Original Research

Can medical scribes improve quality measure documentation?

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Yes, according to this study that found significant improvements in the documentation of 4 pay-for-performance quality measures and higher patient/physician satisfaction.




Purpose To avoid disruption of administrative and clinical workflow in an increasingly complex system of health information technology, health care systems and providers have started using medical scribes. The purpose of this study was to investigate the impact of medical scribes on patient satisfaction, physician satisfaction, and quality measure documentation in a family medicine office.

Methods We reviewed 1000 electronic health records for documentation of specified quality measures in the family medicine setting, before and after the use of medical scribes. We surveyed 150 patients on attitude, comfort, and acceptance of medical scribes during their visit. Five physicians shared their perceptions related to productivity, efficiency, and overall job satisfaction on working with medical scribes.

Results Documentation of 4 quality measures improved with the use of scribes, demonstrating statistical significance: fall risk assessment (odds ratio [OR] = 5.5; P = .02), follow-up tobacco screen (OR = 6.4; P = .01), follow-up body mass index plan (OR = 6.2; P < .01), and follow-up blood pressure plan (OR = 39.6; P < .01). Patients reported comfort with scribes in the examination room (96%, n = 144), a more focused health care provider (76%, n = 113), increased efficiency (74%, n = 109), and a higher degree of satisfaction with the office visit (61%, n = 90). Physicians believed they were providing better care and developing better relationships with patients while spending less time documenting and experiencing less stress.

Conclusions Use of medical scribes in a primary care setting was associated with higher patient and physician satisfaction. Patients felt comfortable with a medical scribe in the room, attested to their professionalism, and understood their purpose during the visit. The use of medical scribes in this primary care setting improved documentation of 4 quality measures.

The widespread implementation and adoption of electronic health records (EHRs) continues to increase, primarily motivated by federal incentives through the Centers for Medicare and Medicaid Services to positively impact patient care. Physician use of the EHR in the exam room has the potential to affect the patient-physician relationship, patient satisfaction, physician satisfaction, physician productivity, and physician reimbursement. In the United States, the Health Information Technology for Economic and Clinical Health Act of 2009 established incentive programs to promote meaningful use of EHRs in primary care.1 Integrating EHRs into physician practice, adoption of meaningful use, and the increasing challenge of pay-for-performance quality measures have generated additional hours of administrative work for health care providers. These intrusions on routine clinical care, while hypothesized to improve care, have diminished physician satisfaction, increased stress, and contributed to physician burnout.2

The expanded role of clinicians incentivized to capture metrics for value-based care introduces an unprecedented level of multitasking required at the point of care. In a clinical setting, multitasking undermines the core clinical activities of observation, communication, problem solving, and, ultimately, the development of trusting relationships.3,4 EHR documentation creates a barrier to patient engagement and may contribute to patients feeling isolated when unable to view data being entered.5,6

Potential benefits of scribes. One means of increasing physician satisfaction and productivity may be the integration of medical scribes into health care systems. Medical scribes do not operate independently but are able to document activities or receive dictation critical for patient management—eg, recording patient histories, documenting physical examination findings and procedures, and following up on lab reports.7

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