Overview

This program in an academic adult general medicine primary care practice utilized medical scribes in primary care visits to increase both patient satisfaction and provider satisfaction with primary care visits. 

Organization Name

University of Missouri School of Medicine

Organization Type

• Academic Medical Center
• Community outpatient clinic

National/Policy Context

• Because the implementation of electronic medical record applications is known to have affected physician-patient interactions, the use of medical scribes has been introduced as one intervention to improve physician satisfaction and provide physicians more face-to-face time with patients.
• However, little is known about medical scribes’ true value to physicians. 

Local/Organizational Context

• This intervention took place in an academic General Internal Medicine practice where computers are stationed in every exam room and are accessible to physicians during outpatient appointments.

Patient Population Served and Payor Information

• The University of Missouri Health Care group sees over 195,000 patients.

Research + Planning

• The intervention was studied with a prospective observational trial. Patients 18-years or older were observed by project assistants during outpatient visits.

Tools or Products Developed

• Patient Satisfaction Survey: Assessed patient satisfaction with their visit and physician
• Medical Scribe Workflow: Medical scribes were allocated to some of the available exam rooms while other exam rooms did not have medical scribes present. 

Tech Involved

• Electronic medical record

Team Members Involved

• Administrative Assistant
• Medical Scribe
• Physicians
• Primary Care Physicians

Workflow Steps

• Project assistants observed the following interactions:
  • Physician-patient
  • Physician-computer
  • Physician-scribe
• Project assistants then conducted a survey with each patient after the physician left the exam room. 
  • The survey evaluated patient satisfaction with the visit. 
  • Patients were also asked for how they perceived the time their physician spent interacting with the computer compared to with them.

Budget Details

• Sources of costs estimated by the CareZooming team:
  • Labor costs of medical scribes
  • Labor costs involved with staff training

Outcomes

• Physician Time with Patient:
  • Physicians spent 57% of their time facing the patient when working with scribes compared to 49% with no scribe. 
  • Physicians spent 27% of their time facing the electronic health record when working with a scribe compared to 38% without scribes. 
  • Physicians spent 15% of their time examining the patient when working with a scribe, compared to 10% without a scribe. 
• Patient Satisfaction:
  • Patients felt that physicians gave more quality attention when working with a scribe than when not working with a scribe(97% v 83%).
  • 28% of patients surveyed felt physicians working without a scribe spent too much time looking at the EHR, compared to the 11% of the patient surveyed who felt physicians did so when working without a scribe.
  • 22% of patients felt their physician looked at the EHR more than half the time without a scribe, compared to 5% of patients who felt this way when their physician worked with a scribe. 
  • 16% of patients did not feel that their physicians’ interactions with the EHR was a distraction during the visit when their physician worked with a scribe compared to 17% of patients who did not feel this way when their physician was working without a scribe. 

Future Outcomes

• Physician satisfaction with scribes
• Physician perception of time spent on the computer

Benefits

• This study demonstrates that medical scribes are valuable in allowing physicians to focus more time on the patient than on the electronic medical record. 
• Patients are more satisfied with appointments that include medical scribes. Patients also perceive that their physicians are paying more attention to the patients themselves rather than the computer. 

Unique Challenges

• A larger trial is needed to verify the impact of medical scribes on physician-patient interactions in the exam room. Because of insufficient statistical power, many of the results of this study did not reach statistical significance. 

Sources

• This primer was developed by CareZooming based on our analysis of a research poster that was used with verbal and written permission of the author(s). Authors or their proxies were able to review the contents of this primer before publication, and all requested edits have been incorporated into the primer as presented above.
• Lancey, R., Bridgeman, P., Moxley, D., Phillips, W., Mosa, A. Impact of Medical Scribes on Physician-Patient Interactions During Outpatient Visits. Poster Session. Society of General Internal Medicine 2019 Annual Meeting, 8-9 May 2019, Washington, D.C.