A Cost-Benefit Analysis of Medical Scribes and Electronic Medical Record System in an Academic Urology Clinic

Carnes, Kevin M.; Riese, Cornelia S. de; Riese, Werner de

doi:10.1016/j.urpr.2014.10.006

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…However, literature states that to balance the increased expenses, additional revenue from increased patient visits is needed for scribes to be financially prudent. 39 In parallel with this study, Amsterdam UMC established a committee that aims to improve data quality in the EHRs to reduce administrative burden and to improve problem list use. We discussed our recommendations with committee member and all were considered relevant for future implementation.…”

Section: Recommendationsmentioning

confidence: 99%

Factors Influencing Problem List Use in Electronic Health Records—Application of the Unified Theory of Acceptance and Use of Technology

2020

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Background Problem-oriented electronic health record (EHR) systems can help physicians to track a patient's status and progress, and organize clinical documentation, which could help improving quality of clinical data and enable data reuse. The problem list is central in a problem-oriented medical record. However, current problem lists remain incomplete because of the lack of end-user training and inaccurate content of underlying terminologies. This leads to modifications of diagnosis code descriptions and use of free-text notes, limiting reuse of data. Objectives We aimed to investigate factors that influence acceptance and actual use of the problem list, and used these to propose recommendations, to increase the value of problem lists for (re)use. Methods Semistructured interviews were conducted with physicians, heads of medical departments, and data quality experts, who were invited through snowball sampling. The interviews were transcribed and coded. Comments were fitted in constructs of the validated framework unified theory of acceptance user technology (UTAUT), and were discussed in terms of facilitators and barriers. Results In total, 24 interviews were conducted. We found large variability in attitudes toward problem list use. Barriers included uncertainty about the responsibility for maintaining the problem list and little perceived benefits. Facilitators included the (re)design of policies, improved (peer-to-peer) training to increase motivation, and positive peer feedback and monitoring. Motivation is best increased through sharing benefits relevant in the care process, such as providing overview, timely generation of discharge or referral letters, and reuse of data. Furthermore, content of the underlying terminology should be improved and the problem list should be better presented in the EHR system. Conclusion To let physicians accept and use the problem list, policies and guidelines should be redesigned, and prioritized by supervising staff. Additionally, peer-to-peer training on the benefits of using the problem list is needed.

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Section: Recommendationsmentioning

confidence: 99%

Factors Influencing Problem List Use in Electronic Health Records—Application of the Unified Theory of Acceptance and Use of Technology

2020

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“…17 As individuals "hired to chart patient-clinician encounters in real time," medical scribes' work helps to share much of the burden associated with documenting in the EHR from healthcare practitioners. 18 Several studies have shown that medical scribes could contribute to higher patient volume, 19,20 increased revenue, [21][22][23] and better patient and provider satisfaction. 20,24,25 As a result, the workforce of medical scribes in the United States has grown substantively in the past few years.…”

Section: Background and Significancementioning

confidence: 99%

“…Besides wages, employment of scribes would also incur additional costs associated with recruitment, training, and management, 23 limiting their affordability to only few settings such as specialty clinics and emergency departments. [21][22][23] Therefore, researchers and technology companies have started to explore the feasibility of using technology-based solutions to provide medical scribing, hereafter referred to as "digital scribes." 27,28 It should be noted that digital scribes discussed in this article differ from the existing automatic speech recognition-based solutions, such as Dragon Medical (Nuance, Burlington, MA), that offer merely 1-on-1 dictation capability to facilitate entering data into computerized systems.…”

Section: Background and Significancementioning

confidence: 99%

How does medical scribes’ work inform development of speech-based clinical documentation technologies? A systematic review

Tran

Chen

Liu

et al. 2020

Journal of the American Medical Informatics Association

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Objective Use of medical scribes reduces clinician burnout by sharing the burden of clinical documentation. However, medical scribes are cost-prohibitive for most settings, prompting a growing interest in developing ambient, speech-based technologies capable of automatically generating clinical documentation based on patient–provider conversation. Through a systematic review, we aimed to develop a thorough understanding of the work performed by medical scribes in order to inform the design of such technologies. Materials and Methods Relevant articles retrieved by searching in multiple literature databases. We conducted the screening process following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in guidelines, and then analyzed the data using qualitative methods to identify recurring themes. Results The literature search returned 854 results, 65 of which met the inclusion criteria. We found that there is significant variation in scribe expectations and responsibilities across healthcare organizations; scribes also frequently adapt their work based on the provider’s style and preferences. Further, scribes’ job extends far beyond capturing conversation in the exam room; they also actively interact with patients and the care team and integrate data from other sources such as prior charts and lab test results. Discussion The results of this study provide several implications for designing technologies that can generate clinical documentation based on naturalistic conversations taking place in the exam room. First, a one-size-fits-all solution will be unlikely to work because of the significant variation in scribe work. Second, technology designers need to be aware of the limited role that their solution can fulfill. Third, to produce comprehensive clinical documentation, such technologies will likely have to incorporate information beyond the exam room conversation. Finally, issues of patient consent and privacy have yet to be adequately addressed, which could become paramount barriers to implementing such technologies in realistic clinical settings. Conclusions Medical scribes perform complex and delicate work. Further research is needed to better understand their roles in a clinical setting in order to inform the development of speech-based clinical documentation technologies.

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“…Their use is being evaluated in many settings: Emergency Departments (EDs) [3][4][5][6][7][8][9][10][11], consultant offices [12][13][14][15], primary care [16,17] and hospital wards [1]. Medical scribes have been found to improve physician productivity [3,4,[8][9][10]12] in most Emergency studies, but not all [5,15]. They have also been useful in most office settings [12][13][14] and wards, but again, not all [15].…”

Section: Background and Significancementioning

confidence: 99%

“…Medical scribes have been found to improve physician productivity [3,4,[8][9][10]12] in most Emergency studies, but not all [5,15]. They have also been useful in most office settings [12][13][14] and wards, but again, not all [15]. Their aim has been to reduce the time a physician spends documenting consultations into electronic medical records (EMRs).…”

Section: Background and Significancementioning

confidence: 99%

The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine

Walker¹,

Wang²,

Dunlop³

et al. 2017

Appl Clin Inform

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SummaryBackground: Scribes are assisting Emergency Physicians by writing their electronic clinical notes at the bedside during consultations. They increase physician productivity and improve their working conditions. The quality of Emergency scribe notes is unevaluated and important to determine. Objective: The primary objective of the study was to determine if the quality of Emergency Department scribe notes was equivalent to physician only notes, using the Physician Documentation Quality Instrument, Nine-item tool (PDQI-9). Methods: This was a retrospective, observational study comparing 110 scribed to 110 non-scribed Emergency Physician notes written at Cabrini Emergency Department, Australia. Consultations during a randomised controlled trial of scribe/doctor productivity in 2016 were used. Emergency physicians and nurses rated randomly selected, blinded and de-identified notes, 2 raters per note. Comparisons were made between paired scribed and unscribed notes and between raters of each note. Characteristics of individual raters were examined. The ability of the tool to discriminate between good and poor notes was tested. Results: The PDQI-9 tool has significant issues. Individual items had good internal consistency (Cronbach's alpha=0.93), but there was very poor agreement between raters (Pearson's r=0.07, p=0.270). There were substantial differences in PDQI-9 scores allocated by each rater, with some giving typically lower scores than others, F(25,206)=1.93, p=0.007. The tool was unable to distinguish good from poor notes, F(3,34)=1.15, p=0.342. There was no difference in PDQI-9 score between scribed and non-scribed notes. Conclusions: The PDQI-9 documentation quality tool did not demonstrate reliability or validity in evaluating Emergency Medicine consultation notes. We found no evidence that scribed notes were of poorer quality than non-scribed notes, however Emergency scribe note quality has not yet been determined.

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A Cost-Benefit Analysis of Medical Scribes and Electronic Medical Record System in an Academic Urology Clinic

Cited by 9 publications

References 14 publications

Factors Influencing Problem List Use in Electronic Health Records—Application of the Unified Theory of Acceptance and Use of Technology

Factors Influencing Problem List Use in Electronic Health Records—Application of the Unified Theory of Acceptance and Use of Technology

How does medical scribes’ work inform development of speech-based clinical documentation technologies? A systematic review

The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine

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