Using scribes to assist with electronic medical record data entry tasks in clinical settings may have some positive results, including improved patient and physician satisfaction along with increased patients per hour treated, according to a recent study.
The systematic review of the use of scribes, conducted by Michael Gottlieb, MD, Joseph Palter, MD, Jennifer Westrick, MSLIS, and Gary D. Peksa, PharmD and published in the February 2021 issue of The Annals of Emergency Medicine, looked at 39 studies comprising more than 562,682 patient encounters.
Based on this research, the authors reported that scribes increased patients treated per hour by 0.30 and increased RVUs per encounter by 0.14 and RVUs per hour by 0.55. While there was no significant difference in time to disposition or ED length of stay, the study did reveal a difference in clinic length of stay. As well, 14 of 16 studies reported favorable provider satisfaction with a scribe, and 7 of 18 studies reported favorable patient satisfaction with a scribe. No studies reported negative provider or patient satisfaction with scribes.
What Does It Mean?
But are these findings enough to justify their use in emergency departments? According to Katie Walker, MBChB, FACEM, and Heather A. Heaton, MD, in their editorial accompanying the study in the February 2021 issue of The Annals of Emergency Medicine, “to justify a scribe program, the role has to make economic sense,” and since there are no reimbursement policies for scribes, the increased “income for scribes needs to be realized elsewhere.”
They identify three ways that can happen:
- improving flow (assuming new patients are always waiting),
- improving physician productivity per unit of time, and
- increasing per-patient revenue.
These factors are then balanced against the cost of employing scribes, which they list as equipment, recruitment, training, administration, and labor.
As the study acknowledges, however, patient flow appears to be unchanged by the use of scribes, and physician productivity and per-patient income both increased just a little in the United States.
The Bigger Issue
That means that in certain settings, scribe programs may be justified, say Walker and Heaton, but overall, “the level of evidence supporting scribes remains of very low quality,” despite the 30-year history of scribes in emergency medicine. And the study’s own authors appear to agree, concluding that more research is needed to determine scribe’s effect on volume and revenue to support their use in the emergency department setting.
But there’s another issue at play which isn’t even addressed in the study, what Walker and Heaton call “the elephant in the room”: the electronic medical record itself. “Despite major advances in technology, clinical documentation remains enough of a burden that a significant number of clinicians are forced to outsource the task,” they write.
Ryan Radecki, MD, who along with Rory Spiegel, MD, hosts the Annals of Emergency Medicine podcast, agrees. “It’s just rather amazing that scribes have integrated themselves so nicely in healthcare without us ever questioning why they are needed,” Radecki says. In their most recent episode, Radecki and Spiegel discussed the scribe study and concluded that in addition to looking more closely at the cost-benefit of scribes in the ED, they believe the administrative burden itself should be examined more closely.
“The fact that we have to have this entire complex of scribe companies because the clerical needs on physicians is becoming so great that it’s burning us out and reducing our productivity is something we should probably better reflect upon in our healthcare delivery models as opposed to just adding more and more administrative burden on the clinicians and finding new ways to put bandages over that with scribes,” Radecki says.
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