Can medical scribes improve quality measure documentation?
Yes, according to this study that found significant improvements in the documentation of 4 pay-for-performance quality measures and higher patient/physician satisfaction.
Some concerns of introducing medical scribes into a health care system include possible patient discomfort with a third party being present during the visit and the cost of employing medical scribes. In this study, the vast majority of patients (96%) felt comfortable with a scribe in the room. Future research could compare patient discomfort due to the presence of a medical scribe with patient discomfort due to a physician using a computer during the visit.
Limitations of this study include the small sample size of both physicians and patients; a lack of validated measures for calculating productivity, time/efficiency, and overall satisfaction; and short time periods leading up to and following the introduction of medical scribes. In addition, EHRs of patients were chosen sequentially and not randomly, which could be a confounder. Participating physicians were aware of being studied; therefore, documentation could have been affected by the Hawthorne effect. The study also was limited to one family medicine site. Although improved documentation of primary care pay-for-performance quality measures was reported, wide confidence intervals and small patient numbers hindered generalizability of findings.
Additional studies are needed with a robust analytic plan sufficient to demonstrate baseline provider familiarity with EHRs, accuracy of medical scribe documentation, and improved documentation of pay-for-performance quality measures. Additional investigation regarding the variable competency of different medical scribes could be useful in measuring the effects of the scribe on a variety of outcomes related to both the physician and patient.
It is possible that the improved documentation yielded by the use of medical scribes could generate billing codes that reimburse physicians at a higher level (eg, a higher ratio of 99214 to 99213), leading to increased pay. Future research could aim to quantify this source of increased revenue. Furthermore, investigations could aim to quantify the revenue that medical scribes generate via improved quality measure pay-for-performance documentation.
CORRESPONDENCE
Jessica Platt, MD, 195 Canal Street, Malden, MA 02148; jpplatt@challiance.org.
