Sustainability

The overlooked benefits of medical scribes

It’s a given that using medical scribes will reduce data-entry time for physicians. But the myriad benefits this produces for patients and physicians are now being quantified by emerging research.

Related Coverage

EHR scribes cut physician documentation time in half, study says

The research helps shed light on questions such as “How does a medical scribe help the physician?” and “What does a medical scribe do?”

Medical scribes, also called documentation assistants, are professionals who transcribe information during clinical visits in real time into electronic health records (EHRs) under physician supervision. Scribing, or “team documentation,” frees physicians from note documentation and entering orders or referrals. This allows doctors to focus on the patient, according to an AMA STEPS Forward™ module on team documentation.

Use of scribes results in lower physician documentation burden and improved efficiency, workflow and patient-physician interaction, according to a study conducted by researchers from the Kaiser Permanente integrated health care organization. The study, “Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience,” was published in JAMA Internal Medicine.

The researchers studied the impact scribes had on 18 primary care physicians in the Kaiser system for over a year. They concluded that the scribes led to significant improvements in productivity and job satisfaction.

The results mirror the findings of a similar previous study in JAMA Dermatologyconducted by researchers at Brigham and Women’s Hospital which echoed the findings of an earlier study, published in ClinicoEconomics and Outcomes Research, showing that scribes had a positive impact on cardiologists.

This emerging body of research illustrates five benefits of using scribes.

Better patient interactions. Of the 735 patients interviewed for the study, 57 percent said their physicians spent less time than usual on the computer during the visit when they were assisted by a scribe. Almost half reported that their doctor spent more time than usual speaking with them.

The AMA STEPS Forward module cites research stating that the “extra person actually improves the physician-patient relationship because the physician is able to provide his or her full attention to the patient and is not distracted by data entry.”

Improved physician satisfaction. After adopting team documentation, 60 physicians working in a Vancouver, Washington, clinic commented “I feel like I have my life back” and “I feel like I’m a real doctor again,” says the STEPS Forward module. They even said the clinic’s improved physician experience was a selling point for recruiting new doctors to the clinic.

On a one-to-four scale with four being “strongly agree,” there was a 3.6 average response to the statement “using a scribe has increased my job satisfaction” from the Brigham dermatologists studied.

That study’s authors enthusiastically concluded that “scribes enable dermatologists to achieve real-time documentation, thereby improving physician efficiency and freeing time for scholarly, leadership, teaching, or personal pursuits.”

Better teamwork. The module concludes that “team documentation instills a sense of cooperation among staff at all levels of your practice.” It also quotes a family physician from Auburn, Indiana, who said, “For me the biggest return on investment was achieving a real sense of teamwork.”

Can pay for itself. In the JAMA Dermatology study, 79 percent of the physicians reported a willingness to increase patient volume with scribe support. The use of scribes was linked to a 7.7 percent rise in fourth-quarter practice revenue comparing 2015 and 2016.

The cardiology practice study compared the annual patient and revenue volume of 10 physicians with scribes and 15 without. The improved productivity was linked to 3,029 more relative-value units (RVUs) of work from 507 more patient visits. This translated into revenue of almost $1.4 million at a cost of almost $99,000.

Can help mitigate physician burnout. “Our results suggest that the use of scribes may be one strategy to mitigate the increasing EHR documentation burden among” primary care physicians, the Kaiser researchers wrote. “Although scribes do not obviate the need for improving suboptimal EHR designs, they may help alleviate some of the inefficiencies of currently implemented EHRs.”

Committed to making physician burnout a thing of the past, the AMA has studied, and is addressing, issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand the challenges physicians face.

AMA’s STEPS Forward is an open-access platform featuring more than 50 modules that offer actionable, expert-driven strategies and insights supported by practical resources and tools. Based on best practices from the field, STEPS Forward modules empower practices to identify areas or opportunities for improvement, set meaningful and achievable goals, and implement transformative changes designed to increase operational efficiencies, elevate clinical team engagement, and improve patient care.

Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.

The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.