Do Medical Scribes Help Primary Care Providers Respond More Quickly to Out-of-Visit Tasks?

Zallman, Leah; Altman, Wayne; Chu, Lendy; Touw, Sharon; Rajagopal, Karissa; Dolat, Steven; Sayah, Assaad

doi:10.3122/jabfm.2021.01.200330

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Aside from decreasing visit length, scribes can also have other benefits for clinical care. This may be more comparable to the findings of Zallman et al, 9,10 who reported that scribes provided other in-visit benefits, like the increase in patient-provider connection by spending the visit face-to-face, as the providers in our project experienced. Scribing did not improve time to completion of out-of-visit tasks, like patient portal and prescription refills by targeting visit documentation completion.…”

Section: Discussionsupporting

confidence: 89%

The Value of Adding Scribe Services to 2 Distinct Pediatric Subspecialties in the Era of the Electronic Medical Record

Edwards

Kanner

Tewar

et al. 2023

Clin Pediatr (Phila)

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To evaluate the impact of adding medical scribes to 2 distinct outpatient pediatric subspecialty clinics on provider burnout, visit length, and patient satisfaction. A total of 2 pediatric endocrinologists and 2 developmental-behavioral pediatrics/pediatrician (DBP) were randomly assigned based on days of the week to see patients aged 0 to 21 years in their clinics with and without in-person medical scribes from February 2019 to February 2020. Parent satisfaction rates were examined through pre- and postappointment surveys. Provider burnout rates were assessed through the Maslach Burnout Inventory-Human Services Survey. A retrospective comparative analysis of average appointment duration was undertaken considering the scribe/no scribe random allocation in the examination room. Funding for this pilot provided by the department of pediatrics budgeted funds. Over 2923 appointments during the project dates, 829 appointments were seen with a scribe. The average appointment time for a new DBP appointment was 61 minutes with scribes and 71 minutes without ( P < .001). Return patient appointments in DBP averaged 31 minutes with scribes and 43 minutes without ( P < .001). There was no significant difference in appointment duration for endocrinology with and without scribes. The average time for chart completion was reduced with the presence of scribes in DBP but not in endocrinology. Out of the 209 families surveyed, patient satisfaction rates with and without a scribe did not differ in that between 96% and 97% of respondents rated the appointment overall as “excellent” for each measure of provider communication with scribes present. Finally, from the Maslach Burnout Inventory-Human Services Survey, the average score across all 4 providers for Emotional Exhaustion and Depersonalization decreased during the project period, whereas Personal Accomplishment scores increased over the project period. Scribes might be more advantageous for some subspecialties that utilize prolonged narratives in clinic notes, like DBP, and an important avenue to consider in reducing provider burnout in busy ambulatory settings.

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Section: Discussionsupporting

confidence: 89%

The Value of Adding Scribe Services to 2 Distinct Pediatric Subspecialties in the Era of the Electronic Medical Record

Edwards

Kanner

Tewar

et al. 2023

Clin Pediatr (Phila)

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“… 82 , 98 , 103 Ten observational studies were longitudinal, comparing EHR use at different points in time including before and after the start of the coronavirus disease 2019 (COVID-19) pandemic, 2 , 3 , 34 , 37 , 89 before and after a change to the EHR interface, 107 before and after policy changes, 101 , 109 and at different points of clinical training. 32 , 52 The 11 experimental studies examined the impact of scribes, 30 , 41 , 111 EHR training, 38 , 45 , 54 , 119 and interface changes on EHR use. 75 , 93 , 94 , 113 Only one of the experimental studies was a randomized controlled trial.…”

Section: Resultsmentioning

confidence: 99%

“…While 70 articles measured a duration of time, 2–4 , 6 , 7 , 19 , 24–62 , 66–73 , 76 , 77 , 79–81 , 83 , 92–96 , 98 , 102 , 108 , 109 , 111 , 119 12 of these measured a duration between 2 specific points in time (e.g., duration of an appointment, or shift), 60 , 68 , 76 , 80 , 81 , 83 , 92–94 , 96 , 102 , 111 leaving 58 articles which measured a duration of active EHR use. 2–4 , 6 , 7 , 19 , 24–59 , 61 , 62 , 66 , 67 , 69–73 , 77 , 79 , 95 , 98 , 108 , 109 , 119 Of these 58 articles, 34 described (or referenced an article that described) how active use was defined.…”

Section: Resultsmentioning

confidence: 99%

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Rule

Melnick

Apathy

2022

Journal of the American Medical Informatics Association

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Objective The aim of this article is to compare the aims, measures, methods, limitations, and scope of studies that employ vendor-derived and investigator-derived measures of electronic health record (EHR) use, and to assess measure consistency across studies. Materials and Methods We searched PubMed for articles published between July 2019 and December 2021 that employed measures of EHR use derived from EHR event logs. We coded the aims, measures, methods, limitations, and scope of each article and compared articles employing vendor-derived and investigator-derived measures. Results One hundred and two articles met inclusion criteria; 40 employed vendor-derived measures, 61 employed investigator-derived measures, and 1 employed both. Studies employing vendor-derived measures were more likely than those employing investigator-derived measures to observe EHR use only in ambulatory settings (83% vs 48%, P = .002) and only by physicians or advanced practice providers (100% vs 54% of studies, P < .001). Studies employing vendor-derived measures were also more likely to measure durations of EHR use (P < .001 for 6 different activities), but definitions of measures such as time outside scheduled hours varied widely. Eight articles reported measure validation. The reported limitations of vendor-derived measures included measure transparency and availability for certain clinical settings and roles. Discussion Vendor-derived measures are increasingly used to study EHR use, but only by certain clinical roles. Although poorly validated and variously defined, both vendor- and investigator-derived measures of EHR time are widely reported. Conclusion The number of studies using event logs to observe EHR use continues to grow, but with inconsistent measure definitions and significant differences between studies that employ vendor-derived and investigator-derived measures.

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“… 45 Using non-physician personnel, such as scribes, to respond to inbox messages for primary care providers has been shown to have no significant effect on time to completion of these tasks. 46 Although improved response time would be ideal, reducing the burden of responding to these messages could improve provider morale and improve the amount of time they can devote to direct patient care, patient phone calls, or consultation with other provider staff.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 lockdown on patient-provider electronic communications

et al. 2023

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Background SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature. Methods All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during 12 months before and after lockdown (March 1st, 2020). Logistic regression was utilized to examine the effects of the lockdown on inbox item rate post-COVID-19 lockdown as compared to the pre-lockdown period. Results Before COVID-19 lockdown, 2.07 new inbox items per encounter were received, which increased to 2.83 items after lockdown. However, only patient-initiated electronic messages increased after lockdown and stabilized at a rate higher than the pre-COVID-19 period (aRR 1.27, p-value < 0.001). In contrast, prescription refill requests and telephone calls quickly spiked, then returned to pre-lockdown levels. Conclusion Based on our observations, providers experienced a quick increase in all inbox items. However, only electronic messages had a sustained increase, exacerbating the workload of administrators, staff, and clinical providers. This study directly correlates healthcare technology adoption to a significant disruptive event but also shows additional challenges to the healthcare system that must be considered with these changes.

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Do Medical Scribes Help Primary Care Providers Respond More Quickly to Out-of-Visit Tasks?

Cited by 7 publications

References 24 publications

The Value of Adding Scribe Services to 2 Distinct Pediatric Subspecialties in the Era of the Electronic Medical Record

The Value of Adding Scribe Services to 2 Distinct Pediatric Subspecialties in the Era of the Electronic Medical Record

Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures

Impact of COVID-19 lockdown on patient-provider electronic communications

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