Finance and Time Use Implications of Team Documentation for Primary Care: A Microsimulation

Basu, Sanjay; Phillips, Russell S.; Bitton, Asaf; Song, Zirui; Landon, Bruce E.

doi:10.1370/afm.2247

Cited by 4 publications

(11 citation statements)

References 17 publications

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“…A microsimulation of the cost of scribes showed that primary care providers would need to increase visits by 8% in fee-for-service models. 23 This is consistent with the visit increases reported in the studies 26 and statements of provider willingness to see 1 more patient per shift to help offset costs. 20 , 21 Given that providers who use a scribe may not experience the same gains in net revenue compared with those who do not, 28 practices may be reluctant to invest in scribes which can cost $33,600 or more in the first year when factoring in start-up and opportunity costs.…”

Section: Discussionsupporting

confidence: 81%

“…Based on these costs, study authors found visit volume would need to increase by 7% (capitation) to 8% (fee for service) to achieve medical scribe net revenue neutrality, noting that volumes need to be higher in the first year of scribe implementation to meet this benchmark. 23 The literature provides evidence that scribes can yield a positive ROI, with 2 pilot studies reporting actual and projected ROIs of 30%, 27 and 112% 25 , respectively.…”

Section: Resultsmentioning

confidence: 99%

“… 20 , 21 Given that providers who use a scribe may not experience the same gains in net revenue compared with those who do not, 28 practices may be reluctant to invest in scribes which can cost $33,600 or more in the first year when factoring in start-up and opportunity costs. 23 The other path for achieving scribe cost neutrality is through improved coding, which may be a more palatable approach for clinics with already overworked providers who are unable or unwilling to divert time saved with scribes to more patient care. In fact, Phillips et al 35 report this scenario in their study.…”

Section: Discussionmentioning

confidence: 99%

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The Use of Medical Scribes in Primary Care Settings

2021

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Background: Clerical burdens have strained primary care providers already facing a shifting health care landscape and workforce shortages. These pressures may cause burnout and job dissatisfaction, with negative implications for patient care. Medical scribes, who perform real-time electronic health record documentation, have been posited as a solution to relieve clerical burdens, thus improving provider satisfaction and other outcomes. Objective: The purpose of this study is to identify and synthesize the published research on medical scribe utilization in primary care and safety net settings. Research Design: We conducted a review of the literature to identify outcomes studies published between 2010 and 2020 assessing medical scribe utilization in primary care settings. Searches were conducted in PubMed and supplemented by a review of the gray literature. Articles for inclusion were reviewed by the study authors and synthesized based on study characteristics, medical scribe tasks, and reported outcomes. Results: We identified 21 publications for inclusion, including 5 that examined scribes in health care safety net settings. Scribe utilization was consistently reported as being associated with improved productivity and efficiency, provider experience, and documentation quality. Findings for patient experience were mixed. Conclusions: Published studies indicate scribe utilization in primary care may improve productivity, clinic and provider efficiencies, and provider experience without diminishing the patient experience. Further large-scale research is needed to validate the reliability of study findings and assess additional outcomes, including how scribes enhance providers’ ability to advance health equity.

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Section: Discussionsupporting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Use of Medical Scribes in Primary Care Settings

2021

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“…50,57 In most cases, the information will be subsequently reviewed and approved by the provider, before it becomes part of the patient's permanent medical record. 20,24,25,43,44,48,[52][53][54]57,65,70,72,74,[83][84][85] In addition, medical scribes are involved in many other activities beyond scribing in the exam room. They are often asked to conduct "pre-charting" (ie, constructing in-progress notes before patient arrival based on historical information, such as summaries of past clinic visits and hospitalizations).…”

Section: Managementmentioning

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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“…17 A microsimulation model by Basu and colleagues estimates the conditions under which it would be financially viable to have a staff member enter patient history, place orders, and guide patients-in both feefor-service and capitated payment. 18 Three essays provide their own kinds of teachable moments. In light of the growing phenomenon of parttime practice, Bodenheimer sees ways that clinicians and practices can make a number of adjustments to foster continuity and relationships.…”

mentioning

confidence: 99%