Scribe use helpful but imperfect, inefficient

Using scribes can be a positive experience for physicians, but they’re imperfect and raise additional issues, according to an editorial published recently in the Journal of General Internal Medicine.

The editorial addresses some of the results from a small study of scribe use that interviewed 18 physicians, 17 scribes, and 36 patients.  The scribes’ notes were perceived as more detailed because of the real-time documentation, and most patients were OK with having a third person in the room, especially since they believed they received more attention from the doctors. However, the workflow shifts caused “stress.”

The editorial noted that while scribe use is growing, the professionals are not a cure all. For one, its authors say, while they may relieve a provider documentation burdens, by no longer documenting personally, doctors become less familiar with what’s in a patients’ medical record. Also, the study found that while scribes can capture more information, they appear to be better at using templates and clicking on boxes, not free text, so the ability of scribes to summarize and convey complex assessments is “less predictable.” And while scribes can document so as to increase billings and reimbursement, there are worries that such activity is gaming the system.

The editorial's authors also expressed concern that scribes don’t increase efficiency, and that they’re really more of a workaround to deal with inadequate EHR design. If EHRs were more usable, there would be less need to resort to scribes, they say.

“[A]lthough it appears that medical scribes are in many ways irresistible and here to stay ... their growth nonetheless raises broader questions about primary care work flow, staffing, clinical documentation, diagnostic assessments, provider burnout, and patient-provider-scribe relationships and communication," the authors write. "Perhaps scribes can not only help document individual encounters, but also document and provide rich insights into ways our clinical encounters, clinicians, teams, primary care systems, and electronic medical records could be improved."

To learn more:
- read the editorial
- here's the study abstract

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