Purpose

The use of the electronic health record (EHR) has led to physician dissatisfaction, physician burnout, and delays in documentation and billing. Medical scribes can mitigate these unintended consequences by reducing documentation workload and increasing efficiency.

Objective

To study the effects of medical scribes on time to completion of notes and clinician experience, with a focus on time spent charting during clinic and after-hours. We hypothesized that medical scribes in an outpatient pediatric setting would decrease clinician time spent charting, time to finalize encounter notes, and clinician's perceived documentation time.

Methods

This 15-month single-center observational study was carried out with 3 study periods: pre-scribe, with-scribe, and scribe-withheld. Time spent in EHR was extracted by our EHR vendor. Participants completed surveys regarding time spent documenting. Six clinicians (5 physicians, 1 nurse practitioner) participated in this study to trial the implementation of medical scribes.

Results

EHR time data were collected for 4329 patient visits (2232 pre-scribe, 1888 with-scribe, 209 scribe-withheld periods). Comparing pre-scribe versus with-scribe periods, documentation time per patient decreased by 3-minutes 28-seconds per patient (pre-scribe IQR: 6, with-scribe IQR: 3, P = .028); note timeliness decreased from 0.96 days to 0.26 days (pre-scribe IQR: 0.22, with-scribe IQR: 0.11, P = .028); and clinicians’ estimates of time spent in the EHR decreased by 1.2 hours per clinic session (pre-scribe IQR: 0.5, with-scribe IQR: 0.5, P = .031).

Conclusions

Medical scribes in an outpatient pediatric setting result in: 1) decreased time spent charting, 2) reduced time to final sign clinic notes, and 3) decrease in clinician's perceived time spent documenting.

中文翻译：

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抄写员干预对门诊儿科初级保健实践中文件的影响

目的

电子健康记录 (EHR) 的使用导致了医生的不满、医生倦怠以及文档和计费的延迟。医学抄写员可以通过减少文档工作量和提高效率来减轻这些意外后果。

客观的

研究医学抄写员对完成笔记的时间和临床医生经验的影响，重点是在临床和下班后绘制图表所花费的时间。我们假设门诊儿科环境中的医学抄写员会减少临床医生花费在图表上的时间、最终确定会诊记录的时间以及临床医生感知的记录时间。

方法

这项为期 15 个月的单中心观察性研究分为 3 个研究阶段：开处方、有处方和隐瞒处方。在 EHR 上花费的时间是由我们的 EHR 供应商提取的。参与者完成了有关记录所用时间的调查。六名临床医生（5 名医师，1 名执业护士）参与了本研究，以试用医学抄写员的实施。

结果

收集了4329次患者就诊的 EHR 时间数据（2232 次处方，1888 年取消，209 次处方保留期）。比较处方与处方期间，每位患者的记录时间减少了 3 分 28 秒（处方IQR：6，处方IQR：3，P  = .028）；注意及时性从 0.96 天减少到 0.26 天（处方 IQR：0.22，-scribe IQR：0.11，P  = .028）；并且临床医生估计在 EHR 中花费的时间减少了 1.2 小时（处方IQR：0.5，与-scribe IQR：0.5，P  = .031）。

结论

门诊儿科环境中的医学抄写员导致：1) 减少绘制图表的时间，2) 减少最终签署临床记录的时间，以及 3) 减少临床医生感知记录所花费的时间。