This study was reviewed by the BIDMC Committee on Clinical Investigation and did not meet the definition of Human Subjects Research. No other significant changes occurred in the practice during this time period, and we made no change to staffing levels of medical assistants, nurses, telephone staff, or administrative assistants. Control physicians experienced no change to their visit lengths. Then, for the next 12 weeks, intervention physicians used scribes with their visit lengths shortened from 20 to 15 min and from 40 to 30 min, increasing the number of patient slots available in each 4-h session. We then implemented scribes in a transitional 3-week “honeymoon” period, in which scribes were provided to the four intervention physicians, but no change to standard visit lengths was made this was intended to represent the expected period of adaptation for patients, physicians, and staff. We first evaluated physician and patient outcomes for 4 weeks at baseline, prior to any modification in the practice. We tested the effect of scribes using a difference-in-differences approach, in which we compared differences between intervention and control periods among physicians who used scribes with the corresponding differences among physicians who did not use scribes during the identical periods. We focused on a real-world implementation model, in which provider workload was adjusted a priori to account for the increased costs incurred by scribes. Here, we present the detailed results of a single-center, quasi-experimental study of the effect of medical scribes on patient satisfaction, provider satisfaction, and provider productivity. 13, 14 Despite promising results, these studies often lack generalizability and fail to provide crucial information about the effects of scribes on patient and provider satisfaction or how to accommodate the increased costs of employing scribes. Collectively, these demonstrate benefit of medical scribes to providers, patients, and healthcare systems. 10– 12 As recently as 2014, a meta-analysis concluded that “confidence in the reliability of the evidence is significantly constrained,” and called for “methodologically and sufficiently powered studies.” Since then, several studies examining the use of medical scribes in the primary care setting have been published. Until recently, evidence on the benefits and tradeoffs of medical scribes has been limited to the emergency and ambulatory subspecialty practice settings. One recent editorial by the American College of Medical Scribe Specialties estimated “industry ranks to swell to 100,000 by 2020.” 8Ī review of existing literature reflects this trend. 9 Scribes have been employed in emergency departments since the late twentieth century 7 and their use has grown steadily since. Duties include real-time transcribing of physician notes, organization of objective healthcare data, point-of-service collections, and patient tracking. 6– 8Ī medical scribe is a non-clinical ancillary staff member who assists a licensed-independent provider. 2– 5 A number of solutions to this largely uncompensated effort have been proposed, ranging from improving the usability of the EHR to medical scribes. Outside of office hours, physicians spend another 1 to 2 h of personal time daily performing additional computer and clerical work. 1 For every hour that physicians provide direct clinical face time to patients, two additional hours are spent on EHR and desk work within the clinic day. This dynamic has a measurable negative effect on patient centeredness and physician work-life balance. With increasing use of the medical record as an instrument for billing, and particularly with advent of the electronic health record (EHR), the medical note may seem as important as the actual patient care. Documentation, once a small part of the patient encounter, has grown to become a major driver of physician time.
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