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Owens LM, Wilda JJ, Grifka R, Westendorp J, Fletcher JJ. Effect of Ambient Voice Technology, Natural Language Processing, and Artificial Intelligence on the Patient-Physician Relationship. Appl Clin Inform 2024; 15:660-667. [PMID: 38834180 PMCID: PMC11305826 DOI: 10.1055/a-2337-4739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/31/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The method of documentation during a clinical encounter may affect the patient-physician relationship. OBJECTIVES Evaluate how the use of ambient voice recognition, coupled with natural language processing and artificial intelligence (DAX), affects the patient-physician relationship. METHODS This was a prospective observational study with a primary aim of evaluating any difference in patient satisfaction on the Patient-Doctor Relationship Questionnaire-9 (PDRQ-9) scale between primary care encounters in which DAX was utilized for documentation as compared to another method. A single-arm open-label phase was also performed to query direct feedback from patients. RESULTS A total of 288 patients were include in the open-label arm and 304 patients were included in the masked phase of the study comparing encounters with and without DAX use. In the open-label phase, patients strongly agreed that the provider was more focused on them, spent less time typing, and made the encounter feel more personable. In the masked phase of the study, no difference was seen in the total PDRQ-9 score between patients whose encounters used DAX (median: 45, interquartile range [IQR]: 8) and those who did not (median: 45 [IQR: 3.5]; p = 0.31). The adjusted odds ratio for DAX use was 0.8 (95% confidence interval: 0.48-1.34) for the patient reporting complete satisfaction on how well their clinician listened to them during their encounter. CONCLUSION Patients strongly agreed with the use of ambient voice recognition, coupled with natural language processing and artificial intelligence (DAX) for documentation in primary care. However, no difference was detected in the patient-physician relationship on the PDRQ-9 scale.
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Affiliation(s)
- Lance M. Owens
- Department of Family Medicine, University of Michigan Health-West, Wyoming, Michigan, United States
| | - J Joshua Wilda
- Health Information Technology, University of Michigan Health-West, Wyoming, Michigan, United States
| | - Ronald Grifka
- Department of Research, University of Michigan Health West, Wyoming, Michigan, United States
| | - Joan Westendorp
- Department of Research, University of Michigan Health West, Wyoming, Michigan, United States
| | - Jeffrey J. Fletcher
- Department of Research, University of Michigan Health West, Wyoming, Michigan, United States
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Sloss EA, Abdul S, Aboagyewah MA, Beebe A, Kendle K, Marshall K, Rosenbloom ST, Rossetti S, Grigg A, Smith KD, Mishuris RG. Toward Alleviating Clinician Documentation Burden: A Scoping Review of Burden Reduction Efforts. Appl Clin Inform 2024; 15:446-455. [PMID: 38839063 PMCID: PMC11152769 DOI: 10.1055/s-0044-1787007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/17/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Studies have shown that documentation burden experienced by clinicians may lead to less direct patient care, increased errors, and job dissatisfaction. Implementing effective strategies within health care systems to mitigate documentation burden can result in improved clinician satisfaction and more time spent with patients. However, there is a gap in the literature regarding evidence-based interventions to reduce documentation burden. OBJECTIVES The objective of this review was to identify and comprehensively summarize the state of the science related to documentation burden reduction efforts. METHODS Following Joanna Briggs Institute Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a comprehensive search of multiple databases, including PubMed, Medline, Embase, CINAHL Complete, Scopus, and Web of Science. Additionally, we searched gray literature and used Google Scholar to ensure a thorough review. Two reviewers independently screened titles and abstracts, followed by full-text review, with a third reviewer resolving any discrepancies. Data extraction was performed and a table of evidence was created. RESULTS A total of 34 articles were included in the review, published between 2016 and 2022, with a majority focusing on the United States. The efforts described can be categorized into medical scribes, workflow improvements, educational interventions, user-driven approaches, technology-based solutions, combination approaches, and other strategies. The outcomes of these efforts often resulted in improvements in documentation time, workflow efficiency, provider satisfaction, and patient interactions. CONCLUSION This scoping review provides a comprehensive summary of health system documentation burden reduction efforts. The positive outcomes reported in the literature emphasize the potential effectiveness of these efforts. However, more research is needed to identify universally applicable best practices, and considerations should be given to the transfer of burden among members of the health care team, quality of education, clinician involvement, and evaluation methods.
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Affiliation(s)
- Elizabeth A. Sloss
- Division of Health Systems and Community Based Care, College of Nursing, University of Utah, Utah, United States
| | - Shawna Abdul
- John D. Dingell VA Medical Center, Detroit, Michigan, United States
| | - Mayfair A. Aboagyewah
- Case Management, Mount Sinai Health System, MSH Main Campus, New York, New York, United States
| | - Alicia Beebe
- Saint Luke's Health System (MO), Kansas City, Missouri, United States
| | - Kathleen Kendle
- Section of Health Informatics, El Paso VA Health Care System, El Paso, Texas, United States
| | - Kyle Marshall
- Department of Emergency Medicine, Geisinger, Danville, Pennsylvania, United States
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Sarah Rossetti
- Biomedical Informatics and Nursing, Columbia University Irving Medical Center, New York, New York, United States
| | - Aaron Grigg
- Department of Informatics, Grande Ronde Hospital, La Grande, Oregon, United States
| | - Kevin D. Smith
- Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois, United States
| | - Rebecca G. Mishuris
- Digital, Mass General Brigham, Somerville, Massachusetts, United States
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
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Edwards A, Kanner L, Tewar S, Pesce L, Leyser M. The Value of Adding Scribe Services to 2 Distinct Pediatric Subspecialties in the Era of the Electronic Medical Record. Clin Pediatr (Phila) 2024; 63:341-349. [PMID: 37194260 DOI: 10.1177/00099228231174849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
To evaluate the impact of adding medical scribes to 2 distinct outpatient pediatric subspecialty clinics on provider burnout, visit length, and patient satisfaction. A total of 2 pediatric endocrinologists and 2 developmental-behavioral pediatrics/pediatrician (DBP) were randomly assigned based on days of the week to see patients aged 0 to 21 years in their clinics with and without in-person medical scribes from February 2019 to February 2020. Parent satisfaction rates were examined through pre- and postappointment surveys. Provider burnout rates were assessed through the Maslach Burnout Inventory-Human Services Survey. A retrospective comparative analysis of average appointment duration was undertaken considering the scribe/no scribe random allocation in the examination room. Funding for this pilot provided by the department of pediatrics budgeted funds. Over 2923 appointments during the project dates, 829 appointments were seen with a scribe. The average appointment time for a new DBP appointment was 61 minutes with scribes and 71 minutes without (P < .001). Return patient appointments in DBP averaged 31 minutes with scribes and 43 minutes without (P < .001). There was no significant difference in appointment duration for endocrinology with and without scribes. The average time for chart completion was reduced with the presence of scribes in DBP but not in endocrinology. Out of the 209 families surveyed, patient satisfaction rates with and without a scribe did not differ in that between 96% and 97% of respondents rated the appointment overall as "excellent" for each measure of provider communication with scribes present. Finally, from the Maslach Burnout Inventory-Human Services Survey, the average score across all 4 providers for Emotional Exhaustion and Depersonalization decreased during the project period, whereas Personal Accomplishment scores increased over the project period. Scribes might be more advantageous for some subspecialties that utilize prolonged narratives in clinic notes, like DBP, and an important avenue to consider in reducing provider burnout in busy ambulatory settings.
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Affiliation(s)
- Anne Edwards
- Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
- Mayo Clinic, Rochester, MN, USA
| | - Lauren Kanner
- Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
| | - Shruti Tewar
- Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
- University of Arkansas Medical Sciences, Arkansas, AR, USA
| | - Liuska Pesce
- Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
| | - Marcio Leyser
- Stead Family Department of Pediatrics, The University of Iowa, Iowa City, IA, USA
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Pollock JR, Moore ML, Llanes AC, Brinkman JC, Makovicka JL, Dulle DL, Hinckley NB, Barcia A, Anastasi M, Chhabra A. Medical Scribes in an Orthopedic Sports Medicine Clinic Improve Productivity and Physician Well-Being. Arthrosc Sports Med Rehabil 2022; 4:e997-e1005. [PMID: 35747641 PMCID: PMC9210372 DOI: 10.1016/j.asmr.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of this study is to examine the effects of scribe use on physicians, nurses, and patients in an orthopaedic sports medicine clinic. Methods Surveys containing validated outcome measures relating to physician well-being and workplace satisfaction, among other variables, were used to assess the influence of medical scribes on clinic function. These surveys were collected for 8 months from all patients, nurses, and orthopaedic surgeons working in one orthopaedic sports medicine clinic. Time during a half-day clinic (i.e., 20 or more patients) was documented by surgeons after the last patient was seen. Results The average time spent per half day of clinic was 104 minutes on nonscribe days and 25 minutes on scribe days. Additionally, the time spent documenting encounters per half day of clinic was 87 minutes on average without scribes and 26 minutes on average with scribes. The average surgeon single assessment numeric evaluation (SANE) score was 48.1 without scribes, and 89.3 with scribes. The overall assessment of the clinic by nurses was 73.4 out of 100 on average without scribes and 87.7 out of 100 on average with scribes. Patients did not report a significant change in rating of overall experience (4.7/5.0 with scribes and 4.8/5.0 without scribes, (P = .27) or wait time between scheduled appointment time and surgeon arrival (15.1 minutes with scribes and 18.1 minutes without scribes; P = .12). Conclusions We found the use of scribes in a high-volume orthopaedic sports medicine clinic to have a favorable impact on physicians, nurses, and trainees. The use of a scribe also significantly reduced the time required by surgeons for documentation during clinic and at the end of each clinic day. Patients also reported no significant difference in patient clinic experience scores. Clinical Relevance Orthopaedic surgeons spend a substantial amount of time on paperwork. The results of this study could provide information on whether the use of a scribe helps to reduce administrative burden on orthopedic surgeons.
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Affiliation(s)
| | - M. Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale Arizona, U.S.A
| | - Aaron C. Llanes
- University of Arizona School of Medicine, Phoenix, Arizona, U.S.A
| | - Joseph C. Brinkman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Donald L. Dulle
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Anthony Barcia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew Anastasi
- Department of Family Medicine, Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
- Address correspondence to Anikar Chhabra, M.D., Department of Orthopedics, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, U.S.A.
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Impact of Scribe Intervention on Documentation in an Outpatient Pediatric Primary Care Practice. Acad Pediatr 2022; 22:289-295. [PMID: 34020102 DOI: 10.1016/j.acap.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE The use of the electronic health record (EHR) has led to physician dissatisfaction, physician burnout, and delays in documentation and billing. Medical scribes can mitigate these unintended consequences by reducing documentation workload and increasing efficiency. OBJECTIVE To study the effects of medical scribes on time to completion of notes and clinician experience, with a focus on time spent charting during clinic and after-hours. We hypothesized that medical scribes in an outpatient pediatric setting would decrease clinician time spent charting, time to finalize encounter notes, and clinician's perceived documentation time. METHODS This 15-month single-center observational study was carried out with 3 study periods: pre-scribe, with-scribe, and scribe-withheld. Time spent in EHR was extracted by our EHR vendor. Participants completed surveys regarding time spent documenting. Six clinicians (5 physicians, 1 nurse practitioner) participated in this study to trial the implementation of medical scribes. RESULTS EHR time data were collected for 4329 patient visits (2232 pre-scribe, 1888 with-scribe, 209 scribe-withheld periods). Comparing pre-scribe versus with-scribe periods, documentation time per patient decreased by 3-minutes 28-seconds per patient (pre-scribe IQR: 6, with-scribe IQR: 3, P = .028); note timeliness decreased from 0.96 days to 0.26 days (pre-scribe IQR: 0.22, with-scribe IQR: 0.11, P = .028); and clinicians' estimates of time spent in the EHR decreased by 1.2 hours per clinic session (pre-scribe IQR: 0.5, with-scribe IQR: 0.5, P = .031). CONCLUSIONS Medical scribes in an outpatient pediatric setting result in: 1) decreased time spent charting, 2) reduced time to final sign clinic notes, and 3) decrease in clinician's perceived time spent documenting.
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Gyimah MB, Shah HP, Lee YH. Maximizing the effectiveness of scribes in surgical practices. Am J Surg 2021; 223:208-210. [PMID: 34392911 DOI: 10.1016/j.amjsurg.2021.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
Surgeons are spending increasing amounts of time on non-patient facing responsibilities such as electronic health record (EHR) documentation, coding, and inter-office communication. The burden of documentation is a significant contributor to burnout, which adversely affects surgeons' work satisfaction, productivity, and personal wellness. Scribes can help reduce the clerical burden experienced by surgeons. Studies have shown that scribes increase work satisfaction, reduce EHR documentation time, improve provider productivity, and increase work relative value units (wRVUs). That being said, surgeons must learn how to work with scribes effectively in order to yield these benefits. We outline considerations and strategies for optimizing the role of scribes in a surgical practice. Scribes can be valuable members of the surgeon's healthcare team by 1) learning the language and pathologies specific to a surgical specialty, 2) efficiently documenting prior to, during, and after clinical encounters, and 3) assisting with coding and inter-office communication.
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Affiliation(s)
| | - Hemali P Shah
- Yale University School of Medicine, New Haven, CT, USA.
| | - Yan Ho Lee
- Division of Otolaryngology, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Gold JA, Becton J, Ash JS, Corby S, Mohan V. Do You Know What Your Scribe Did Last Spring? The Impact of COVID-19 on Medical Scribe Workflow. Appl Clin Inform 2020; 11:807-811. [PMID: 33264803 DOI: 10.1055/s-0040-1721396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To understand the impact of the shift to virtual medicine induced by coronavirus disease 2019 (COVID-19) has had on the workflow of medical scribes. DESIGN This is a prospective observational survey-based study. SETTING This study was conducted at academic medical center in the United States. PARTICIPANTS Seventy-four scribes working in ambulatory practices within an academic medical center. INTERVENTIONS All medical scribes received a survey assessing their workflow since beginning of COVID-19 restrictions. PRIMARY AND SECONDARY OUTCOMES To assess the current workflow of medical scribes since transition to virtual care. Secondary outcomes are to assess the equipment used and location of their new workflow. RESULTS Fifty-seven scribes completed the survey. Overall 42% of scribes have transitioned to remote scribing with 97% serving as remote scribes for remote visits. This workflow is conducted at home and with personal equipment. Of those not working as scribes, 46% serve in preclinic support, with a wide range of EHR-related activities being reported. The remaining scribes have been either redeployed or furloughed. CONCLUSION The rapid transition to virtual care brought about by COVID-19 has resulted in a dramatic shift in scribe workflow with the adoption of a previously unreported workflow of remote scribing for virtual care. Additional work is now needed to ensure these new workflows are safe and effective and that scribes are trained to work in this new paradigm.
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Affiliation(s)
- Jeffrey A Gold
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, United States.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - James Becton
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
| | - Sky Corby
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, United States
| | - Vishnu Mohan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
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