TY - JOUR
T1 - Variable Impact of Medical Scribes on Physician Electronic Health Record Documentation Practices
T2 - A Quantitative Analysis Across a Large, Integrated Health-System
AU - Florig, Sarah T.
AU - Corby, Sky
AU - Devara, Tanuj
AU - Weiskopf, Nicole G.
AU - Gold, Jeffrey
AU - Mohan, Vishnu
N1 - Publisher Copyright:
© 2024 American Board of Family Medicine. All rights reserved.
PY - 2024/3
Y1 - 2024/3
N2 - Background: Medical scribes have been utilized to reduce electronic health record (EHR) associated documentation burden. Although evidence suggests benefits to scribes, no large-scale studies have quantitatively evaluated scribe impact on physician documentation across clinical settings. This study aimed to evaluate the effect of scribes on physician EHR documentation behaviors and performance. Methods: This retrospective cohort study used EHR audit log data from a large academic health system to evaluate clinical documentation for all ambulatory encounters between January 2014 and December 2019 to evaluate the effect of scribes on physician documentation behaviors. Scribe services were provided on a first-come, first-served basis on physician request. Based on a physician's scribe use, encounters were grouped into 3 categories: never using a scribe, prescribe (before scribe use), or using a scribe. Outcomes included chart closure time, the proportion of delinquent charts, and charts closed after-hours. Results: Three hundred ninety-five physicians (23% scribe users) across 29 medical subspecialties, encompassing 1,132,487 encounters, were included in the analysis. At baseline, scribe users had higher chart closure time, delinquent charts, and after-hours documentation than physicians who never used scribes. Among scribe users, the difference in outcome measures postscribe compared with baseline varied, and using a scribe rarely resulted in outcome measures approaching a range similar to the performance levels of nonusing physicians. In addition, there was variability in outcome measures across medical specialties and within similar subspecialties. Conclusion: Although scribes may improve documentation efficiency among some physicians, not all will improve EHR-related documentation practices. Different strategies may help to optimize documentation behaviors of physician-scribe dyads and maximize outcomes of scribe implementation.
AB - Background: Medical scribes have been utilized to reduce electronic health record (EHR) associated documentation burden. Although evidence suggests benefits to scribes, no large-scale studies have quantitatively evaluated scribe impact on physician documentation across clinical settings. This study aimed to evaluate the effect of scribes on physician EHR documentation behaviors and performance. Methods: This retrospective cohort study used EHR audit log data from a large academic health system to evaluate clinical documentation for all ambulatory encounters between January 2014 and December 2019 to evaluate the effect of scribes on physician documentation behaviors. Scribe services were provided on a first-come, first-served basis on physician request. Based on a physician's scribe use, encounters were grouped into 3 categories: never using a scribe, prescribe (before scribe use), or using a scribe. Outcomes included chart closure time, the proportion of delinquent charts, and charts closed after-hours. Results: Three hundred ninety-five physicians (23% scribe users) across 29 medical subspecialties, encompassing 1,132,487 encounters, were included in the analysis. At baseline, scribe users had higher chart closure time, delinquent charts, and after-hours documentation than physicians who never used scribes. Among scribe users, the difference in outcome measures postscribe compared with baseline varied, and using a scribe rarely resulted in outcome measures approaching a range similar to the performance levels of nonusing physicians. In addition, there was variability in outcome measures across medical specialties and within similar subspecialties. Conclusion: Although scribes may improve documentation efficiency among some physicians, not all will improve EHR-related documentation practices. Different strategies may help to optimize documentation behaviors of physician-scribe dyads and maximize outcomes of scribe implementation.
KW - Ambulatory Care
KW - Burnout
KW - Communication
KW - Documentation
KW - Electronic Health Records
KW - Health Care Systems
KW - Health Services
KW - Outcomes Assessment
KW - Physicians
KW - Primary Health Care
KW - Quality Improvement
KW - Quantitative Research
KW - Retrospective Studies
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U2 - 10.3122/jabfm.2023.230211R2
DO - 10.3122/jabfm.2023.230211R2
M3 - Article
C2 - 38740487
AN - SCOPUS:85192926193
SN - 1557-2625
VL - 37
SP - 228
EP - 241
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 2
ER -