8/14/2023 0 Comments Scribe medical papers![]() ![]() ![]() During the week in which a physician was assigned a scribe, the scribe attended all appointments and drafted all relevant documentation, including the history and physical findings, objective examination findings, laboratory and radiology results, assessment and plan, and patient instructions. We also chose not to randomize at the physician level, as the small number of physicians included in this study would not properly protect against imbalance in the scribe and no-scribe groups. Randomization at the physician-week level was chosen instead of randomizing at the level of patients, as variations in length of patient appointments posed challenges for proper allocation of scribes across patients and was too disruptive to normal clinic flow. Physicians were randomly assigned to 1 week practicing with a scribe then 1 week without a scribe for the course of 52 weeks. Given that most office visits are to primary care physicians, 26 research in this setting is particularly warranted. 24, 25 There has been no randomized controlled study of scribes, and few studies have been undertaken in the primary care setting. Two systematic reviews found, using data from observational studies, that scribes may improve revenue, patient and physician satisfaction, productivity, efficiency, and the quality of patient-physician interactions. 23ĭespite the increasing presence of scribes, methodologically rigorous studies regarding their impact are lacking. 23 It is estimated that by 2020, there will be 100,000 scribes in the United States, or 1 scribe for every 9 physicians. 22 Scribes are currently being used in more than 1,000 hospitals and clinics across 44 states. 21 Although the use of scribes as physician extenders in emergency departments has been reported as early as the 1970s, it is only recently that the popularity of scribes has skyrocketed. 20 Scribes do not act independently but may assist with charting, recording laboratory and radiology results, and supporting physician workflow with EHR data entry. Scribes are nonlicensed team members trained to document patient encounters in real time under the direct supervision of a physician. One strategy to decrease clerical burden is the use of scribes. 19 Many physicians leave most charting to the end of the day, and spend 1 to 2 hours each night working on the EHR. 16– 18 For every hour physicians provide direct face time to patients, 2 more hours are spent on EHR and desk work. ![]() 15 Among the largest contributors to burnout is a growing clerical workload. More than one-half of all US physicians experience burnout, with primary care physicians having one of the highest rates. ![]() 5– 9 There is also growing evidence, however, that in their current state, EHRs are associated with decreased physician productivity and revenue, 10 negative patient-physician interactions and relationships, 11 and widespread physician dissatisfaction. 3, 4 Electronic health records hold promise to improve patient safety, quality of care, physician efficiency and performance, patient-physician communication, patient participation, cost of care, and health outcomes. Driven by federal meaningful use incentives and penalties, 1, 2 more than 95% of US hospitals and 56% of office-based physicians have adopted EHRs. Electronic health records (EHRs) have radically transformed the practice of medicine. ![]()
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