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Lam M, Sabharwal S. The Role of Scribes in Orthopaedics. JBJS Rev 2023; 11:01874474-202303000-00005. [PMID: 36947638 DOI: 10.2106/jbjs.rvw.22.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
» The rapid increase in the use of electronic medical records (EMRs) has led to some unintended consequences that negatively affect physicians and their patients. » The use of medical scribes may serve as a possible solution to some of the EMR-related concerns. » Research has demonstrated an overall positive impact of having scribes on both physician and patient well-being, safety, and satisfaction. » Adaptation of advances in technology, including remote and asynchronous scribing, use of face-mounted devices, voice recognition software, and applications of artificial intelligence may address some of the barriers to more traditional in-person scribes.
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Affiliation(s)
- Michelle Lam
- Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
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Benko S, Idarraga AJ, Bohl DD, Hamid KS. Virtual Scribe Services Decrease Documentation Burden Without Affecting Patient Satisfaction: A Randomized Controlled Trial. Foot Ankle Spec 2022; 15:252-257. [PMID: 32844674 DOI: 10.1177/1938640020950544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Virtual scribe services (VSS) are a contemporary take on the in-person scribes utilized as a means to reduce administrative burden on physicians and enhance the physician-patient interaction. The purpose of this study was to determine whether VSS use could decrease the time an orthopaedic foot and ankle surgeon spends on documentation without diminishing the patient experience as compared with traditional postencounter dictation (TD). METHODS Fifty patients presenting for first-time visits with a single orthopaedic foot and ankle surgeon were prospectively enrolled and randomized to VSS or TD prior to the physician-patient encounter. Time spent with the patient in the exam room and time spent documenting away from the patient were recorded. A postencounter survey assessed patient satisfaction, perception of physician empathy, understanding of the plan, and perception of the amount of time spent with the physician. RESULTS Of 50 patients enrolled, 25 were randomized to VSS. Time spent documenting away from the patient differed significantly between VSS and TD (1.2 ± 0.7 minutes for VSS vs 5.8 ± 1.7 minutes for TD, P < .001) as did time elapsed between the end of the visit and the start of dictation (0 ± 0 for VSS vs 118.2 ± 72.7 minutes for TD, P < .001). There was a trend toward more time spent with the patient in the VSS group than in the TD group (14.2 ± 5.9 minutes for VSS vs 11.4 ± 5.1 minutes for TD, P = .069). There were no differences between groups in survey responses regarding satisfaction, empathy, understanding, or perception of sufficient time spent with the physician (P > .05 for each). CONCLUSIONS VSS use in an orthopaedic foot and ankle practice significantly decreased documentation time and allowed for completion of documentation during patient visits without differences in quality metrics as compared to TD. Orthopaedic surgeons can consider VSS a HIPAA-compliant documentation option with time savings and no measurable difference in patient satisfaction. LEVELS OF EVIDENCE Level II: Randomized controlled trial.
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Affiliation(s)
- Savannah Benko
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Alex J Idarraga
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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The utility of scribes in the academic dermatology clinic: An opportunity for mutual benefit to patients, trainees, and shareholders. Clin Dermatol 2022; 40:402-404. [DOI: 10.1016/j.clindermatol.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tran BD, Rosenbaum K, Zheng K. An interview study with medical scribes on how their work may alleviate clinician burnout through delegated health IT tasks. J Am Med Inform Assoc 2021; 28:907-914. [PMID: 33576391 DOI: 10.1093/jamia/ocaa345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To understand how medical scribes' work may contribute to alleviating clinician burnout attributable directly or indirectly to the use of health IT. MATERIALS AND METHODS Qualitative analysis of semistructured interviews with 32 participants who had scribing experience in a variety of clinical settings. RESULTS We identified 7 categories of clinical tasks that clinicians commonly choose to offload to medical scribes, many of which involve delegated use of health IT. These range from notes-taking and computerized data entry to foraging, assembling, and tracking information scattered across multiple clinical information systems. Some common characteristics shared among these tasks include: (1) time-consuming to perform; (2) difficult to remember or keep track of; (3) disruptive to clinical workflow, clinicians' cognitive processes, or patient-provider interactions; (4) perceived to be low-skill "clerical" work; and (5) deemed as adding no value to direct patient care. DISCUSSION The fact that clinicians opt to "outsource" certain clinical tasks to medical scribes is a strong indication that performing these tasks is not perceived to be the best use of their time. Given that a vast majority of healthcare practices in the US do not have the luxury of affording medical scribes, the burden would inevitably fall onto clinicians' shoulders, which could be a major source for clinician burnout. CONCLUSIONS Medical scribes help to offload a substantial amount of burden from clinicians-particularly with tasks that involve onerous interactions with health IT. Developing a better understanding of medical scribes' work provides useful insights into the sources of clinician burnout and potential solutions to it.
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Affiliation(s)
- Brian D Tran
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, California, USA.,School of Medicine, University of California, Irvine, California, USA
| | - Kathryn Rosenbaum
- School of Medicine, University of California, Irvine, California, USA
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, California, USA.,Department of Emergency Medicine, School of Medicine, University of California, Irvine, California, USA
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Piersa AP, Laiteerapong N, Ham SA, Del Castillo FF, Shah S, Burnet DL, Lee WW. Impact of a medical scribe on clinical efficiency and quality in an academic general internal medicine practice. BMC Health Serv Res 2021; 21:686. [PMID: 34247600 PMCID: PMC8272908 DOI: 10.1186/s12913-021-06710-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice. Methods Six faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations. Results Median time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35–22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13–4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22–2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes. Conclusions Working with a scribe in an academic internal medicine practice was associated with more timely documentation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06710-y.
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Affiliation(s)
| | | | - Sandra A Ham
- University of Chicago Center for Health and the Social Sciences, Chicago, USA
| | | | - Sachin Shah
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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Tawfik DS, Sinha A, Bayati M, Adair KC, Shanafelt TD, Sexton JB, Profit J. Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study. J Med Internet Res 2021; 23:e26817. [PMID: 34255674 PMCID: PMC8292941 DOI: 10.2196/26817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/08/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND New technology adoption is common in health care, but it may elicit frustration if end users are not sufficiently considered in their design or trained in their use. These frustrations may contribute to burnout. OBJECTIVE This study aimed to evaluate and quantify health care workers' frustration with technology and its relationship with emotional exhaustion, after controlling for measures of work-life integration that may indicate excessive job demands. METHODS This was a cross-sectional, observational study of health care workers across 31 Michigan hospitals. We used the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey to measure work-life integration and emotional exhaustion among the survey respondents. We used mixed-effects hierarchical linear regression to evaluate the relationship among frustration with technology, other components of work-life integration, and emotional exhaustion, with adjustment for unit and health care worker characteristics. RESULTS Of 15,505 respondents, 5065 (32.7%) reported that they experienced frustration with technology on at least 3-5 days per week. Frustration with technology was associated with higher scores for the composite Emotional Exhaustion scale (r=0.35, P<.001) and each individual item on the Emotional Exhaustion scale (r=0.29-0.36, P<.001 for all). Each 10-point increase in the frustration with technology score was associated with a 1.2-point increase (95% CI 1.1-1.4) in emotional exhaustion (both measured on 100-point scales), after adjustment for other work-life integration items and unit and health care worker characteristics. CONCLUSIONS This study found that frustration with technology and several other markers of work-life integration are independently associated with emotional exhaustion among health care workers. Frustration with technology is common but not ubiquitous among health care workers, and it is one of several work-life integration factors associated with emotional exhaustion. Minimizing frustration with health care technology may be an effective approach in reducing burnout among health care workers.
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Affiliation(s)
- Daniel S Tawfik
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Amrita Sinha
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mohsen Bayati
- Operations, Information, and Technology, Stanford University Graduate School of Business, Stanford, CA, United States
- Department of Biomedical Informatics, Stanford University School of Medicine, Stanford, CA, United States
| | - Kathryn C Adair
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- WellMD Center, Stanford University School of Medicine, Stanford, CA, United States
| | - J Bryan Sexton
- Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, NC, United States
- Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, NC, United States
| | - Jochen Profit
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
- California Perinatal Quality Care Collaborative, Palo Alto, CA, United States
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Lin S, Duong A, Nguyen C, Teng V. Five Years' Experience With a Medical Scribe Fellowship: Shaping Future Health Professions Students While Addressing Provider Burnout. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:671-679. [PMID: 32969839 DOI: 10.1097/acm.0000000000003757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Professional burnout has reached epidemic levels among U.S. medical providers. One key driver is the burden of clinical documentation in the electronic health record, which has given rise to medical scribes. Despite the demonstrated benefits of scribes, many providers-especially those in academic health systems-have been unable to make an economic case for them. With the aim of creating a cost-effective scribe program in which premedical students gain skills that better position them for professional schooling, while providers at risk of burnout obtain documentation support, the authors launched the Clinical Observation and Medical Transcription (COMET) Program in June 2015 at Stanford University School of Medicine. COMET is a new type of postbaccalaureate premedical program that combines an apprenticeship-like scribing experience and a package of teaching, advising, application support, and mentored scholarship that is supported by student tuition. Driven by strong demand from both participants and faculty, the program grew rapidly during its first 5 years (2015-2020). Program evaluations indicated high levels of satisfaction among participants and faculty with their mentors and mentees, respectively; that participants felt the experience better positioned them for professional schooling; and that faculty reported improved joy of practice. In summary, tuition-supported medical scribe programs, like COMET, appear to be feasible and cost-effective. The COMET model may have the potential to help shape future health professions students, while simultaneously combating provider burnout. While scalability and generalizability remain uncertain, this model may be worth exploring at other institutions.
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Affiliation(s)
- Steven Lin
- S. Lin is clinical associate professor and executive director, Stanford Medical Scribe Fellowship, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Anthony Duong
- A. Duong is program manager, Stanford Medical Scribe Fellowship, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Cathina Nguyen
- C. Nguyen is research associate, Stanford Medical Scribe Fellowship, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Valerie Teng
- V. Teng is clinical assistant professor and associate director, Stanford Medical Scribe Fellowship, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Lam C, Shumaker K, Butt M, Leiphart P, Miller JJ, Anderson BE. Impact of medical scribes on physician and patient satisfaction in dermatology. Arch Dermatol Res 2021; 314:71-76. [PMID: 33683446 DOI: 10.1007/s00403-021-02206-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/26/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Abstract
Physician burnout and its association with the use of electronic health records (EHRs) is well known. The impact of scribes for academic dermatologists and their patients needs to be explored. As physician burnout increases, system-based solutions are needed. To assess the impact of a scribe on physician and patient satisfaction at an academic dermatology clinic. Prospective, pre-post-pilot intervention study. During the pilot intervention, clinicians had clinic sessions with and without a scribe. We assessed changes in (1) clinician satisfaction and burnout, (2) time spent on EHR, and (3) patient satisfaction. An electronic 7-item baseline survey, 23-item mid-study survey, and a 22-item end-of-study survey to assess clinician burnout and feedback on satisfaction with medical scribes. A 19-item post visit satisfaction survey was given to patients. EHR was queried to compare amount of time spent on EHR, closure of charts, and number of patients seen during scribe coverage and at baseline. Of the six clinicians, 100% felt that there was value to scribe support. Physician burnout was low at baseline and did not change post-pilot. Active documentation time, on average, decreased by 67% per patient with a 28% increase in patients seen per clinic. Over 88% of patients disagreed with the statement, "I was uncomfortable disclosing personal information when a scribe was present" (p < 0.001). In an academic dermatology and Mohs surgery setting, medical scribes increased clinician satisfaction without compromising patient satisfaction.
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Affiliation(s)
- Charlene Lam
- Department of Dermatology, The Milton S. Hershey Medical Center, 500 University Drive, HU 14, Hershey, PA, 17033, USA.
| | - Kassidy Shumaker
- Department of Dermatology, The Milton S. Hershey Medical Center, 500 University Drive, HU 14, Hershey, PA, 17033, USA
| | - Melissa Butt
- Department of Dermatology, The Milton S. Hershey Medical Center, 500 University Drive, HU 14, Hershey, PA, 17033, USA
| | - Paul Leiphart
- Department of Dermatology, The Milton S. Hershey Medical Center, 500 University Drive, HU 14, Hershey, PA, 17033, USA
| | - Jeffery J Miller
- Department of Dermatology, The Milton S. Hershey Medical Center, 500 University Drive, HU 14, Hershey, PA, 17033, USA
| | - Bryan E Anderson
- Department of Dermatology, The Milton S. Hershey Medical Center, 500 University Drive, HU 14, Hershey, PA, 17033, USA
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Gottlieb M, Palter J, Westrick J, Peksa GD. Effect of Medical Scribes on Throughput, Revenue, and Patient and Provider Satisfaction: A Systematic Review and Meta-analysis. Ann Emerg Med 2021; 77:180-189. [PMID: 32868143 PMCID: PMC9756438 DOI: 10.1016/j.annemergmed.2020.07.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE Documentation in the medical record increases clerical burden to clinicians and reduces time available to spend with patients, thereby leading to less efficient care and increased clinician stress. Scribes have been proposed as one approach to reduce this burden on clinicians and improve efficiency. The primary objective of this study is to assess the effect of scribes on throughput, revenue, provider satisfaction, and patient satisfaction in both the emergency department (ED) and non-ED setting. METHODS PubMed, Scopus, the Cumulative Index of Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature database, Google Scholar, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched for studies assessing the effect of scribes versus no scribes on the following outcomes: patients per hour, relative value units (RVUs) per hour, RVUs per encounter, clinic length of stay, time to disposition, ED length of stay, ED length of stay for admitted patients, ED length of stay for discharged patients, provider satisfaction, and patient satisfaction. Data were dual extracted into a predefined work sheet, and quality analysis was performed with the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Subgroup analyses were planned between ED versus non-ED studies. RESULTS We identified 39 studies comprising greater than 562,682 patient encounters. Scribes increased patients treated per hour by 0.30 (95% confidence interval [CI] 0.10 to 0.51). Scribes increased RVUs per encounter by 0.14 (95% CI 0.03 to 0.24) and RVUs per hour by 0.55 (0.30 to 0.80). There was no difference in time to disposition (5.74 minutes; 95% CI -2.63 to 14.10 minutes) or ED length of stay (-3.44 minutes; 95% CI -7.68 to 0.81 minutes), although a difference was found in clinic length of stay (5.74 minutes; 95% CI 0.42 to 11.05 minutes). Fourteen of 16 studies reported favorable provider satisfaction with a scribe. Seven of 18 studies reported favorable patient satisfaction with a scribe. No studies reported negative provider or patient satisfaction with scribes. CONCLUSION Overall, we found that scribes improved RVUs per hour, RVUs per encounter, patients per hour, provider satisfaction, and patient satisfaction. However, we did not identify an improvement in ED length of stay. Future studies are needed to determine the cost-benefit effect of scribes and ED volume necessary to support their use.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
| | - Joseph Palter
- Department of Emergency Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Jennifer Westrick
- Library of Rush University Medical Center, Rush University, Chicago, IL
| | - Gary D. Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
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Sharma HP. Enhancing practice efficiency: A key organizational strategy to improve professional fulfillment in allergy and immunology. Ann Allergy Asthma Immunol 2020; 126:235-239. [PMID: 33309885 DOI: 10.1016/j.anai.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To review evidence-based strategies that have been noted to improve professional fulfillment and reduce burnout by enhancing practice efficiency. DATA SOURCES A comprehensive literature review was conducted to evaluate the strategies to improve efficiency of practice-a key driver of burnout among physicians. STUDY SELECTIONS Studies of efficiency-enhancing practices relevant to allergy-immunology were included. RESULTS Professional burnout is prevalent among physicians and is associated with negative outcomes affecting physicians, patients, and health care organizations. Recent surveys suggest at least 35% of US allergists-immunologists experience burnout. There are multiple drivers of professional burnout, some at the individual level and others at the organizational or practice level. Strategies to improve professional fulfillment may be conceptualized using the Stanford physician wellness framework, in which efforts target the following 3 reciprocal domains: culture, personal resilience, and practice efficiency. Organizational strategies that support physician well-being by creating a more efficient practice environment hold great promise, particularly for allergists-immunologists. The reduction of administrative burden and fostering of team-based care have been found in multiple studies to be cost-effective strategies to improve physician and patient satisfaction. CONCLUSION To ensure the well-being of the US allergy-immunology workforce and optimize patient outcomes, both private and academic allergy-immunology institutions should prioritize the adoption and iterative evaluation and refinement of these strategies to cocreate an efficient and ideal practice environment.
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Affiliation(s)
- Hemant P Sharma
- Division of Allergy and Immunology, Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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Taylor KA, McQuilkin D, Hughes RG. Medical Scribe Impact on Patient and Provider Experience. Mil Med 2020; 184:388-393. [PMID: 30811535 DOI: 10.1093/milmed/usz030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/13/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The electronic health record (EHR) has created additional administrative burdens on providers to perform data entry while trying to engage with the patient during the health care visit. Providers have become frustrated and distracted with the documentation requirements which further hindered connectivity, and communication with the patient. The utilization of medical scribes in the outpatient clinical setting was a strategy shown to enhance patient and provider interaction, decrease clinician's administrative tasks, and promote satisfaction among providers and patients. This was an innovative quality improvement pilot project to improve the patient and provider experience using scribes in an outpatient setting. MATERIALS AND METHODS Two providers, to include one Family Medicine doctor and one Internal Medicine physician, and four hospital corpsmen participated in this pilot project. The four hospital corpsmen received a 2-week training of the fundamentals of the EHR and their role as scribes prior to the start of the project. Two corpsmen were designated for each provider and worked with their provider throughout the 12-week project period. The two primary aspects evaluated during the implementation of the scribes were the patient experience, and provider experience. Navy Medicine and the University of South Carolina Institutional Review Boards (IRB) considered this project exempt from full IRB review. RESULTS The experience questionnaire results indicated a slight mean decrease, but did not negatively impact patient satisfaction or overall patient experience. The local Medical Treatment Facility patient satisfaction, obtained through the Interactive Customer Evaluation, and the Joint Outpatient Experience Survey, indicated that there was no decrease in patient satisfaction or overall experience during the project period. The providers' experience improved with an average 50% decrease in time spent after hours documenting in the EHR, enhanced engagement with patient, staff, and ancillary team members, and improved work life balance. Additional findings of improved clinic efficiencies, completion of notes for both providers and positive qualitative comments from the scribes were identified. CONCLUSION In multiple settings, documentation requirements burden providers. The consideration of scribes could foster work life balance, retention, and wellness. The patient and provider experience was strengthened through the utilization of medical scribes, so future research centered on the provider and patient experience could be beneficial to organizations. Further study of the scribe's experience, especially considering the positive comments from the hospital corpsmen that participated as scribes during the project, could provide beneficial outcomes. Navy Medicine is advancing every opportunity to strengthen clinical and operational readiness, health and partnerships to provide the highest quality care and promote wellness for our patients. This type of quality improvement initiative could positively support readiness, quality and wellness for our organization, providers, and patients.
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Affiliation(s)
- Kimberly A Taylor
- Naval Health Clinic Corpus Christi, Command Suite, 10651 E Street, Corpus Christi, TX
| | - Deborah McQuilkin
- University of South Carolina, College of Nursing, 1601Greene Street, Columbia, SC
| | - Ronda G Hughes
- University of South Carolina, College of Nursing, 1601Greene Street, Columbia, SC
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Blackley SV, Schubert VD, Goss FR, Al Assad W, Garabedian PM, Zhou L. Physician use of speech recognition versus typing in clinical documentation: A controlled observational study. Int J Med Inform 2020; 141:104178. [PMID: 32521449 DOI: 10.1016/j.ijmedinf.2020.104178] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Speech recognition (SR) is increasingly used directly by clinicians for electronic health record (EHR) documentation. Its usability and effect on quality and efficiency versus other documentation methods remain unclear. OBJECTIVE To study usability and quality of documentation with SR versus typing. DESIGN In this controlled observational study, each subject participated in two of five simulated outpatient scenarios. Sessions were recorded with Morae® usability software. Two notes were documented into the EHR per encounter (one dictated, one typed) in randomized order. Participants were interviewed about each method's perceived advantages and disadvantages. Demographics and documentation habits were collected via survey. Data collection occurred between January 8 and February 8, 2019, and data analysis was conducted from February through September of 2019. SETTING Brigham and Women's Hospital, Boston, Massachusetts, USA. PARTICIPANTS Ten physicians who had used SR for at least six months. MAIN OUTCOMES AND MEASURES Documentation time, word count, vocabulary size, number of errors, number of corrections and quality (clarity, completeness, concision, information sufficiency and prioritization). RESULTS Dictated notes were longer than typed notes (320.6 vs. 180.8 words; p = 0.004) with more unique words (170.9 vs. 120.4; p = 0.01). Documentation time was similar between methods, with dictated notes taking slightly less time to complete than typed notes. Typed notes had more uncorrected errors per note than dictated notes (2.9 vs. 1.5), although most were minor misspellings. Dictated notes had a higher mean quality score (7.7 vs. 6.6; p = 0.04), were more complete and included more sufficient information. CONCLUSIONS AND RELEVANCE Participants felt that SR saves them time, increases their efficiency and allows them to quickly document more relevant details. Quality analysis supports the perception that SR allows for more detailed notes, but whether dictation is objectively faster than typing remains unclear, and participants described some scenarios where typing is still preferred. Dictation can be effective for creating comprehensive documentation, especially when physicians like and feel comfortable using SR. Research is needed to further improve integration of SR with EHR systems and assess its impact on clinical practice, workflows, provider and patient experience, and costs.
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Affiliation(s)
- Suzanne V Blackley
- Clinical and Quality Analysis, Information Systems, Partners HealthCare, Boston, MA, USA.
| | - Valerie D Schubert
- Heidelberg University, Heidelberg, Germany; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Foster R Goss
- Department of Emergency Medicine, University of Colorado Hospital, Aurora, CO, USA
| | - Wasim Al Assad
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Pamela M Garabedian
- Clinical and Quality Analysis, Information Systems, Partners HealthCare, Boston, MA, USA
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Tran BD, Chen Y, Liu S, Zheng K. How does medical scribes' work inform development of speech-based clinical documentation technologies? A systematic review. J Am Med Inform Assoc 2020; 27:808-817. [PMID: 32181812 PMCID: PMC7309239 DOI: 10.1093/jamia/ocaa020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Use of medical scribes reduces clinician burnout by sharing the burden of clinical documentation. However, medical scribes are cost-prohibitive for most settings, prompting a growing interest in developing ambient, speech-based technologies capable of automatically generating clinical documentation based on patient-provider conversation. Through a systematic review, we aimed to develop a thorough understanding of the work performed by medical scribes in order to inform the design of such technologies. MATERIALS AND METHODS Relevant articles retrieved by searching in multiple literature databases. We conducted the screening process following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in guidelines, and then analyzed the data using qualitative methods to identify recurring themes. RESULTS The literature search returned 854 results, 65 of which met the inclusion criteria. We found that there is significant variation in scribe expectations and responsibilities across healthcare organizations; scribes also frequently adapt their work based on the provider's style and preferences. Further, scribes' job extends far beyond capturing conversation in the exam room; they also actively interact with patients and the care team and integrate data from other sources such as prior charts and lab test results. DISCUSSION The results of this study provide several implications for designing technologies that can generate clinical documentation based on naturalistic conversations taking place in the exam room. First, a one-size-fits-all solution will be unlikely to work because of the significant variation in scribe work. Second, technology designers need to be aware of the limited role that their solution can fulfill. Third, to produce comprehensive clinical documentation, such technologies will likely have to incorporate information beyond the exam room conversation. Finally, issues of patient consent and privacy have yet to be adequately addressed, which could become paramount barriers to implementing such technologies in realistic clinical settings. CONCLUSIONS Medical scribes perform complex and delicate work. Further research is needed to better understand their roles in a clinical setting in order to inform the development of speech-based clinical documentation technologies.
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Affiliation(s)
- Brian D Tran
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, Irvine, California, USA
- Medical Scientist Training Program, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Yunan Chen
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, Irvine, California, USA
| | - Songzi Liu
- The School of Information and Library Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, Irvine, California, USA
- Department of Emergency Medicine, School of Medicine, University of California, Irvine, Irvine, California, USA
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Heckman J, Mukamal KJ, Christensen A, Reynolds EE. Medical Scribes, Provider and Patient Experience, and Patient Throughput: a Trial in an Academic General Internal Medicine Practice. J Gen Intern Med 2020; 35:770-774. [PMID: 31808131 PMCID: PMC7080913 DOI: 10.1007/s11606-019-05352-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/13/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Medical scribes have been proposed as a solution to the problems of excessive documentation, work-life balance, and burnout facing general internists. However, their acceptability to patients and effects on provider experience have not been tested in a real-world model of effectiveness. OBJECTIVE To measure the effect of medical scribes on patient satisfaction, provider satisfaction, and provider productivity. DESIGN Quasi-experimental difference-in-differences longitudinal design. PARTICIPANTS Four attending physicians who worked with scribes, 9 control physicians who did not, and their patients in a large, hospital-affiliated academic general internal medicine practice. MAIN MEASURES Provider experience and patient experience using 5-point Likert scale surveys from the AMA Steps Forward Team Documentation Module, and visits and wRVUs per hour during 4 weeks before and 12 weeks after initiation of a practice model that included use of scribes and a shortened visit template. KEY RESULTS Participating providers worked a total of 664 clinic sessions and returned 547 (82%) surveys. Average provider experience scores did not differ between providers working with scribes and control providers working without (4.01 vs. 3.40 respectively; p time-by-group interaction = 0.26). Providers with scribes were more likely to agree that work for the encounter would be completed during the visit then controls (3.58 vs. 2.48 respectively; p interaction = 0.04). A total of 6202 visits occurred during the study period. Average patient experience scores did not differ between the experimental and control groups (4.73 vs. 4.75 respectively; p interaction = 0.90). Compared with the control providers, providers with scribes completed more visits per hour (2.29 vs. 1.91; p interaction < 0.001) and generated more wRVUs per hour (3.42 vs. 3.27; p interaction < 0.001). CONCLUSIONS In this test of a modified practice model, scribes supported greater patient throughput and improved provider perceptions of documentation burden with no decrement in high patient satisfaction.
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Affiliation(s)
- James Heckman
- Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, Shapiro Clinical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Kenneth J Mukamal
- Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, Shapiro Clinical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Adam Christensen
- Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, Shapiro Clinical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Eileen E Reynolds
- Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, Shapiro Clinical Center, 330 Brookline Ave, Boston, MA, 02215, USA
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Gao RW, Dugala A, Maxwell J, Falconer P, Birkeland AC, Divi V, Rosenthal EL. Effect of Medical Scribes on Outpatient Oncology Visits at a Multidisciplinary Cancer Center. JCO Oncol Pract 2019; 16:e139-e147. [PMID: 31804877 DOI: 10.1200/jop.19.00307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The use of medical scribes has emerged as a strategy to increase clinic workflow efficiency and reduce physician burnout. While oncology clinics may be ideally suited to scribe integration because of the high burden of documentation, oncology-specific scribe research has been limited. The objective of this study was to determine the effect of scribe integration on clinic workflow efficiency and physician satisfaction and quality of life in outpatient oncology clinics. METHODS We conducted a retrospective, concurrent qualitative and quantitative analysis of patient visit durations and survey data for 129 attending physicians affiliated with an academic hospital's cancer center between January 2017 and January 2019. Thirty-three physicians were paired with scribes in each physician's individual clinic or clinics. RESULTS In terms of clinic efficiency, physicians with scribes had a 12.1% decrease in their overall average patient visit duration compared with their own time before receiving a scribe (P < .0001) and spent significantly less time completing charts at the end of the day (P = .04). Compared with their peers, oncologists with scribes showed a 10%-20% decrease in the duration of all patient visits. Scribes also contributed to patient care, as shown by 90% of physicians surveyed who strongly agreed that they spent less time at the computer and more time with patients; 100% of physicians surveyed strongly agreed that scribes improved their quality of life. CONCLUSION The integration of medical scribes into oncology clinics across several oncologic disciplines has the potential to reduce burnout through increasing physician satisfaction and quality of life, improving patient care, and streamlining clinic workflow.
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Utilizing a Physician Scribe in a Pediatric Plastic Surgical Practice: A Time-driven Activity-based Costing Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2460. [PMID: 31772889 PMCID: PMC6846305 DOI: 10.1097/gox.0000000000002460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/25/2022]
Abstract
To use time-driven activity-based costing methodology to compare the costs of routine pediatric plastic surgical patient visits with and without a physician scribe.
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Walker K, Johnson M, Dunlop W, Staples M, Rodda H, Turner I, Ben-Meir M. Feasibility evaluation of a pilot scribe-training program in an Australian emergency department. AUST HEALTH REV 2019; 42:210-217. [PMID: 28355527 DOI: 10.1071/ah16188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/19/2017] [Indexed: 11/23/2022]
Abstract
Objective Medical scribes have an emerging and expanding role in health, particularly in Emergency Medicine in the US. Scribes assist physicians with documentation and clerical tasks at the bedside while the physician consults with his or her patient. Scribes increase medical productivity. The aim of the present study was to examine the feasibility of a pilot hospital-administered scribe-training program in Australia and to evaluate the ability of an American training course (Medical Scribe Training Systems) to prepare trainee scribes for clinical training in an emergency department in Australia. Methods The present study was a pilot, prospective, observational cohort study from September 2015 to February 2016 at Cabrini Emergency Department, Melbourne. Scribe trainees were enrolled in the pre-work course and then trained clinically. Feasibility of training scribes and limited efficacy testing of the course was undertaken. Results The course was acceptable to users and demand for training exists. There were many implementation tasks and issues experienced and resources were required to prepare the site for scribe implementation. Ten trainees were enrolled for preclinical training. Six candidates undertook clinical training, five achieved competency (required seven to 16 clinical shifts after the preclinical course). The training course was helpful and provided a good introduction to the scribe role. The course required adaptation to a non-US setting and the specific hospital setting. In addition, it needed more detail in some common emergency department topics. Conclusion Training scribes at a hospital in Australia is feasible. The US training course used can assist with preclinical training. Course modification is required. What is known about the topic? Scribes increase emergency physician productivity in Australia. There is no previous work on how to train scribes in Australia. What does this paper add? We show that implementing a scribe-training program is feasible and that a training package can be purchased from the US to train scribes in Australia and that it is useful. We also show the adaptation that the course may require to meet Australian emergency department needs. What are the implications for practitioners? Scribes could become an additional member of the emergency department team in Australia and can be trained locally.
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Affiliation(s)
- Katherine Walker
- Emergency Department, Cabrini, 183 Wattletree Road, Malvern, Vic. 3144, Australia. ;
| | - Matthew Johnson
- Department of Education, Cabrini Institute, 154 Wattletree Road, Malvern, Vic. 3144, Australia. Email
| | - William Dunlop
- Emergency Department, Cabrini, 183 Wattletree Road, Malvern, Vic. 3144, Australia. ;
| | - Margaret Staples
- Department of Epidemiology and Preventative Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne Vic. 3004, Australia. Email
| | - Hamish Rodda
- Emergency Department, Cabrini, 183 Wattletree Road, Malvern, Vic. 3144, Australia. ;
| | - Ian Turner
- Emergency Department, Cabrini, 183 Wattletree Road, Malvern, Vic. 3144, Australia. ;
| | - Michael Ben-Meir
- Emergency Department, Cabrini, 183 Wattletree Road, Malvern, Vic. 3144, Australia. ;
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Nambudiri VE, Watson AJ, Buzney EA, Kupper TS, Rubenstein MH, Yang FSC. Medical Scribes in an Academic Dermatology Practice. JAMA Dermatol 2019; 154:101-103. [PMID: 29094159 DOI: 10.1001/jamadermatol.2017.3658] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Alice J Watson
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A Buzney
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Mitchell H Rubenstein
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Fei-Shiuann Clarissa Yang
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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19
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Butala NM, Hidrue MK, Swersey AJ, Singh JP, Weilburg JB, Ferris TG, Armstrong KA, Wasfy JH. Measuring individual physician clinical productivity in an era of consolidated group practices. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2019; 7:S2213-0764(18)30051-4. [PMID: 30744992 DOI: 10.1016/j.hjdsi.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND As physician groups consolidate and value-based payment replaces traditional fee-for-service systems, physician practices have greater need to accurately measure individual physician clinical productivity within team-based systems. We compared methodologies to measure individual physician outpatient clinical productivity after adjustment for shared practice resources. METHODS For cardiologists at our hospital between January 2015 and June 2016, we assessed productivity by examining completed patient visits per clinical session per week. Using mixed-effects models, we sequentially accounted for shared practice resources and underlying baseline characteristics. We compared mixed-effects and Generalized Estimating Equations (GEE) models using K-fold cross validation, and compared mixed-effect, GEE, and Data Envelopment Analysis (DEA) models based on ranking of physicians by productivity. RESULTS A mixed-effects model adjusting for shared practice resources reduced variation in productivity among providers by 63% compared to an unadjusted model. Mixed-effects productivity rankings correlated strongly with GEE rankings (Spearman 0.99), but outperformed GEE on K-fold cross validation (root mean squared error 2.66 vs 3.02; mean absolute error 1.89 vs 2.20, respectively). Mixed-effects model rankings had moderate correlation with DEA model rankings (Spearman 0.692), though this improved upon exclusion of outliers (Spearman 0.755). CONCLUSIONS Mixed-effects modeling accounts for significant variation in productivity secondary to shared practice resources, outperforms GEE in predictive power, and is less vulnerable to outliers than DEA. IMPLICATIONS With mixed-effects regression analysis using otherwise easily accessible administrative data, practices can evaluate physician clinical productivity more fairly and make more informed management decisions on physician compensation and resource allocation.
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Affiliation(s)
- Neel M Butala
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael K Hidrue
- Massachusetts General Physicians Organization, Boston, MA, United States
| | | | - Jagmeet P Singh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey B Weilburg
- Massachusetts General Physicians Organization, Boston, MA, United States
| | - Timothy G Ferris
- Massachusetts General Physicians Organization, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Katrina A Armstrong
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Massachusetts General Physicians Organization, Boston, MA, United States.
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20
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Tawfik DS, Profit J, Webber S, Shanafelt TD. Organizational factors affecting physician well-being. ACTA ACUST UNITED AC 2019; 5:11-25. [PMID: 31632895 DOI: 10.1007/s40746-019-00147-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose of review Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic. Recent findings Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources. Summary Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.
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Affiliation(s)
- Daniel S Tawfik
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.,California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Sarah Webber
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Addesso LC, Nimmer M, Visotcky A, Fraser R, Brousseau DC. Impact of Medical Scribes on Provider Efficiency in the Pediatric Emergency Department. Acad Emerg Med 2019; 26:174-182. [PMID: 30069952 DOI: 10.1111/acem.13544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/13/2018] [Accepted: 07/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Today's emergency department (ED) providers spend a significant amount of time on medical record documentation, decreasing clinical productivity. One proposed solution is to utilize medical scribes who assist with documentation. We hypothesized that scribes would increase provider productivity and increase provider satisfaction without affecting patient experience or nursing satisfaction. METHODS We conducted an observational pre-post study comparing ED prescribe and postscribe clinical productivity metrics for 18 pediatric emergency medicine physicians, two general pediatricians, and two nurse practitioners working in the 12-bed nonurgent area of the pediatric ED. Productivity metrics included patients per hour (pts/hr), work relative value units per hour (wRVUs/hr), and visit duration measured for 1 year pre- and postscribe implementation. Cross-sectional satisfaction surveys were administered to patient families, providers, and nurses during the initial scribe rollout. RESULTS Overall, 24,518 prescribe and 27,062 postscribe visits were analyzed. Following scribe implementation, overall provider efficiency increased by 0.24 pts/hr (11.98%, p < 0.001) and 0.72 wRVUs/hr (20.14%, p < 0.001). The largest efficiency increase (0.36 pts/hr, 0.96 wRVUs/hr) occurred in January-March, when ED census peaked. Patient visit duration was 53 minutes in both the prescribe and the postscribe periods. During initial scribe implementation, 80% of parents of patients without a scribe rated the visit as very good/great compared to 84% with a scribe (p = 0.218). Of the 34 providers surveyed, 88% preferred working with a scribe. A majority of providers (82%) felt that their skills were used more effectively when working with a scribe, decreasing their likelihood of experiencing burnout. Of the 43 nurses surveyed, 51% preferred scribes and 47% were indifferent. CONCLUSIONS Medical scribes increased ED efficiency without decreasing patient satisfaction. Providers strongly favored the use of scribes, while nurses were indifferent. The next steps include a cost analysis of the scribe program.
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Affiliation(s)
- Luke C. Addesso
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
| | - Mark Nimmer
- Department of Pediatrics Medical College of Wisconsin Milwaukee WI
| | - Alexis Visotcky
- Department of Biostatistics Medical College of Wisconsin Milwaukee WI
| | - Raphael Fraser
- Department of Biostatistics Medical College of Wisconsin Milwaukee WI
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Walker K, Ben-Meir M, Dunlop W, Rosler R, West A, O'Connor G, Chan T, Badcock D, Putland M, Hansen K, Crock C, Liew D, Taylor D, Staples M. Impact of scribes on emergency medicine doctors' productivity and patient throughput: multicentre randomised trial. BMJ 2019; 364:l121. [PMID: 30700408 PMCID: PMC6353062 DOI: 10.1136/bmj.l121] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the changes in productivity when scribes were used by emergency physicians in emergency departments in Australia and assess the effect of scribes on throughput. DESIGN Randomised, multicentre clinical trial. SETTING Five emergency departments in Victoria used Australian trained scribes during their respective trial periods. Sites were broadly representative of Australian emergency departments: public (urban, tertiary, regional referral, paediatric) and private, not for profit. PARTICIPANTS 88 physicians who were permanent, salaried employees working more than one shift a week and were either emergency consultants or senior registrars in their final year of training; 12 scribes trained at one site and rotated to each study site. INTERVENTIONS Physicians worked their routine shifts and were randomly allocated a scribe for the duration of their shift. Each site required a minimum of 100 scribed and non-scribed shifts, from November 2015 to January 2018. MAIN OUTCOME MEASURES Physicians' productivity (total patients, primary patients); patient throughput (door-to-doctor time, length of stay); physicians' productivity in emergency department regions. Self reported harms of scribes were analysed, and a cost-benefit analysis was done. RESULTS Data were collected from 589 scribed shifts (5098 patients) and 3296 non-scribed shifts (23 838 patients). Scribes increased physicians' productivity from 1.13 (95% confidence interval 1.11 to 1.17) to 1.31 (1.25 to 1.38) patients per hour per doctor, representing a 15.9% gain. Primary consultations increased from 0.83 (0.81 to 0.85) to 1.04 (0.98 to 1.11) patients per hour per doctor, representing a 25.6% gain. No change was seen in door-to-doctor time. Median length of stay reduced from 192 (interquartile range 108-311) minutes to 173 (96-208) minutes, representing a 19 minute reduction (P<0.001). The greatest gains were achieved by placing scribes with senior doctors at triage, the least by using them in sub-acute/fast track regions. No significant harm involving scribes was reported. The cost-benefit analysis based on productivity and throughput gains showed a favourable financial position with use of scribes. CONCLUSIONS Scribes improved emergency physicians' productivity, particularly during primary consultations, and decreased patients' length of stay. Further work should evaluate the role of the scribe in countries with health systems similar to Australia's. TRIAL REGISTRATION ACTRN12615000607572 (pilot site); ACTRN12616000618459.
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Affiliation(s)
- Katherine Walker
- Emergency Department, Cabrini Hospital, Malvern, VIC 3144, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Ben-Meir
- Emergency Department, Cabrini Hospital, Malvern, VIC 3144, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - William Dunlop
- Emergency Department, Cabrini Hospital, Malvern, VIC 3144, Australia
- Australian National University, Canberra, ACT, Australia
| | - Rachel Rosler
- Emergency Department, Monash Health, Dandenong, Melbourne, VIC, Australia
| | - Adam West
- Emergency Department, Monash Health, Dandenong, Melbourne, VIC, Australia
| | | | - Thomas Chan
- Emergency Department, Austin Health, Heidelberg, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Diana Badcock
- Emergency Department, Bendigo Health, Bendigo, VIC, Australia
| | - Mark Putland
- Emergency Department, Monash Health, Dandenong, Melbourne, VIC, Australia
- Emergency Department, Bendigo Health, Bendigo, VIC, Australia
- Emergency Department, Melbourne Health, Parkville, VIC, Australia
| | - Kim Hansen
- Emergency Department, Prince Charles Hospital, Chermside, QLD, Australia
- Emergency Department, St Andrews War Memorial Hospital, Brisbane, QLD, Australia
| | - Carmel Crock
- Emergency Department, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David Taylor
- University of Melbourne, Melbourne, VIC, Australia
- Emergency Medicine, Austin Health, Heidelberg, VIC, Australia
| | - Margaret Staples
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Biostatistics, Cabrini Institute, Malvern, VIC, Australia
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The emergence of new data work occupations in healthcare: The case of medical scribes. Int J Med Inform 2019; 123:76-83. [PMID: 30654906 DOI: 10.1016/j.ijmedinf.2019.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/29/2018] [Accepted: 01/01/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Increasing demand for more and better documentation as well as digitalization of healthcare entail shifts in competencies and roles of healthcare occupations and professions. As a result of this data-centric technological development, new kinds of work and occupations emerge of which medical scribes are an example. To investigate and provide a case of an emergent occupation focused on 'data work', we describe the emergence, growth and stabilization of medical scribes, outline their history and provide a literature overview. METHOD We conducted a review of the literature on medical scribes in academic journals until 2017. These publications are categorized according to the country of study, medical specialization, method, focus, attitude to the use of medical scribes, and the reasons given for the use of medical scribes. We outline the history of the emergence of medical scribes and provide a summary of the existing research publications on medical scribes. FINDINGS We identified 60 papers of which a majority are based on cases from the USA; conducted in emergency departments; based on quantitative methods; focus on economic feasibility and satisfaction; are positive towards the use of medical scribes; and link the use of medical scribes to the implementation of electronic health records (EHR). There is a distinct lack of research on medical scribes themselves and their interaction with physicians, patients, and EHR. CONCLUSIONS Medical scribes have emerged as a new data-work occupation as a response to increased demands for documentation and digitalization through EHRs. Research on medical scribes has hitherto focused on efficiency and economic feasibility of scribes, and there is a need to look into the interaction of medical scribes with physicians and patients as well as look at opportunities for redesign of EHR. More generally, there is a need to look beyond the most prominent professions such as physicians and nurses in discussions of digitization and datafication of healthcare, and investigate how new and previous tasks are (re)distributed between occupations and professions.
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Johannessen KA, Alexandersen N. Improving accessibility for outpatients in specialist clinics: reducing long waiting times and waiting lists with a simple analytic approach. BMC Health Serv Res 2018; 18:827. [PMID: 30382845 PMCID: PMC6211460 DOI: 10.1186/s12913-018-3635-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Lack of resources is often cited as a reason for long waiting times and queues in health services. However, recent research indicates these problems are related to factors such as uncoordinated variation of demand and capacity, planning horizons, and lower capacity than the potential of actual resources. This study aimed to demonstrate that long waiting times and wait lists are not necessarily associated with increasing demand or changes in resources. We report how substantial reductions in waiting times/wait lists across a range of specialties was obtained by improvements of basic problems identified through value-stream mapping and unsophisticated analyses. Methods In-depth analyses of current operational processes by value-stream mapping were used to identify bottlenecks and sources of waste. Waiting parameters and measures of demand and resources were assessed monthly from 12 months before the intervention to 6 months after the intervention. The effect of the intervention on reducing waiting time and number of patients waiting were evaluated by a difference-in-differences analysis. Results Mean waiting time across all clinics was reduced from 162 + 69 days (range 74–312 days) at baseline to 52 + 10 days (range 41–74 days) 6 months after the intervention. The time needed to achieve a waiting time of 65 days varied from 4 to 21 months. The number of new patients waiting was reduced from 15,874 (range 369–2980) to 8922 (range 296–1650), and the number of delayed returning patients was reduced from 18,700 (310–3324) to 5993 (40–1337) (p < 0.01 for all). Improvement in waiting measures paralleled a significant increase in planning horizon. Conclusions Significant improvements in accessibility for patients waiting for service may be achieved by applying unsophisticated methods and analyses and without increasing resources. Engagement of clinical management and involvement of front line personnel are important factors for improvement.
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Affiliation(s)
- Karl Arne Johannessen
- The Intervention Center, Oslo university hospital, Oslo, Norway. .,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Nina Alexandersen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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Pozdnyakova A, Laiteerapong N, Volerman A, Feld LD, Wan W, Burnet DL, Lee WW. Impact of Medical Scribes on Physician and Patient Satisfaction in Primary Care. J Gen Intern Med 2018; 33:1109-1115. [PMID: 29700790 PMCID: PMC6025675 DOI: 10.1007/s11606-018-4434-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/16/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. OBJECTIVE Assess the impact of a scribe on physician and patient satisfaction at an academic general internal medicine (GIM) clinic. DESIGN Prospective, pre-post-pilot study. During the 3-month pilot, physicians had clinic sessions with and without a scribe. We assessed changes in (1) physician workplace satisfaction and burnout, (2) time spent on EHR documentation, and (3) patient satisfaction. PARTICIPANTS Six GIM faculty and a convenience sample of their patients (N = 325) at an academic GIM clinic. MAIN MEASURES A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout. Physicians used logs to record time spent on EHR documentation outside of clinic hours. A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe. KEY RESULTS Of six physicians, 100% were satisfied with clinic workflow post-pilot (vs. 33% pre-pilot), and 83% were satisfied with EHR use post-pilot (vs. 17% pre-pilot). Physician burnout was low at baseline and did not change post-pilot. Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session (p = 0.02). Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age, gender, and race. Compared to patients 65 years or older, younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present (p = 0.03 and 0.02, respectively). Male patients were more likely to report that they disliked having a scribe (p = 0.03). CONCLUSION In an academic GIM setting, employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction.
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Affiliation(s)
| | - Neda Laiteerapong
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Anna Volerman
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Lauren D Feld
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Wen Wan
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Wei Wei Lee
- Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
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McCormick BJ, Deal A, Borawski KM, Raynor MC, Viprakasit D, Wallen EM, Woods ME, Pruthi RS. Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction. World J Urol 2018; 36:1691-1697. [PMID: 29637266 DOI: 10.1007/s00345-018-2293-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/05/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Pressure on physicians to increase productivity is rising in parallel with administrative tasks, regulations, and the use of electronic health records (EHRs). Physician extenders and clinical pathways are already in use to increase productivity and reduce costs and burnout, but other strategies are required. We evaluated whether implementation of medical scribes in an academic urology clinic would affect productivity, revenue, and patient/provider satisfaction. METHODS Six academic urologists were assigned scribes for 1 clinic day per week for 3 months. Likert-type patient and provider surveys were developed to evaluate satisfaction with and without scribes. Matched clinic days in the year prior were used to evaluate changes in productivity and physician/hospital charges and revenue. RESULTS After using scribes for 3 months, providers reported increased efficiency (p value = 0.03) and work satisfaction (p value = 0.03), while seeing a mean 2.15 more patients per session (+ 0.96 return visits, + 0.99 new patients, and + 0.22 procedures), contributing to an additional 2.6 wRVUs, $542 in physician charges, and $861 in hospital charges per clinic session. At a gross collection rate of 36%, actual combined revenue was + $506/session, representing a 26% increase in overall revenue. At a cost of $77/session, the net financial impact was + $429 per clinic session, resulting in a return-to-investment ratio greater than 6:1, while having no effect on patient satisfaction scores. Additionally, with scribes, clinic encounters were closed a mean 8.9 days earlier. CONCLUSIONS Implementing medical scribes in academic urology practices may be useful in increasing productivity, revenue, and provider satisfaction, while maintaining high patient satisfaction.
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Affiliation(s)
- Benjamin J McCormick
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA.
| | - Allison Deal
- Lineberger Comprehensive Cancer Center, Biostatistics and Clinical Data Management Core, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristy M Borawski
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Mathew C Raynor
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Davis Viprakasit
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Eric M Wallen
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Michael E Woods
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Raj S Pruthi
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
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Ewelukwa O, Perez R, Carter LE, Fernandez A, Glover S. Incorporation of Scribes Into the Inflammatory Bowel Disease Clinic Improves Quality of Care and Physician Productivity. Inflamm Bowel Dis 2018; 24:552-557. [PMID: 29462396 DOI: 10.1093/ibd/izx078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Electronic health records (EHRs), despite their positive attributes, increase physician workload and decrease efficiency. The aim of this study was to evaluate the impact of scribes in the Inflammatory Bowel Disease Clinic on improvement of the physician-patient relationship, physician productivity, clinical efficiency, and achievement of some Physician Quality Reporting System (PQRS) metrics. METHODS We analyzed of pre- and postscribe data between fiscal years 2015 (FY15) and 2016 (FY16) using data from patients at the Inflammatory Bowel Clinic at the University of Florida. The main outcomes were patient satisfaction scores (PSS), qualitative physician interview, clinic appointment lengths, work relative value units (wRVUs), level of coding, revenue, and PQRS data on bone density screening and vaccination. RESULTS PSS increased from 6.8/10 to 9.2/10 (P < 0.01), clinic appointment length decreased by 13.5 minutes (P < 0.05), and documentation stress decreased. Clinic visits increased by 76, leading to an increase in work RVUs by 332.55, total charges billed by $71,439, and total charges collected by $27,387 between the first quarters of FY15 and FY16. The extra revenue for the first quarter was 536% higher than the salary of the scribe for the same period ($4302.84). There was a 1.8-fold increase in referrals for bone density scans and 2.9-fold and 4.8-fold increases in vaccination rates for influenza and pneumonia, respectively. CONCLUSIONS The use of scribes improved the physician-patient relationship, clinical efficiency, physician productivity, bone density screening, and vaccinations for flu and pneumonia. If adopted by health systems, it may lead to significant cost savings and improved clinical outcomes.
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Affiliation(s)
- Ofor Ewelukwa
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida
| | - Roque Perez
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida
| | - Lee Ellen Carter
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida
| | - Alyka Fernandez
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida
| | - Sarah Glover
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida
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Walker KJ, Wang A, Dunlop W, Rodda H, Ben-Meir M, Staples M. The 9-Item Physician Documentation Quality Instrument (PDQI-9) score is not useful in evaluating EMR (scribe) note quality in Emergency Medicine. Appl Clin Inform 2017; 8:981-993. [PMID: 28956888 PMCID: PMC6220701 DOI: 10.4338/aci2017050080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/02/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Scribes are assisting Emergency Physicians by writing their electronic clinical notes at the bedside during consultations. They increase physician productivity and improve their working conditions. The quality of Emergency scribe notes is unevaluated and important to determine. OBJECTIVE The primary objective of the study was to determine if the quality of Emergency Department scribe notes was equivalent to physician only notes, using the Physician Documentation Quality Instrument, Nine-item tool (PDQI-9). METHODS This was a retrospective, observational study comparing 110 scribed to 110 non-scribed Emergency Physician notes written at Cabrini Emergency Department, Australia. Consultations during a randomised controlled trial of scribe/doctor productivity in 2016 were used. Emergency physicians and nurses rated randomly selected, blinded and de-identified notes, 2 raters per note. Comparisons were made between paired scribed and unscribed notes and between raters of each note. Characteristics of individual raters were examined. The ability of the tool to discriminate between good and poor notes was tested. RESULTS The PDQI-9 tool has significant issues. Individual items had good internal consistency (Cronbach's alpha=0.93), but there was very poor agreement between raters (Pearson's r=0.07, p=0.270). There were substantial differences in PDQI-9 scores allocated by each rater, with some giving typically lower scores than others, F(25,206)=1.93, p=0.007. The tool was unable to distinguish good from poor notes, F(3,34)=1.15, p=0.342. There was no difference in PDQI-9 score between scribed and non-scribed notes. CONCLUSIONS The PDQI-9 documentation quality tool did not demonstrate reliability or validity in evaluating Emergency Medicine consultation notes. We found no evidence that scribed notes were of poorer quality than non-scribed notes, however Emergency scribe note quality has not yet been determined.
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Affiliation(s)
- Katherine J Walker
- Dr Katie Walker, Emergency Department Cabrini, 183 Wattletree Rd, Malvern, VIC 3144, Australia, Phone +61 431 272 262,
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Gidwani R, Nguyen C, Kofoed A, Carragee C, Rydel T, Nelligan I, Sattler A, Mahoney M, Lin S. Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial. Ann Fam Med 2017; 15:427-433. [PMID: 28893812 PMCID: PMC5593725 DOI: 10.1370/afm.2122] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/15/2017] [Accepted: 05/03/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency. METHODS We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close. RESULTS Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028). CONCLUSIONS To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout.
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Affiliation(s)
- Risha Gidwani
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford University, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Cathina Nguyen
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Alexis Kofoed
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Catherine Carragee
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Tracy Rydel
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Ian Nelligan
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Amelia Sattler
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Megan Mahoney
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
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Morgan DJ, Leppin A, Smith CD, Korenstein D. A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction. J Hosp Med 2017; 12:346-351. [PMID: 28459906 PMCID: PMC5570540 DOI: 10.12788/jhm.2738] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient-clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation. Journal of Hospital Medicine 2017;12:346-351.
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Affiliation(s)
- Daniel J. Morgan
- VA Maryland Healthcare System, University of Maryland School of Medicine and Centers for Disease Dynamics, Economics and Policy, Baltimore, MD, USA
| | - Aaron Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | | | - Deborah Korenstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Shuaib W, Hilmi J, Caballero J, Rashid I, Stanazai H, Tawfeek K, Amari A, Ajanovic A, Moshtaghi A, Khurana A, Hasabo H, Baqais A, Szczerba AJ, Gaeta TJ. Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department. Health Informatics J 2017; 25:216-224. [DOI: 10.1177/1460458217704255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician’s efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor–patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics
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Affiliation(s)
- Waqas Shuaib
- Wichita Falls Family Practice Residency Program, USA; United Regional Hospital, USA; Plaza de la Salud, Dominican Republic; Auburn Community Hospital, USA
| | | | | | - Ijaz Rashid
- Plaza de la Salud, Dominican Republic; Auburn Community Hospital, USA
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Shuaib W, Hilmi J, Caballero J, Rashid I, Stanazai H, Ajanovic A, Moshtaghi A, Amari A, Tawfeek K, Khurana A, Hasabo H, Baqais A, Mattar AA, Gaeta TJ. Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department. Health Informatics J 2017; 27:1460458217692930. [PMID: 29239230 DOI: 10.1177/1460458217692930] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician's efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor-patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics.
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Affiliation(s)
- Waqas Shuaib
- Wichita Falls Family Practice Residency Program, USA; United Regional Health Care System, USA; Hospital General de la Plaza de la Salud, Dominican Republic; Auburn Community Hospital, USA
| | | | | | - Ijaz Rashid
- Plaza de la Salud, Dominican Republic; Auburn Community Hospital, USA
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Johannessen KA, Kittelsen SAC, Hagen TP. Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis. Soc Sci Med 2017; 175:117-126. [PMID: 28088617 DOI: 10.1016/j.socscimed.2017.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although health care reforms may improve efficiency at the macro level, less is known regarding their effects on the utilization of health care personnel. Following the 2002 Norwegian hospital reform, we studied the productivity of the physician workforce and the effect of personnel mix on this measure in all nineteen Norwegian hospitals from 2001 to 2013. METHODS We used panel analysis and non-parametric data envelopment analysis (DEA) to study physician productivity defined as patient treatments per full-time equivalent (FTE) physician. Resource variables were FTE and salary costs of physicians, nurses, secretaries, and other personnel. Patient metrics were number of patients treated by hospitalization, daycare, and outpatient treatments, as well as corresponding diagnosis-related group (DRG) scores accounting for differences in patient mix. Research publications and the fraction of residents/FTE physicians were used as proxies for research and physician training. RESULTS The number of patients treated increased by 47% and the DRG scores by 35%, but there were no significant increases in any of the activity measures per FTE physician. Total DRG per FTE physician declined by 6% (p < 0.05). In the panel analysis, more nurses and secretaries per FTE physician correlated positively with physician productivity, whereas physician salary was neutral. In 2013, there was a 12%-80% difference between the hospitals with the highest and lowest physician productivity in the differing treatment modalities. In the DEA, cost efficiency did not change in the study period, but allocative efficiency decreased significantly. Bootstrapped estimates indicated that the use of physicians was too high and the use of auxiliary nurses and secretaries was too low. CONCLUSIONS Our measures of physician productivity declined from 2001 to 2013. More support staff was a significant variable for predicting physician productivity. Personnel mix developments in the study period were unfavorable with respect to physician productivity.
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Affiliation(s)
| | - Sverre A C Kittelsen
- Frisch Centre, Oslo, Norway; Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Terje P Hagen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Walker KJ, Dunlop W, Liew D, Staples MP, Johnson M, Ben-Meir M, Rodda HG, Turner I, Phillips D. An economic evaluation of the costs of training a medical scribe to work in Emergency Medicine. Emerg Med J 2016; 33:865-869. [DOI: 10.1136/emermed-2016-205934] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/04/2016] [Accepted: 06/09/2016] [Indexed: 11/04/2022]
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