Re: The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions

To the Editor: We appreciate the review entitled “The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions,” by Drs. Shultz and Holmstom.¹ We are in complete agreement with the key points raised: electronic health records have important benefits to patient care and health systems, but can be time consuming, disruptive during face-to-face encounters with patients, and a source of professional dissatisfaction.

Meaningful use of an electronic medical record requires effort and a thoughtful approach. Medical scribes are able to improve and personalize the documentation of clinical encounters. As noted in the review by Shultz and Holmstom,¹ medical scribes have been shown to improve clinician efficiency as well as various financial measures.

We recently implemented a process by which the medical scribes at our institution document chronic medical conditions using the Medicare-based risk adjustment model of hierarchical condition categories (HCCs). Risk adjustment further increases the documentation burden on providers to meet annual documentation requirements. If these requirements are not met, or if documentation is incomplete, reimbursement rates for the population cared for by the group or institution at large are negatively affected. Using medical scribes, we have seen modest improvements in the documentation of the HCC-related diagnoses among our primary care patient population.

Drs. Shultz and Holmstrom help shed light on the limited data available concerning the use of medical scribes in various clinical settings. In addition, they highlight the importance of more research to understand how scribes can be used in the patient care arena, suggesting small-scale studies first.

At the core of our practice is a passion to care for people, not computers. We firmly believe that medical scribes augment the patient–provider relationship. To our knowledge, ours is the first application assessing the utility of medical scribes in the documentation of HCCs and risk adjustment. Our program may represent an additional method by which scribes can add to the financial vitality of a practice and help refocus providers' attention on the patient rather than the electronic health record.