Impact of Medical Scribes in Healthcare: A Systematic Review

Background: The utilization of medical scribes has increased significantly in healthcare facilities over the last ten years. Medical scribes are hired to assist providers with documentation in the electronic health record (EHR). The purpose of this systematic review is to evaluate how scribes impact productivity/throughput, revenue, provider satisfaction, and patient satisfaction in healthcare. Methods: A database search from January 2000 to May 2017 of PubMed, Google Scholar, and Academic Search Premier was done using the keywords medical scribe, scribes, and healthcare. Based on inclusion criteria, this review includes studies from 5 emergency departments, 2 primary care clinics, and 1 cardiology clinic. Also, an in-person interview was conducted with an Internal Medicine physician. Results: Of the studies that evaluated productivity/throughput, all showed improvements with scribe intervention. Revenue was also generated by healthcare facilities using scribes. Provider satisfaction was overall positive, although documentation errors were noted. Patient surveys demonstrated predominantly positive remarks regarding medical scribes, as this allowed the provider to focus more on the patient versus a computer screen. Conclusions: Evidence demonstrates medical scribes have improved the burdens of EHRs in emergency departments, primary care clinics, and a specialty clinic. Due to the limited number of peer-reviewed sources, further research should be done to justify the future of medical scribes. To further improve the role of scribes, recommendations have been made regarding training protocols, staffing models, patient education, and areas for future research. Impact of Medical Scribes in Healthcare 4 Introduction The medical record was first adapted in the 1920s to allow physicians to briefly document a patient’s medical history. While this helped physicians quickly remember why and how they were treating a patient, these records were handwritten, were often illegible, and lacked organization. Overtime, the medical record has evolved into the electronic health record (EHR). As of 2015, 86.9% of healthcare providers are using EHRs to document with the intent to improve quality of care. The EHR has been widely accepted as it allows for better organization of a patient’s medical history and for quick communication between healthcare professionals. The expansion of EHRs has also increased its purpose and is now used for scheduling, billing, and data tracking. While there are many highlights to this advancement, providers have found digital documentation to be a time-consuming and burdensome process. Emergency department (ED) physicians spend significantly more time entering data into EHRs than on actual patient care. Increased documentation time has led to poor ED throughput, which measures how many patients can by cycled through a hospital’s fixed resources. Some examples of throughput measurements include: time it takes for a patient to be roomed, time it takes to be seen by a provider, and time it takes to be discharged, which can all impact quality of care received by the patient. Poor throughput has been linked with increased morbidity and mortality, delayed delivery of treatment, increased number of people leaving without being seen, and lower patientprovider satisfaction scores. 6 In a general response to EHRs, providers have changed the way they interact with patients. Many will sit at the keyboard with their eyes on the computer screen versus on the patient. To offset the burdens of EHRs, medical scribes are a proposed solution for many healthcare facilities. Impact of Medical Scribes in Healthcare 5 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines scribes as, “an unlicensed person hired to enter information in the electronic medical record (EMR) or chart at the direction of a physician or practitioner. Medical scribes mostly work in emergency departments, but clinics and specialties are becoming more prevalent. In general, scribes listen to and document the provider-patient interaction while noting pertinent positives and negatives in the patient’s history and review of systems. The specific duties of a medical scribe include updating record templates, gathering laboratory and radiographic results, and assisting to coordinate communication between consulting and referring physicians. There are three different types of staffing models, yet there is no national, state, or local regulations governing the scribe scope of practice. See Figure 1 for a complete description of the role of medical scribes. Given increasing implications of EHRs, many healthcare facilities have implemented medical scribes. This systematic review will assess the contribution of scribes in healthcare and the future significance for their utilization in clinical practice. It is hypothesized that medical scribes will improve provider productivity, throughput, and satisfaction, while maintaining a positive patient experience. In addition, this paper will explore the benefits and risks to using different staffing models for hiring medical scribes. Definitions EHR: electronic health record; ED: emergency department; JCAHO: Joint Commission on Accreditation of Healthcare Organizations; EMR: electronic medical record; ROI: return on investment; HCO: healthcare organization; HPI: history of present illness; ROS: review of systems