Impact of Scribe Intervention on Documentation in an Outpatient Pediatric Primary Care Practice

Purpose

The use of the electronic health record (EHR) has led to physician dissatisfaction, physician burnout, and delays in documentation and billing. Medical scribes can mitigate these unintended consequences by reducing documentation workload and increasing efficiency.

Objective

To study the effects of medical scribes on time to completion of notes and clinician experience, with a focus on time spent charting during clinic and after-hours. We hypothesized that medical scribes in an outpatient pediatric setting would decrease clinician time spent charting, time to finalize encounter notes, and clinician's perceived documentation time.

Methods

This 15-month single-center observational study was carried out with 3 study periods: pre-scribe, with-scribe, and scribe-withheld. Time spent in EHR was extracted by our EHR vendor. Participants completed surveys regarding time spent documenting. Six clinicians (5 physicians, 1 nurse practitioner) participated in this study to trial the implementation of medical scribes.

Results

EHR time data were collected for 4329 patient visits (2232 pre-scribe, 1888 with-scribe, 209 scribe-withheld periods). Comparing pre-scribe versus with-scribe periods, documentation time per patient decreased by 3-minutes 28-seconds per patient (pre-scribe IQR: 6, with-scribe IQR: 3, P = .028); note timeliness decreased from 0.96 days to 0.26 days (pre-scribe IQR: 0.22, with-scribe IQR: 0.11, P = .028); and clinicians’ estimates of time spent in the EHR decreased by 1.2 hours per clinic session (pre-scribe IQR: 0.5, with-scribe IQR: 0.5, P = .031).

Conclusions

Medical scribes in an outpatient pediatric setting result in: 1) decreased time spent charting, 2) reduced time to final sign clinic notes, and 3) decrease in clinician's perceived time spent documenting.

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Metadata

Work Title Impact of Scribe Intervention on Documentation in an Outpatient Pediatric Primary Care Practice
Access
Open Access
Creators
  1. Pooja Jhaveri
  2. Denise Abdulahad
  3. Benjamin Fogel
  4. Cynthia Chuang
  5. Erik Lehman
  6. Lucky Chawla
  7. Kasey Foley
  8. Troy Phillips
  9. Benjamin Levi
Keyword
  1. Medical scribe
  2. Pediatrics
  3. Electronic health record
  4. EHR
  5. Burnout
License CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives)
Work Type Article
Publication Date March 1, 2022
Publisher Identifier (DOI)
  1. https://www.doi.org/10.1016/j.acap.2021.05.004
Deposited March 31, 2022

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Work History

Version 1
published

  • Created
  • Updated
  • Updated
  • Added Creator Pooja Jhaveri
  • Added Creator Denise Abdulahad
  • Added Creator Benjamin Fogel
  • Added Creator Cynthia H Chuang
  • Added Creator Erik Lehman
  • Added Creator Lucky Chawla
  • Added Creator Kasey A Foley
  • Added Creator Troy Allan Phillips
  • Added Creator Benjamin H Levi
  • Added Resubmission_Scribes_Documentation_Time_ACADEMICPEDS-D-20-01153_R1_5-8-21_for_PSU_3-24-2022.pdf
  • Updated License Show Changes
    License
    • https://creativecommons.org/licenses/by-nc-nd/4.0/
  • Published
  • Updated Description Show Changes
    Description
    • Purpose
    • **Purpose**
    • The use of the electronic health record (EHR) has led to physician dissatisfaction, physician burnout, and delays in documentation and billing. Medical scribes can mitigate these unintended consequences by reducing documentation workload and increasing efficiency.
    • Objective
    • **Objective**
    • To study the effects of medical scribes on time to completion of notes and clinician experience, with a focus on time spent charting during clinic and after-hours. We hypothesized that medical scribes in an outpatient pediatric setting would decrease clinician time spent charting, time to finalize encounter notes, and clinician's perceived documentation time.
    • Methods
    • This 15-month single-center observational study was carried out with 3 study periods: pre -scribe, with -scribe, and scribe- withheld . Time spent in EHR was extracted by our EHR vendor. Participants completed surveys regarding time spent documenting. Six clinicians (5 physicians, 1 nurse practitioner) participated in this study to trial the implementation of medical scribes.
    • Results
    • **Methods**
    • This 15-month single-center observational study was carried out with 3 study periods: *pre*-scribe, *with*-scribe, and scribe-*withheld*. Time spent in EHR was extracted by our EHR vendor. Participants completed surveys regarding time spent documenting. Six clinicians (5 physicians, 1 nurse practitioner) participated in this study to trial the implementation of medical scribes.
    • **Results**
    • EHR time data were collected for 4329 patient visits (2232 *pre*-scribe, 1888 *with*-scribe, 209 scribe-*withheld* periods). Comparing *pre*-scribe versus *with*-scribe periods, documentation time per patient decreased by 3-minutes 28-seconds per patient (*pre*-scribe IQR: 6, *with*-scribe IQR: 3, P = .028); note timeliness decreased from 0.96 days to 0.26 days (*pre*-scribe IQR: 0.22, *with*-scribe IQR: 0.11, P = .028); and clinicians’ estimates of time spent in the EHR decreased by 1.2 hours per clinic session (*pre*-scribe IQR: 0.5, *with*-scribe IQR: 0.5, P = .031).
    • EHR time data were collected for 4329 patient visits (2232 pre -scribe, 1888 with- scribe, 209 scribe- withheld periods). Comparing pre -scribe versus with -scribe periods, documentation time per patient decreased by 3-minutes 28-seconds per patient ( pre -scribe IQR: 6, with -scribe IQR: 3, P = .028); note timeliness decreased from 0.96 days to 0.26 days ( pre -scribe IQR: 0.22, with -scribe IQR: 0.11, P = .028); and clinicians’ estimates of time spent in the EHR decreased by 1.2 hours per clinic session ( pre -scribe IQR: 0.5, with -scribe IQR: 0.5, P = .031).
    • Conclusions
    • **Conclusions**
    • Medical scribes in an outpatient pediatric setting result in: 1) decreased time spent charting, 2) reduced time to final sign clinic notes, and 3) decrease in clinician's perceived time spent documenting.
  • Updated Keyword, Publisher Identifier (DOI) Show Changes
    Keyword
    • medical scribe, pediatrics, electronic health record, EHR, burnout
    • Medical scribe, Pediatrics, Electronic health record, EHR, Burnout
    Publisher Identifier (DOI)
    • 10.1016/j.acap.2021.05.004
    • https://www.doi.org/10.1016/j.acap.2021.05.004
  • Renamed Creator Cynthia Chuang Show Changes
    • Cynthia H Chuang
    • Cynthia Chuang
  • Renamed Creator Kasey Foley Show Changes
    • Kasey A Foley
    • Kasey Foley
  • Renamed Creator Troy Phillips Show Changes
    • Troy Allan Phillips
    • Troy Phillips
  • Renamed Creator Benjamin Levi Show Changes
    • Benjamin H Levi
    • Benjamin Levi
  • Updated