Clinicians Unable to Complete Tasks with an EHR Documentation Scribe

Hiring an EHR documentation scribe does not improve the time for a clinician to complete out-of-visit tasks, such as answer patient portal messages, fill prescription requests, and send test results, according to a study published in the Journal of the American Board of Family Medicine.

According to the American Medical Association, the clinician burnout rate is roughly 44 percent, which is much higher than burnout in other professions. That burnout is closely linked with EHR use and cumbersome EHR documentation.

Health systems hire human scribes to aid clinicians with documentation during patient visits to mitigate clinician burnout. These assistants intend to give clinicians more time away from the EHR or allow clinicians to complete out-of-visit tasks. However, issues can still occur.

The research team compared scribed primary care providers and non-scribed PCPs for time taken for clinicians to address patient portal messages, fill prescription requests, and send test results. The researchers looked at before and after scribe implementation.

The researchers observed 472,411 tasks. These ranged from 27,645 tasks for five scribed PCPs and 444,766 tasks for 74 non-scribed PCPs.

The researchers found scribe implementation has no association with changes in time that a clinician can complete patient portal messages, fill prescription requests, or send test results.

The change in time between pre-to-post intervention between scribed PCPs was 1.06 times that of non-scribed providers for answering patient portal messages. There was also a negligible difference in improvement for prescription refill requests and sending test results.

“Prior examinations suggest that scribes decrease both the time spent in visits and the time spent charting outside of visits,” wrote the researchers. “Our findings suggest that this time saved due to scribes does not result in quicker responses to out-of-visit tasks.”

The researchers hypothesized five explanations for these somewhat surprising results.

The study authors said clinicians might use the added time to address other aspects of patient care, such as communicating with patients or other staff members. Clinicians might review the EHR documentation quality to ensure accuracy because student scribes or inexperienced scribes do not always know how to accurately write progress notes or pick out the key parts of a conversation.

Providers could also use this extra time to address more significant EHR inbox items that are more time consuming and time sensitive. On the other side of the spectrum, clinicians could step away from the EHR workflow completely to boost their work-life balance and decrease EHR use.

Medical offices typically hire a medical student to shadow the clinician and type information into the EHR. But, increased documentation training on how to transcribe provider responses to patient inbox messages could further aid the clinician, the study authors recommended.

“Care redesign efforts have historically focused on redesigning visit workflows to engage care team members,” wrote the study authors. “Increasingly, these care redesign efforts are focusing on reducing the burden of the EMR on providers by engaging team members in out-of-visit tasks such as in-basket management.”

The study authors noted the low number of scribes hired for a high number of inbox tasks as a significant limitation. Another limitation was the lack of clinical training. Scribes with clinical practice, such as a medical assistant, typically have a more significant impact than an untrained scribe.

“While scribes seem to have many benefits, our study suggests they may not improve time to completion of out-of-visit tasks,” concluded the study authors. “This suggests that the key value of scribes may be their impact on other aspects of care, such as productivity, after-hours use of the EMR, and provider satisfaction.”