of a combined family medicine and internal medicine clinic that implemented in-person scribes, the clinic saw a 10.5% increase in work relative value units (RVUs) and an 8.8% increase in patients seen per hour.3 In addition, physicians’ time spent facing patients increased by 57% and time spent facing the computer decreased by 27%. However, the proportion of the clinic's charts still open at the end of the day did not change significantly compared to the pre-scribe period.

Increased physician satisfaction. Another study found that scribes improved all aspects of physician satisfaction, including time spent charting, time spent with patients, and chart quality and accuracy.4 The use of scribes also improved the time it took to close charts; 32.6% of charts drafted by scribes were closed at 48 hours, while 28.5% of charts drafted by physicians were closed at 48 hours.

In another study investigating how scribes affect physician attitude and behavior, most of the physicians’ negative comments were related to clinic operational inefficiencies (e.g., workflows and administrative tasks), and not the scribing support itself.5 Physician satisfaction increased when scribe support went beyond documentation to include assisting with clinical procedures, paperwork, and writing letters.

No change in patient satisfaction. Scribes do not appear to change the patient experience. Patients report high levels of satisfaction with their care, regardless of whether a scribe is present in the exam room.4,6-7

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. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

Read the full FPM article: “What Can a Scribe Do for You?

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Posted at 11:45PM Nov 14, 2020 by FPM Editors

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