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Analysis

Scribes Slash Physician EHR Burden, Boost Efficiency, Improve Patient Visits

By Christopher Cheney  
   September 27, 2018

Scribes have the potential to address several causes of physician burnout at primary care practices.

High-quality scribes generate high-level gains in primary care practices.

That's the conclusion of recent research published in JAMA Internal Medicine, which found scribes decreased physician EHR documentation burden, boosted work efficiency, and improved patient visit interactions.

Scribes can have a significant impact on a prominent factor for physician burnout, the researchers wrote.

"Emerging evidence indicates that EHRs, as currently implemented, increase clerical workload and physician stress and interfere with direct physician-patient interaction, thereby diminishing professional satisfaction and contributing to professional burnout," the researchers wrote.

The research featured 18 primary care physicians (PCPs) in a study conducted from July 2016 to June 2017. For the study, the researchers enlisted scribes from a private agency that was relatively more expensive compared to internally employed scribes.

There were several key results:

  • Scribes were associated with fewer after-hours EHR documentation by PCPs
     
  • Scribes increased the likelihood that PCPs would spend more than 75% of a visit interacting with the patient rather than interacting with a computer
     
  • Scribes were associated with PCPs completing encounter documentation by the end of the next business day
     
  • Among patients, 61.2% reported that scribes made a positive impact on visits, and only 2.4% reported scribes had a negative impact
     
  • The vast majority of PCPs (88%) reported satisfaction with the quality of scribe EHR documentation

"We found that scribe assistance resulted in significant reduction in PCP-reported EHR documentation burden outside visits and significant increase in time spent on face-to-face patient interaction during visits. These self-reported results were corroborated by objective improvement in measured time to completion of encounter documentation," the researchers wrote.

The scribes also demonstrated a likelihood of improving work-life balance, which has been linked to physician burnout.

"During periods of scribe assistance, the PCPs reported significant reductions in their EHR documentation burden during off hours, suggesting that scribes may also improve a physician's work-life balance," the researchers wrote.

Potential drawbacks
 

There are at least half dozen potential pitfalls associated with employing scribes in the primary care setting, according to Richard Grant, MD, MPH, a coauthor of the JAMA Internal Medicine article and member of the Division of Research at Kaiser Permanente Northern California in Oakland:

  • Cost of scribe services
     
  • Scribe quality, which was high with the private service used in the study but varies with internal scribes
     
  • Scribe turnover can be high such as scribes using the position as stepping stone for medical school or nursing school
     
  • Patients could be reluctant to share sensitive information with a scribe present during office visits
     
  • Many health systems view scribes as a way to add more patients to a physician's panel, which offsets burnout-condition gains
     
  • Scribes do not address EHRs that are poorly designed for patient care

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

In recent research, scribes at primary care practices were associated with less after-hour EHR documentation by physicians.

Scribes increased the likelihood that primary care physicians would spend more than 75% of a visit interacting with the patient.

Nearly two-thirds of patients reported that scribes had a positive impact on their visits.


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