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Scribes Improve Physician Satisfaction, EHR Clinical Documentation

Research ties the use of medical scribes for EHR clinical documentation to improved physician satisfaction and reduced physician burnout.

EHR Clinical Documentation

Source: Thinkstock

By Kate Monica

- The authors of a new study published in the September issue of Annals of Family linked medical scribes with improving all aspects of physician satisfaction, including satisfaction with patient encounters and clinical documentation accuracy.

Gidwani et al. Medicine examined the effects of using medical scribes in clinical practices on physician satisfaction, patient satisfaction, and charting efficiency. Researchers conducted trials in which physicians in academic family medicine clinics alternately spent one week with medical scribes and one week without for 52 weeks.

Scribes were responsible for all relevant documentation, which was subsequently reviewed by physicians before attestation and signing. During patient encounters where medical scribes were not present, physicians were responsible for performing all charting activities.

Researchers found scribes improved overall physician satisfaction with clinics, face-to-face patient interactions, chart accuracy, time spent charting, and chart quality.

According to study results, medical scribes had no effect on patient satisfaction. While scribes may not boost patient satisfaction, the study also found no evidence the presence of a scribe reduces patient satisfaction, either.

“Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout,” stated researchers.

The study spanned July 2015 to June 2016. Four physicians and two scribes participated in the study at a family medicine clinic part of a larger academic medical center in Northern California. None of the physicians taking part in the study had prior experience working with medical scribes.

Each physician had four clinic sessions lasting four hours per week. Physician satisfaction was measured using self-administered questionnaires, with participating physicians completing a total of 361 questionnaires throughout the study.

Physician charting efficiency was measured judging by the time it took to complete or close a chart, or the time between a patient encounter and a physician signing the chart note marked by timestamps in the EHR. Medicare clinical documentation guidelines state charts should be closed within 48 hours or less of a patient encounter. Overall, scribes improved the time it took to close a chart.

Given the myriad benefits medical scribes reportedly contribute to provider satisfaction and clinical documentation efficiency, researchers advocated for more widespread utilization of the service in hospitals and physician practices.

“When working with a scribe, physicians were much more satisfied with how their clinic went, the length of time they spent face-to-face with patients, and the time they spent charting,” wrote researchers in a discussion of the report. “These findings suggest that scribes may have a protective effect on physicians’ well-being.”

Implementing team documentation in clinics could also be a way of achieving the quadruple aim of healthcare, which researchers defined as “a patient-centered approach to care that also emphasizes improving the work life of physicians.”

Researchers also suggested medical scribes could be useful outside the clinical care setting. While spending less time on clinical documentation frees up physicians to focus on delivering patient care and improving care coordination, academic centers could use scribes to give faculty physicians more time to teach medical students and residents.

Physicians also reported significant improvements in chart quality. “We found that not only were physicians satisfied with the quality and accuracy of charting done by scribes, they were more satisfied with scribed charts than with their own,” noted researchers.

Utilizing medical scribes in physician practices could also improve patient safety by cutting down on the frequency with which physicians rely on EHR shortcuts such as the copy and paste functionality.

Using the copy and paste EHR shortcut is associated with a higher risk of recording redundant, nonspecific, or erroneous information in physician notes.

While scribes can improve physician satisfaction with EHR use and reduce administrative burden, researchers maintained EHR usability improvements are still paramount to cutting rates of physician burnout.

“Some have suggested that scribes are not an appropriate solution, arguing that they are no substitute for better functioning EHRs or may remove some of the pressure on EHR designers to improve their systems,” stated researchers. “We agree that scribes are not a replacement for EHR redesign, but we do consider them an immediate solution that can be implemented while the more onerous and time-consuming problem of EHR redesign is also tackled.”

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