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Esquerda M, Pifarré-Esquerda F. [Artificial intelligence in medicine: Ethical, deontological aspects and the impact on the doctor-patient relationship]. Med Clin (Barc) 2024; 163:e44-e48. [PMID: 38719685 DOI: 10.1016/j.medcli.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Montse Esquerda
- Institut Borja de Bioètica-URL, Comissió de Deontología Consell de Col·legis de Metges de Catalunya, Esplugues de Llobregat, Barcelona, España.
| | - Francesc Pifarré-Esquerda
- Estudiante de matemáticas, Facultat de Matemàtiques i Estadística (FME), Universitat Politècnica de Catalunya (UPC), Barcelona, España
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Shafer PR, Palani S, Saeed I, Legler A, Barr K, Carvalho K, Pizer SD. Costs and Productivity Benefits of the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act Scribes Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:713-720. [PMID: 38462222 DOI: 10.1016/j.jval.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/18/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVES To improve access, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 mandated a 2-year study of medical scribes in Veterans Health Administration specialty clinics and emergency departments. Medical scribes are employed in clinical settings with the goals of increasing provider productivity and satisfaction by minimizing physicians' documentation burden. Our objective is to quantify the economic outcomes of the MISSION Act scribes trial. METHODS A cluster-randomized trial was designed with 12 Department of Veterans Affairs (VA) medical centers randomized into the intervention. We estimated the total cost of the trial, cost per scribe-year, and projected cost of hiring additional physicians to achieve the observed scribe productivity benefits in relative value units and visits per full-time-equivalent over the 2-year intervention period (June 30, 2020 to July 1, 2022). RESULTS The estimated cost of the trial was $4.6 million, below the Congressional Budget Office estimate of $5 million. A full-time scribe-year cost approximately $74 600 through contracting and $62 900 through VA hiring. Randomization into the trial led to an approximate 30% increase in productivity in cardiology and 20% in orthopedics. The projected incremental cost of using additional physicians instead of scribes to achieve the same productivity benefits was nearly $1.7 million more, or 75% higher, than the observed cost of scribes in cardiology and orthopedics. CONCLUSIONS As the largest randomized trial of scribes to date, the MISSION Act scribes trial provides important evidence on the costs and benefits of scribes. Improving productivity enhances access and scribes may give VA a new tool to improve productivity in specialty care at a lower cost than hiring additional providers.
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Affiliation(s)
- Paul R Shafer
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA; Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA.
| | - Sivagaminathan Palani
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA; Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA
| | - Iman Saeed
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA; Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA
| | - Aaron Legler
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
| | - Kyle Barr
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
| | - Kristina Carvalho
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA
| | - Steven D Pizer
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA; Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA
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Otsuka Y, Hagiya H, Sunada N, Otsuka F. Task shifting of medical office works: A preliminary questionnaire survey for generalists. J Gen Fam Med 2023; 24:317-319. [PMID: 37727622 PMCID: PMC10506393 DOI: 10.1002/jgf2.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 09/21/2023] Open
Abstract
To reduce physician burden, task shifting of clerical work from physicians to medical assistants is being promoted; however, it depends on hospitals. A questionnaire survey was conducted among 40 general physicians at Okayama University Hospital in December 2022 to investigate physicians' preferences toward task shifting. Compared to other tasks, most physicians thought that ordering examinations (14, 47%), replying to referral letters (19, 63%), and prescriptions (21, 70%) and medical record entries (22, 73%) should not be task shifted. Physicians' controversial opinions on task shifting maybe the reason behind the slow progress in task shifting.
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Affiliation(s)
- Yuki Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Hideharu Hagiya
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Naruhiko Sunada
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
| | - Fumio Otsuka
- Department of General MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
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Less J, Nguyen C, Teng V, Lin S. Impact of a Medical Scribe Program on the Educational Trajectory of Prehealth and Underrepresented in Medicine Students. Fam Med 2023; 55:389-393. [PMID: 37307390 PMCID: PMC10622087 DOI: 10.22454/fammed.2023.416490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Sparse research exists on evaluating the effects of medical scribing programs on the educational trajectory of prehealth students. This study assesses the impact of the Stanford Medical Scribe Fellowship (COMET) on its prehealth participants' educational goals, preparation for graduate training, and acceptance into health professional schools. METHODS We distributed a 31-question survey with both closed- and open-ended questions to 96 alumni. The survey collected participant demographics, self-reported underrepresented in medicine (URM) status, pre-COMET clinical experiences and educational goals, application to and acceptance at health professional schools, and perceived impact of COMET on their educational trajectory. SPSS was used to complete the analyses. RESULTS The survey had a 97% (93/96) completion rate. Among all respondents, 69% (64/93) applied to a health professional school and 70% (45/64) were accepted. Among URM respondents, 68% (23/34) applied to a health professional school and 70% (16/23) were accepted. Overall acceptance rates for MD/DO and PA/NP programs were 51% (24/47) and 61% (11/18), respectively. URM acceptance rates for MD/DO and PA/NP programs were 43% (3/7) and 58% (7/12), respectively. For current or recently graduated health professional school respondents, 97% (37/38) "strongly agreed" or "agreed" that COMET helped them succeed in their training. CONCLUSIONS COMET is associated with a positive impact on the educational trajectory of its prehealth participants and a higher acceptance rate into health professional schools than the national rates for both overall and URM applicants. Scribing programs may serve as pipeline development and help increase the diversity of the future health care workforce.
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Affiliation(s)
- Jacob Less
- Division of Primary Care and Population Health, Department of Medicine, Stanford Medical Scribe Fellowship, Stanford University School of MedicineStanford, CA
| | - Cathina Nguyen
- Division of Primary Care and Population Health, Department of Medicine, Stanford Medical Scribe Fellowship, Stanford University School of MedicineStanford, CA
| | - Valerie Teng
- Division of Primary Care and Population Health, Department of Medicine, Stanford Medical Scribe Fellowship, Stanford University School of MedicineStanford, CA
| | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford Medical Scribe Fellowship, Stanford University School of MedicineStanford, CA
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Shemtob L, Beaney T, Norton J, Majeed A. How can we improve the quality of data collected in general practice? BMJ 2023; 380:e071950. [PMID: 36921932 DOI: 10.1136/bmj-2022-071950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Lara Shemtob
- Department of Primary Care and Public Health, Imperial College London, London, UK
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, UK
| | - Thomas Beaney
- Department of Primary Care and Public Health, Imperial College London, London, UK
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, UK
| | - John Norton
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, UK
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Adedeji T, Fraser H, Scott P. Implementing Electronic Health Records in Primary Care Using the Theory of Change: A Nigerian Case Study (Preprint). JMIR Med Inform 2021; 10:e33491. [PMID: 35969461 PMCID: PMC9412900 DOI: 10.2196/33491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/25/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Taiwo Adedeji
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Hamish Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, RI, United States
| | - Philip Scott
- Institute of Management and Health, University of Wales Trinity Saint David, Carmarthen, United Kingdom
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