Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction

McCormick, Benjamin; Deal, Allison M.; Borawski, Kristy M.; Raynor, Mathew C.; Viprakasit, Davis P.; Wallen, Eric; Woods, Michael; Pruthi, Raj S.

doi:10.1007/s00345-018-2293-8

Cited by 29 publications

(52 citation statements)

References 14 publications

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“…38 Expanding the duties of medical assistants to add EHR documentation, health coaching, or navigation and/or management of population health and between-visit care improved survey scores of professional fulfillment 34 and practice satisfaction. 19,23,24,26,27,30,35 Notably, 9 of the 20 studies examined the impact of scribes, and 7 of the 9 studies examining the use of scribes successfully improved clinic workflow efficiencies. 20,21,23,24,26,27,30 Finally, providing full-time clerical support for physician order entry in primary care (n¼16) also decreased weekly self-reported burnout (baseline, 43%; 4-month follow-up, 14%; P¼not reported).…”

Section: Teamworkmentioning

confidence: 99%

Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

DeChant

Acs

Rhee

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

124

132

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To assess the impact of organization-directed workplace interventions on physician burnout, including stress or job satisfaction in all settings, we conducted a systematic review of the literature published from multiple databases. Manual searches of grey literature and bibliographies were also performed. Of the 633 identified citations, 50 met inclusion criteria. Four unique categories of organization-directed workplace interventions were identified. Teamwork involved initiatives to incorporate scribes or medical assistants into electronic health record (EHR) processes, expand team responsibilities, and improve communication among physicians. Time studies evaluated the impact of schedule adjustments, duty hour restrictions, and time-banking initiatives. Transitions referred to workflow changes such as process improvement initiatives or policy changes within the organization. Technology related to the implementation or improvement of EHRs. Of the 50 included studies, 35 (70.0%) reported interventions that successfully improved the 3 measures of physician burnout, job satisfaction, and/or stress. The largest benefits resulted from interventions that improved processes, promoted teambased care, and incorporated the use of scribes/medical assistants to complete EHR documentation and tasks. Implementation of EHR interventions to improve clinical workflows worsened burnout, but EHR improvements had positive effects. Time interventions had mixed effects on burnout. The results of our study suggest that organization-directed workplace interventions that improve processes, optimize EHRs, reduce clerical burden by the use of scribes, and implement team-based care can lessen physician burnout. Benefits of process changes can enhance physician resiliency, augment care provided by the team, and optimize the coordination and communication of patient care and health information.

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Section: Teamworkmentioning

confidence: 99%

Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

DeChant

Acs

Rhee

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

124

132

View full text Add to dashboard Cite

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“…Total work relative value units, a measure of physician productivity used to determine Medicare reimbursement, increased after implementation of a scribe program. 9,15,16,19 Other studies have found decreased visit length 8,16,17 and a resulting increase in the number of patients seen per hour and per day. 7,16,19 Multiple studies have reported reduced documentation time.…”

Section: Discussionmentioning

confidence: 97%

“…Similarly, a study of six internal medicine physicians reported 100% satisfaction with clinic workflow in the primary care setting after implementation of a scribe program, compared to only 33% before the scribe program . Two studies in urology clinics also found that physicians were more satisfied with their workload and clinic hours when working with a scribe . In a study of emergency medicine physicians, the majority of providers enjoyed working with scribes, and particularly felt that scribes improved their efficiency and ability to spend time with patients .…”

Section: Discussionmentioning

confidence: 99%

“…Although patients have reported positive attitudes toward scribes and perceived improvement of provider-patient interactions, [10][11][12] no studies have found a quantitative difference in patient's satisfaction with providers. 11,[13][14][15][16][17] Conclusions are further limited by heterogeneity in the methodology for assessing patient satisfaction in all of these studies, including many studies that created their own surveys and metrics.…”

Section: Discussionmentioning

confidence: 99%

“…14 Two studies in urology clinics also found that physicians were more satisfied with their workload and clinic hours when working with a scribe. 15,18 In a study of emergency medicine physicians, the majority of providers enjoyed working with scribes, and particularly felt that scribes improved their efficiency and ability to spend time with patients. 19 These findings have been confirmed by a meta-analysis; however, they qualified this conclusion by describing that there is no level 1 evidence on the topic, and the approaches to evaluating provider satisfaction have been varied.…”

Section: Discussionmentioning

confidence: 99%

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Clinical scribes and their association with patient experience in the otolaryngology clinic

et al. 2019

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Objectives/Hypothesis Electronic health records have brought many advantages but also placed a documentation burden on the provider during and after the clinic visit. Some otolaryngologists have countered this challenge by employing clinical scribes. This project aimed to better understand the influence of scribes on patient experience in the otolaryngology clinic. Study Design Retrospective cohort survey study. Methods Patients presenting to the otolaryngology clinic for new and follow‐up appointments were recruited to complete surveys about their experience. Results A total of 153 patients completed the survey, and 96 of those patients (62.7%) interacted with a scribe. Patient satisfaction was not significantly associated with participation of the scribe (P = .668). Similarly, patient rating of their physician on a scale of 1 to 10 was not associated with scribe involvement (P = .851). The patients who did interact with a scribe responded that the scribe positively impacted the visit 77.1% of the time. Participation of a resident, primary language other than English, and use of interpreter were associated with lower satisfaction (P = .004, P < .001, and P < .001, respectively). Conclusions There are no published data on the effect of scribes on patient experience in the otolaryngology clinic. In other specialties, scribes have been demonstrated as having a positive effect on provider satisfaction, clinical productivity, and patient perception. These data demonstrate that patient satisfaction was neither impaired nor improved by the presence of the scribe in this clinic. In light of benefits demonstrated by prior studies, these findings support the conclusion that scribes are a useful adjunct in providing high‐level otolaryngology care. Level of Evidence 4 Laryngoscope, 130:E134–E139, 2020

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Virtual Scribes and Physician Time Spent on Electronic Health Records

Rotenstein,

Melnick,

Iannaccone

et al. 2024

JAMA Netw Open

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ImportanceTime on the electronic health record (EHR) is associated with burnout among physicians. Newer virtual scribe models, which enable support from either a real-time or asynchronous scribe, have the potential to reduce the burden of the EHR and EHR-related documentation.ObjectiveTo characterize the association of use of virtual scribes with changes in physicians’ EHR time and note and order composition and to identify the physician, scribe, and scribe response factors associated with changes in EHR time upon virtual scribe use.Design, Setting, and ParticipantsRetrospective, pre-post quality improvement study of 144 physicians across specialties who had used a scribe for at least 3 months from January 2020 to September 2022, were affiliated with Brigham and Women’s Hospital and Massachusetts General Hospital, and cared for patients in the outpatient setting. Data were analyzed from November 2022 to January 2024.ExposureUse of either a real-time or asynchronous virtual scribe.Main OutcomesTotal EHR time, time on notes, and pajama time (5:30 pm to 7:00 am on weekdays and nonscheduled weekends and holidays), all per appointment; proportion of the note written by the physician and team contribution to orders.ResultsThe main study sample included 144 unique physicians who had used a virtual scribe for at least 3 months in 152 unique scribe participation episodes (134 [88.2%] had used an asynchronous scribe service). Nearly two-thirds of the physicians (91 physicians [63.2%]) were female and more than half (86 physicians [59.7%]) were in primary care specialties. Use of a virtual scribe was associated with significant decreases in total EHR time per appointment (mean [SD] of 5.6 [16.4] minutes; P &lt; .001) in the 3 months after vs the 3 months prior to scribe use. Scribe use was also associated with significant decreases in note time per appointment and pajama time per appointment (mean [SD] of 1.3 [3.3] minutes; P &lt; .001 and 1.1 [4.0] minutes; P = .004). In a multivariable linear regression model, the following factors were associated with significant decreases in total EHR time per appointment with a scribe use at 3 months: practicing in a medical specialty (−7.8; 95% CI, −13.4 to −2.2 minutes), greater baseline EHR time per appointment (−0.3; 95% CI, −0.4 to −0.2 minutes per additional minute of baseline EHR time), and decrease in the percentage of the note contributed by the physician (−9.1; 95% CI, −17.3 to −0.8 minutes for every percentage point decrease).Conclusions and RelevanceIn 2 academic medical centers, use of virtual scribes was associated with significant decreases in total EHR time, time spent on notes, and pajama time, all per appointment. Virtual scribes may be particularly effective among medical specialists and those physicians with greater baseline EHR time.

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Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction

Cited by 29 publications

References 14 publications

Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

Clinical scribes and their association with patient experience in the otolaryngology clinic

Virtual Scribes and Physician Time Spent on Electronic Health Records

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