A study published in JAMA Internal Medicine reported that the use of medical scribes for electronic health record (EHR) documentation reduced the primary care physician (PCP) burden, improved work efficiency, and improved PCP-patient interaction.
From July 1, 2016 to June 30, 2017, investigators conducted a 12-month crossover study with 2 sequences and 4 periods. In the study, 18 PCPs were randomly assigned to start the first 3-month period with or without a medical scribe. PCPs then alternated between scribed and non-scribed periods every 3 months for 1 year, serving as their own controls. At the end of each 3-month period, the physicians completed a 6-question survey. Patients were also surveyed after scribed clinic visits. Outcomes included PCP perceptions of documentation burden and visit interactions, as well as measures of time spent on EHR activity and patient perception of visit quality.
Of the 18 participating PCPs, 10 were women, 12 were internal medicine physicians, and 6 were family practice physicians. All the PCPs had graduated from medical school a mean of 13.7 years prior to the start of the study. At baseline, 61% of the physicians spent 1 to 2 hours per day during the week and 1 to 3 hours daily on weekends outside of scheduled clinic hours on EHR documentation. Only 28% of physicians reported spending more than 75% of a typical return visit on interaction with the patient and less than 25% on EHR documentation.
PCPs experienced significant improvement in all outcomes during scribed periods. Compared with periods when they did not have a scribe, physicians spent fewer off-hours performing documentation work, with 69% of PCPs spending less than 1 hour daily on weekdays vs 17% during non-scribed periods. Greater patient interaction also occurred during scribed periods, with 85% of physicians spending more than 75% of a visit interacting with the patient compared with 13% during non-scribed periods. Furthermore, 94% of participants reported having greater job satisfaction and 89% reported improved clinical interactions during scribed periods.
The study investigators argued that addressing physician burnout is a complex issue, but the use of scribes to decrease the EHR documentation burden among PCPs may help alleviate some of the difficulties these physicians encounter.
Mishra P, Kiang JC, Grant RW. Association of medical scribes in primary care with physician workflow and patient experience [published online September 17, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.3956