US-based studies published between 2010 and the spring of 2020 that examined scribe utilization in ambulatory primary care practice settings (either sole setting of interest or as an included setting in multisite studies) were selected for inclusion. Two members of the research team independently performed a title and abstract review of all PubMed search results. (Fig.1): 1): ((((medical) OR (clinical)) OR (physician)) OR (primary)) AND (((scribe) OR (scribing)) OR (scribes)) ((scribe) OR (scribes)) OR (scribing) and “documentation assistant”. Searches were conducted in PubMed using the following search strings (Fig. Findings may elucidate potential benefits and considerations for scribe utilization in primary care, including health safety net settings.Ī literature search was conducted to identify published articles on medical scribe utilization in the primary care setting. Given the heightened national focus on health equity, we pay added attention to scribes in health safety net settings and also outline new research avenues for assessing how they enhance providers’ ability to deliver high-quality care, address social determinants of health, and improve population health.
We, therefore, aim to describe and synthesize the published research on medical scribe utilization in the primary care setting as it relates to study characteristics, scribe tasks, and reported outcomes. While recent observations in the literature suggest an increased interest in the integration of medical scribes in the primary care setting, 20– 22 no review of this subset of the literature has been conducted to date, making reliability and generalizability of findings difficult. 17, 18 Further, medical scribes may serve as a crucial tool for decreasing provider burnout. 16 Systematic reviews of the use of scribes in the emergency department and specialty settings indicate positive associations between scribe utilization and productivity and efficiency, provider satisfaction, and documentation quality. 14 Scribes can be unlicensed, certified, or licensed clinical staff that accompanies a provider in the examination room and provide real-time documentation assistance of the clinical visit. 14 Medical scribes have been identified by many primary care leaders as a way to reinstate joy in practice while simultaneously increasing provider efficiency 15 and strengthening patient-provider relationships. Medical scribes (scribes) have emerged as a solution to offsetting growing provider dissatisfaction with the clerical burden and perceptions of the diminished patient and provider interactions associated with the use of EHRs. 10, 11 The culmination of these challenges may result in shocks to workflows that can be especially hard to absorb in primary care, where workforce shortages are widespread, demand is expected to exceed physician supply, and the emergence of coronavirus disease 2019 (COVID-19) has stressed the already vulnerable primary care system. 9Īt the same time, health care providers, especially those in primary care, are navigating rapid shifts in the health care landscape, including the emergence of alternative payment models and a growing call to document and address patients’ social needs in the delivery of health care.
8 Patient satisfaction and perception of clinical visits may also suffer when providers spend more time looking at the computer and less time interacting directly with the patient. 2, 3 While the emergence of the EHR has been heralded for its positive impacts on patient safety, the efficiency of care, and other outcomes, 4 providers are experiencing a negative impact on joy in practice, 5 with studies showing providers spend more time working in the EHR than in direct face time with the patient 6, 7 including spending significant after-hours time updating charts. 1 As a result, nearly all primary care practices, including community health centers (CHCs), have adopted EHRs, though smaller practices have been slower to fully transition from paper records. Pressure to integrate electronic health records (EHRs) in the clinical setting has intensified over the past decade, with financial incentives offered for its adoption and the threat of revenue losses for nonadoption.
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