Safe use of the EHR by medical scribes: a qualitative study

Abstract

Objective Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. Materials and Methods Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. Results We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the “technical” dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The “environmental” dimension included the changing scribe industry and need for standards. Within the “personal” dimension, themes included the need for provider diligence and training when using scribes. Finally, the “organizational” dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. Conclusion Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.

Do You Know What Your Scribe Did Last Spring? The Impact of COVID-19 on Medical Scribe Workflow

“…Prior to COVID-19, there were concerns about the risks of scribes going beyond their documentation duties. 3,5 With workflow changes post-COVID expanding their duties and limiting their interactions with providers to audio only, this rapid transition might result in additional unintended safety consequences.…”

“…While the use of remote scribes has been described previously, the sudden shift to virtual/tele visits due to COVID-19 has now juxtaposed remote scribing with remote patient visits in a way that patient, provider, and scribe are all in different physical locations. 5,10,11 Therefore, several potential patient safetyrelated concerns arise related to the quality of documentation due to the lack of visual cues as was described in a recent evaluation of multiple scribe models. 5 Prior studies suggest deterioration with note veracity, which is potentially further confounded by these factors.…”

“…5,10,11 Therefore, several potential patient safetyrelated concerns arise related to the quality of documentation due to the lack of visual cues as was described in a recent evaluation of multiple scribe models. 5 Prior studies suggest deterioration with note veracity, which is potentially further confounded by these factors. 7 This concern is also exacerbated by the observation that the supervision of scribes is varied and unstructured.…”

“…Questions were based on both institutional experience and the results of a series of grant-funded site visits conducted by our study team on scribe utilization in different settings. 5 The survey instrument can be found in the ►Supplementary Material (available in the online version). The survey was built and deployed by institutional email in Smartsheet to all scribes currently employed.…”

The future of medical scribes documenting in the electronic health record: results of an expert consensus conference

“…Finally, there is the concern that scribes are a merely a “Band-Aid solution” and fixing EHR usability is critical; an increased use and reliance on medical scribes could result in a slower development of a more capable EHR system [ 13 ]. Many of these concerns are not evidence-based because there is a large gap in our knowledge about scribe activities in the U.S.. To identify present practices, the research team conducted site visits around the U.S. to determine the scribes’ workflow and their impact on health systems [ 16 ]. These site visits were to develop lists of needed knowledge, skills, and attitudes of scribes (KSAs) and a standardized training program for scribes so they could become more efficient at their jobs.…”