Hate Dealing With an EHR? Use a Scribe and Profits Increase

Neil Chesanow

Disclosures

February 27, 2014

In This Article

Gains in Productivity as Well as Satisfaction

Research has found significant gains in physician and patient satisfaction with the use of scribes.[1,2,3,9] In one study, investigators randomly assigned scribes to 5 academic urologists and used surveys to evaluate patient and physician acceptance and satisfaction.[1] They found that patients not only were accepting of scribes, their satisfaction rates were higher (93% vs 87% in the absence of a scribe).

The satisfaction rates of the participating urologists were even higher.[1] "Physicians were dramatically more satisfied with office hours when a scribe was present (69% vs 19%)," the researchers observed. However, they were unable to determine whether the presence of a scribe improves productivity.

But scribes make physicians significantly more productive, most research on the subject has concluded. In a study on the impact of scribes on doctor performance in the ED, for example, 13 emergency physicians using scribes were retrospectively evaluated over an 18-month period.[10] Their relative value units (RVUs) per hour increased by 0.24 units, and the number of patients seen per hour increased by 0.08 for every 10% increment of scribe usage during a shift.

Until last summer, emergency physician Christopher Hanes, DO, was Director of the Department of Emergency Medicine at St. Christopher's Hospital for Children in Philadelphia, Pennsylvania, which employs 10-15 scribes.

"We saw increased customer service, increased physician satisfaction, and increased productivity of our physicians," he says. "They were able to see more patients per hour or per shift. We had increasing and improved levels of documentation. It was an across-the-board winner."

"Scribes are phenomenal," he says.

Hanes is now introducing scribes at pediatric specialty outpatient practices affiliated with Children's Specialized Hospital in Mountainside, New Jersey, where he is now Chief Medical Officer.

In one much-discussed study, researchers tracked 4 doctors in a cardiology clinic who saw 129 patients using standard care and 210 patients using scribes during 65 clinic hours each.[2] The number of patients seen with scribes increased by 59%, and RVUs per hour increased by 57%.

While direct contact time with patients was shorter overall when scribes were present, the doctors actually spent more time interacting with patients than they had offering standard care.[2] The researchers' subjective assessment of physician-patient interactions was also higher on visits in which scribes took part.

The ability to see at least 1 additional patient an hour with a scribe is a standard anecdotal claim by scribe vendors that independent research supports.[1,2,3,4,9,10]

Emergency physician Kevin J. Parkes, MD, Medical Director at San Antonio Community Hospital in Upland, California, which has been using scribes since 2007, says that his providers can see 1-2 additional patients per hour.[11]

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