ORIGINAL RESEARCH
Sarah T. Florig, MS; Sky Corby, MS; Tanuj Devara, MS; Nicole G. Weiskopf, PhD; Jeffrey A. Gold, MD; Vishnu Mohan, MD, MBI
Corresponding Author: Jeffrey A. Gold, MD; Division of Pulmonology, Allergy, and Critical Care Medicine - Oregon Health & Science University
Email: goldje@ohsu.edu
DOI: 10.3122/jabfm.2023.230211R2
Keywords: Ambulatory Care, Burnout, Communication, Documentation, Electronic Health Records, Health Care Systems, Health Services, Outcomes Assessment, Physicians, Primary Health Care, Retrospective Studies, Quality Improvement, Quantitative Research
Dates: Submitted: 05-31-2023; Revised: 08-10-2023; 09-12-2023; Accepted: 09-18-2023
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: Medical scribes have been utilized to reduce electronic health record (EHR) associated documentation burden. While 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 upon physician request. Based on a physician’s scribe use, encounters were grouped into three categories: never using a scribe, pre-scribe (before scribe use), or using a scribe. Outcomes included chart closure time, the proportion of delinquent charts, and charts closed after-hours.
RESULTS: 395 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 post-scribe compared with baseline varied, and using a scribe rarely resulted in outcome measures approaching a range similar to the performance levels of non-using physicians. Additionally, 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.