In the Journals

Medical scribes help improve PCP workflow, patient experience

Use of medical scribes was associated with significant improvements in electronic health record documentation burden, productivity, job satisfaction and patient interactions among primary care physicians, according to research published in JAMA Internal Medicine.

“Widespread adoption of EHRs in medical care has resulted in increased physician documentation workload and decreased interaction with patients,” Pranita Mishra, MPP, from Kaiser Permanente Northern California, and colleagues wrote. “Despite the increasing use of medical scribes for EHR documentation assistance, few methodologically rigorous studies have examined the use of medical scribes in primary care.”

Mishra and colleagues conducted a 12-month crossover study to determine whether medical scribes improve PCP workflow and patient experience.

At the start of the study, 18 PCPs were randomly assigned to receive or not receive a scribe. Scribe exposure was alternated every 3 months for 1 year. At the end of each 3-month period, PCPs completed surveys regarding their perceptions of documentation burden, visit interactions, communication with patients and job satisfaction. The amount of time PCPs spent on EHRs was also measured. After each scribed clinical visit, patients completed surveys on their perceptions of visit quality.

The researchers found that there were significant improvements across all outcome measures reported by PCPs during scribed periods.

More PCPs with scribes reported less after-hours EHR documentation than those without scribes: 69% vs. 17% reported less than 1 hour daily on weekdays (adjusted OR = 18; 95% CI, 4.7-69), and 77% vs. 40% reported less than 1 hour daily on weekends (aOR = 8.7; 95% CI, 2.7-28.7). PCPs were more likely to spend more than 75% of the visit interacting with the patient (aOR = 295; 95% CI, 19.7 to > 900) and less than 25% of the visit on a computer (aOR = 31.5; 95% CI, 7.3-136.4) during scribe periods, compared with nonscribe periods.

Greater job satisfaction was reported by 94% of PCPs when assisted by scribes. Most PCPs (89%) also reported improved clinical interactions during scribe periods. Scribe periods were associated with greater odds of encounter documentation to be completed by the end of the next business day (aOR = 2.8; 95% CI, 1.2-7.1).

Most patients (61.2%) believed that scribes had positive effects on their visits, while 2.4% thought they had negative effects.

“Our results suggest that the use of scribes may be one strategy to mitigate the increasing EHR documentation burden among PCPs, who are at the highest risk of burnout among physicians,” Mishra and colleagues concluded. “Although scribes do not obviate the need for improving suboptimal EHR designs, they may help alleviate some of the inefficiencies of currently implemented EHRs.”

In an accompanying editorial, David W. Bates, MD, MSc, and Adam B. Landman, MD, both from Brigham and Women’s Hospital, wrote that the findings by Mishra and colleagues demonstrate that scribes are beneficial, but may not be the solution to end clinician burnout.

“Overall, we think that scribes are likely to be a short-term strategy, helping organizations that can afford it get through some of the current difficulties with EHR implementation,” they wrote. “The results of the study by Mishra et al suggest that this approach can be beneficial, at least for now, while we continue to work toward fundamentally different models of documentation.” – by Alaina Tedesco

Disclosures: Bates reports receiving cash compensation from CDI (Negev) Ltd, receiving equity from Clew, MDClone and ValeraHealth and consulting for EarlySense. Landman reports no relevant financial disclosures. Mishra and colleagues report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

Use of medical scribes was associated with significant improvements in electronic health record documentation burden, productivity, job satisfaction and patient interactions among primary care physicians, according to research published in JAMA Internal Medicine.

“Widespread adoption of EHRs in medical care has resulted in increased physician documentation workload and decreased interaction with patients,” Pranita Mishra, MPP, from Kaiser Permanente Northern California, and colleagues wrote. “Despite the increasing use of medical scribes for EHR documentation assistance, few methodologically rigorous studies have examined the use of medical scribes in primary care.”

Mishra and colleagues conducted a 12-month crossover study to determine whether medical scribes improve PCP workflow and patient experience.

At the start of the study, 18 PCPs were randomly assigned to receive or not receive a scribe. Scribe exposure was alternated every 3 months for 1 year. At the end of each 3-month period, PCPs completed surveys regarding their perceptions of documentation burden, visit interactions, communication with patients and job satisfaction. The amount of time PCPs spent on EHRs was also measured. After each scribed clinical visit, patients completed surveys on their perceptions of visit quality.

The researchers found that there were significant improvements across all outcome measures reported by PCPs during scribed periods.

More PCPs with scribes reported less after-hours EHR documentation than those without scribes: 69% vs. 17% reported less than 1 hour daily on weekdays (adjusted OR = 18; 95% CI, 4.7-69), and 77% vs. 40% reported less than 1 hour daily on weekends (aOR = 8.7; 95% CI, 2.7-28.7). PCPs were more likely to spend more than 75% of the visit interacting with the patient (aOR = 295; 95% CI, 19.7 to > 900) and less than 25% of the visit on a computer (aOR = 31.5; 95% CI, 7.3-136.4) during scribe periods, compared with nonscribe periods.

Greater job satisfaction was reported by 94% of PCPs when assisted by scribes. Most PCPs (89%) also reported improved clinical interactions during scribe periods. Scribe periods were associated with greater odds of encounter documentation to be completed by the end of the next business day (aOR = 2.8; 95% CI, 1.2-7.1).

Most patients (61.2%) believed that scribes had positive effects on their visits, while 2.4% thought they had negative effects.

“Our results suggest that the use of scribes may be one strategy to mitigate the increasing EHR documentation burden among PCPs, who are at the highest risk of burnout among physicians,” Mishra and colleagues concluded. “Although scribes do not obviate the need for improving suboptimal EHR designs, they may help alleviate some of the inefficiencies of currently implemented EHRs.”

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In an accompanying editorial, David W. Bates, MD, MSc, and Adam B. Landman, MD, both from Brigham and Women’s Hospital, wrote that the findings by Mishra and colleagues demonstrate that scribes are beneficial, but may not be the solution to end clinician burnout.

“Overall, we think that scribes are likely to be a short-term strategy, helping organizations that can afford it get through some of the current difficulties with EHR implementation,” they wrote. “The results of the study by Mishra et al suggest that this approach can be beneficial, at least for now, while we continue to work toward fundamentally different models of documentation.” – by Alaina Tedesco

Disclosures: Bates reports receiving cash compensation from CDI (Negev) Ltd, receiving equity from Clew, MDClone and ValeraHealth and consulting for EarlySense. Landman reports no relevant financial disclosures. Mishra and colleagues report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.