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To evaluate the impact of adding medical scribes to 2 distinct outpatient pediatric subspecialty clinics on provider burnout, visit length, and patient satisfaction. A total of 2 pediatric endocrinologists and 2 developmental-behavioral pediatrics/pediatrician (DBP) were randomly assigned based on days of the week to see patients aged 0 to 21 years in their clinics with and without in-person medical scribes from February 2019 to February 2020. Parent satisfaction rates were examined through pre- and postappointment surveys. Provider burnout rates were assessed through the Maslach Burnout Inventory-Human Services Survey. A retrospective comparative analysis of average appointment duration was undertaken considering the scribe/no scribe random allocation in the examination room. Funding for this pilot provided by the department of pediatrics budgeted funds. Over 2923 appointments during the project dates, 829 appointments were seen with a scribe. The average appointment time for a new DBP appointment was 61 minutes with scribes and 71 minutes without (P < .001). Return patient appointments in DBP averaged 31 minutes with scribes and 43 minutes without (P < .001). There was no significant difference in appointment duration for endocrinology with and without scribes. The average time for chart completion was reduced with the presence of scribes in DBP but not in endocrinology. Out of the 209 families surveyed, patient satisfaction rates with and without a scribe did not differ in that between 96% and 97% of respondents rated the appointment overall as "excellent" for each measure of provider communication with scribes present. Finally, from the Maslach Burnout Inventory-Human Services Survey, the average score across all 4 providers for Emotional Exhaustion and Depersonalization decreased during the project period, whereas Personal Accomplishment scores increased over the project period. Scribes might be more advantageous for some subspecialties that utilize prolonged narratives in clinic notes, like DBP, and an important avenue to consider in reducing provider burnout in busy ambulatory settings.

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Studies have quantified various specific benefits related to the use of medical scribes, finding physician workflow and productivity improvements, with some demonstrating marginal value or detrimental impact. However, this evidence base misses a critical underlying issue with the expanding number of physicians using medical scribes routinely. There are an estimated 28,000-33,000 peer reviewed biomedical journals worldwide, currently publishing an estimated 1.8-2 million scientific articles every year. Over a typical physician's career from the 11-13 years of undergraduate through medical school and specialty/residency training as well as 34-36 practice/care delivery years beyond (to age 65), this yields 84-94+ million peer reviewed journal articles that are published in the global medical literature and to be potentially consumed/ considered over a roughly 47-year career. Clinical trial results in various stages of peer review, with 409,000 clinical trials registered in 2022, augment this massive volume of new clinical and bioscience information that clinicians might utilize to advance their care delivery by over 19 million bioscientific reports over a lifetime of training and care delivery. Inclusive of clinical trial reports and peer reviewed journal articles, a physician might derive clinical care value from an expanding career-long evidence base of 103-113+ million scientific communications. Even if only 0.1 percent of the global output of biomedical science has clinical relevance to a highly specialized physician, the narrowed career-long total remains a staggering 103,000 journal publications and clinical trial reports. For physicians with a more general and diverse clinical focus such as family medicine, emergency medicine physicians, and hospitalists, if 1 percent of newly published evidence-based literature is pertinent, the total career-long estimate is over 1 million journal articles and clinical trials to be reviewed and clinically integrated. As a result, a challenging issue created by the increasing role of medical scribes is not just evaluating their value (or lack thereof) for practicing physicians in their workflows and productivity. Rather it concerns the impact that medical scribes may be having by decoupling physicians from the iterative technological and cognitive progression of the electronic health record (EHR) and its evolving artificial intelligence (AI), which can facilitate the integration of the year-over-year proliferation of clinically pertinent new scientific evidence into a physician's practice of medicine. This commentary addresses the challenge to the evolution of the AI of the EHR posed by physicians' increasing use of and reliance upon medical scribes, and highlights how medical scribes may also, inadvertently, isolate and insulate physicians from their essential role in continuous refinement and advancement of EHR AI. Consideration is given to the broader challenge of inadequate focus and resources needed across sectors to drive the evolution of AI in the EHR, and associated health informatics research, as a US national priority.

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Medical-school applicants learn from many sources that they must stand out to fit in. Many construct self-presentations intended to appeal to medical-school admissions committees from the raw materials of work and volunteer experiences, in order to demonstrate that they will succeed in a demanding profession to which access is tightly controlled. Borrowing from the field of architecture the lens of construction ecology, which considers buildings in relation to the global effects of the resources required for their construction, we reframe medical-school admissions as a social phenomenon that has far-reaching harmful unintended consequences, not just for medicine but for the broader world. Illustrating with discussion of three common pathways to experiences that applicants widely believe will help them gain admission, we describe how the construction ecology of medical school admissions can recast privilege as merit, reinforce colonizing narratives, and lead to exploitation of people who are already disadvantaged.

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Background: The high documentation demands and limited time in direct patient care in the first year of internal medicine residency represent concerns for burnout and low job satisfaction in this important year of training. Objective: To assess the effect of scribes on the time PGY-1 residents spent on various work tasks. Methods: Participants were 24 PGY-1 internal medicine residents on two inpatient medicine teams at one site for 6 months (September 2019-February 2020). Residents were assigned a scribe during the first or second 2 weeks of a 4-week rotation and had no scribe for the other 2 weeks. Time study observers documented resident work activities. Residents ranked the meaningfulness of work activities via survey at the end of each 2-week period. Results: Of 24 residents, 18 (75%) completed the survey at both time points. Residents ranked patient care as the most meaningful and EHR work as the least meaningful work activity. EHR work claimed the largest percentage of time, with or without a scribe (mean, 33.2% and 39%, respectively). With a scribe, residents spent significantly less time (-5.8%, P < 0.0001) in EHR work and significantly more time (1.3%, P = 0.0267) in direct patient care and coordinating patient care (3.0%, P < 0.0001). Conclusions: The presence of a scribe with PGY-1 internal medicine residents on inpatient teams resulted in a significantly greater percentage of total work time spent in work they considered most meaningful and a significantly lower percentage of total work time in work they considered least meaningful.

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BACKGROUND: The use of electronic health records has generated an increase in after-hours and weekend work for providers. To alleviate this situation, the hiring of medical scribes has rapidly increased. Given the lack of scribe industry standards and the wide variance in how providers and scribes work together, it could potentially create new patient safety-related risks. OBJECTIVE: The purpose of this paper was to identify how providers can optimize the effective and safe use of scribes. DESIGN: The research team conducted a secondary analysis of qualitative data where we reanalyzed data from interview transcripts, field notes, and transcribed group discussions generated by four previous projects related to medical scribes. PARTICIPANTS: Purposively selected participants included subject matter experts, providers, informaticians, medical scribes, medical assistants, administrators, social scientists, medical students, and qualitative researchers. APPROACH: The team used NVivo12 to assist with the qualitative analysis. We used a template method followed by word queries to identify an optimum level of scribe utilization. We then used an inductive interpretive theme-generation process. KEY RESULTS: We identified three themes: (1) communication aspects, (2) teamwork efforts, and (3) provider characteristics. Each theme contained specific practices so providers can use scribes safely and in a standardized way. CONCLUSION: We utilized a secondary qualitative data analysis methodology to develop themes describing how providers can optimize their use of scribes. This new knowledge could increase provider efficiency and safety and be incorporated into further and future training tools for them.

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OBJECTIVE: While the use of medical scribes is rapidly increasing, there are not widely accepted standards for their training and duties. Because they use electronic health record systems to support providers, inadequately trained scribes can increase patient safety related risks. This paper describes the development of desired core knowledge, skills, and attitudes (KSAs) for scribes that provide the curricular framework for standardized scribe training. MATERIALS AND METHODS: A research team used a sequential mixed qualitative methods approach. First, a rapid ethnographic study of scribe activities was performed at 5 varied health care organizations in the United States to gather qualitative data about knowledge, skills, and attitudes. The team's analysis generated preliminary KSA related themes, which were further refined during a consensus conference of subject-matter experts. This was followed by a modified Delphi study to finalize the KSA lists. RESULTS: The team identified 90 descriptions of scribe-related KSAs and subsequently refined, categorized, and prioritized them for training development purposes. Three lists were ultimately defined as: (1) Hands-On Learning KSA list with 47 items amenable to simulation training, (2) Didactic KSA list consisting of 32 items appropriate for didactic lecture teaching, and (3) Prerequisite KSA list consisting of 11 items centered around items scribes should learn prior to being hired or soon after being hired. CONCLUSION: We utilized a sequential mixed qualitative methodology to successfully develop lists of core medical scribe KSAs, which can be incorporated into scribe training programs.

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This article addresses ethical concerns with the use of electronic health records (EHRs) by physicians in clinical practice. It presents arguments for two claims. First, requiring physicians to maintain patient EHRs for medically unnecessary tasks is likely contributing to increased burnout, decreased quality of care, and potential risks to patient safety. Second, medical institutions have ethical reasons to employ medical scribes to maintain patient EHRs. Finally, this article reviews central objections to employing medical scribes and provides responses to each.

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Physician burnout and its association with the use of electronic health records (EHRs) is well known. The impact of scribes for academic dermatologists and their patients needs to be explored. As physician burnout increases, system-based solutions are needed. To assess the impact of a scribe on physician and patient satisfaction at an academic dermatology clinic. Prospective, pre-post-pilot intervention study. During the pilot intervention, clinicians had clinic sessions with and without a scribe. We assessed changes in (1) clinician satisfaction and burnout, (2) time spent on EHR, and (3) patient satisfaction. An electronic 7-item baseline survey, 23-item mid-study survey, and a 22-item end-of-study survey to assess clinician burnout and feedback on satisfaction with medical scribes. A 19-item post visit satisfaction survey was given to patients. EHR was queried to compare amount of time spent on EHR, closure of charts, and number of patients seen during scribe coverage and at baseline. Of the six clinicians, 100% felt that there was value to scribe support. Physician burnout was low at baseline and did not change post-pilot. Active documentation time, on average, decreased by 67% per patient with a 28% increase in patients seen per clinic. Over 88% of patients disagreed with the statement, "I was uncomfortable disclosing personal information when a scribe was present" (p < 0.001). In an academic dermatology and Mohs surgery setting, medical scribes increased clinician satisfaction without compromising patient satisfaction.

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OBJECTIVE: Provider burnout is a crisis in healthcare and leads to medical errors, a decrease in patient satisfaction, and provider turnover. Many feel that the increased use of electronic health records contributes to the rate of burnout. To avoid provider burnout, many organizations are hiring medical scribes. The goal of this study was to identify relevant elements of the provider-scribe relationship (like decreasing documentation burden, extending providers' careers, and preventing retirement) and describe how and to what extent they may influence provider burnout. MATERIALS AND METHODS: Qualitative methods were used to gain a broad view of the complex landscape surrounding scribes. Data were collected in 3 phases between late 2017 and early 2019. Data from 5 site visits, interviews with medical students who had experience as scribes, and discussions at an expert conference were analyzed utilizing an inductive approach. RESULTS: A total of 184 transcripts were analyzed to identify patterns and themes related to provider burnout. Provider burnout leads to increased provider frustration and exhaustion. Providers reported that medical scribes improve provider job satisfaction and reduce burnout because they reduce the documentation burden. Medical scribes extend providers' careers and may prevent early retirement. Unfortunately, medical scribes themselves may experience similar forms of burnout. CONCLUSION: Our data from providers and managers suggest that medical scribes help to reduce provider burnout. However, scribes are not the only solution for reducing documentation burden and there may be potentially better options for preventing burnout. Interestingly, medical scribes sometimes suffer from burnout themselves, despite their temporary roles.

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BACKGROUND: With the use of electronic health records (EHRs) increasing and causing unintended negative consequences, the medical scribe profession has burgeoned, but it has yet to be regulated. The purpose of this study was to describe scribe workflow as well as identify the threats and opportunities for the future of the scribe industry. METHODS: The first phase of the study used ethnographic methods consisting of interviews and observations by a multi-disciplinary team of researchers at five United States sites. In April 2019, a two-day conference of experts representing different stakeholder perspectives was held to discuss the results from site visits and to predict the future of medical scribing. An interpretive content analysis approach was used to discover threats and opportunities for the future of medical scribes. RESULTS: Threats facing the medical scribe industry were related to changes in the documentation model, EHR usability, different payment structures, the need to acquire disparate data during clinical encounters, and workforce-related changes relevant to the scribing model. Simultaneously, opportunities for medical scribing in the future included extension of their role to include workflow analysis, acting as EHR-related subject-matter-experts, and becoming integrated more effectively into the clinical care delivery team. Experts thought that if EHR usability increases, the need for medical scribes might decrease. Additionally, the scribe role could be expanded to allow scribes to document more or take on more informatics-related tasks. The experts also anticipated an increased use of alternative models of scribing, like tele-scribing. CONCLUSION: Threats and opportunities for medical scribing were identified. Many experts thought that if the scribe role could be expanded to allow scribes to document more or take on more informatics activities, it would be beneficial. With COVID-19 continuing to change workflows, it is critical that medical scribes receive standardized training as tele-scribing continues to grow in popularity and new roles for scribes as medical team members are identified.

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BACKGROUND: Integrating medical scribes with clinicians has been suggested to improve access, quality of care, enhance patient/clinician satisfaction, and increase productivity revenue. OBJECTIVE: Conduct a systematic review to evaluate the effects of medical scribes in emergency departments. METHODS: Electronic databases from 2010 through December 2019. Two individuals independently reviewed study eligibility, rated risk of bias, and determined overall certainty of evidence. Data abstracted included study and population characteristics, outcomes (efficiency, patient or clinician satisfaction, financial productivity, documentation quality, cost, and training time), and the effect of compensation structure, qualifications, duties, and setting on outcomes. RESULTS: Twenty studies (18 observational) were included; 12 from two institutions. All utilized in-person rather than virtual scribes. Fifteen were rated as serious or critical risk of bias; five were rated moderate. Findings indicate that scribes may increase patients seen per day and decrease length of stay; however, effects were small and may vary by setting and outcome measured (low certainty). Scribes may increase financial productivity; however, costs associated with developing, implementing, and maintaining scribe programs were not adequately reported. Results were mixed for door-to-room or door-to-provider time, patients left without being seen, and patient/clinician satisfaction. No studies examined the effects of scribes based on compensation structure, qualifications or duties. CONCLUSIONS: Although information quality, quantity, and applicability are limited, in-person medical scribes may improve emergency department efficiency and financial productivity. There was no information on virtual scribes. There was little information on patient or clinician satisfaction, scribe documentation quality, or whether results vary by in-house vs. contracted hiring and training.

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BACKGROUND: Medical scribes are trained professionals who assist health care providers by administratively expediting patient encounters. Section 507 of the MISSION Act of 2018 mandated a 2-year study of medical scribes in VA Medical Centers (VAMC). This study began in 2020 in the emergency departments and specialty clinics of 12 randomly selected VAMCs across the country, in which 48 scribes are being deployed. METHODS: We are using a cluster randomized trial to assess the effects of medical scribes on productivity (visits and relative value units [RVUs]), wait times, and patient satisfaction in selected specialties within the VA that traditionally have high wait times. Scribes will be assigned to emergency departments and/or specialty clinics (cardiology, orthopedics) in VAMCs randomized into the intervention. Remaining sites that expressed interest but were not randomized to the intervention will be used as a comparison group. RESULTS: Process measures from early implementation of the trial indicate that contracting may hold an advantage over direct hiring in terms of reaching staffing targets, although onboarding contractor scribes has taken somewhat longer (from job posting to start date). CONCLUSIONS: Our evaluation findings will provide insight into whether scribes can increase provider productivity and decrease wait times for high demand specialties in the VA without adversely affecting patient satisfaction. IMPLICATIONS: As a learning health care system, this trial has great potential to increase our understanding of the potential effects of scribes while also informing a real policy problem in high wait times and provider administrative burdens.

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This study examined if preclerkship medical students would find it educational to scribe in a pediatric setting. Scribing promoted students' learning about pediatric clinical encounters enhanced their competency with electronic health record use, and moderately reduced attending physician documentation burden.

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OBJECTIVE: Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. MATERIALS AND METHODS: Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. RESULTS: We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the "technical" dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The "environmental" dimension included the changing scribe industry and need for standards. Within the "personal" dimension, themes included the need for provider diligence and training when using scribes. Finally, the "organizational" dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. CONCLUSION: Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.

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BACKGROUND: Medical scribes have been proposed as a solution to the problems of excessive documentation, work-life balance, and burnout facing general internists. However, their acceptability to patients and effects on provider experience have not been tested in a real-world model of effectiveness. OBJECTIVE: To measure the effect of medical scribes on patient satisfaction, provider satisfaction, and provider productivity. DESIGN: Quasi-experimental difference-in-differences longitudinal design. PARTICIPANTS: Four attending physicians who worked with scribes, 9 control physicians who did not, and their patients in a large, hospital-affiliated academic general internal medicine practice. MAIN MEASURES: Provider experience and patient experience using 5-point Likert scale surveys from the AMA Steps Forward Team Documentation Module, and visits and wRVUs per hour during 4 weeks before and 12 weeks after initiation of a practice model that included use of scribes and a shortened visit template. KEY RESULTS: Participating providers worked a total of 664 clinic sessions and returned 547 (82%) surveys. Average provider experience scores did not differ between providers working with scribes and control providers working without (4.01 vs. 3.40 respectively; p time-by-group interaction = 0.26). Providers with scribes were more likely to agree that work for the encounter would be completed during the visit then controls (3.58 vs. 2.48 respectively; p interaction = 0.04). A total of 6202 visits occurred during the study period. Average patient experience scores did not differ between the experimental and control groups (4.73 vs. 4.75 respectively; p interaction = 0.90). Compared with the control providers, providers with scribes completed more visits per hour (2.29 vs. 1.91; p interaction < 0.001) and generated more wRVUs per hour (3.42 vs. 3.27; p interaction < 0.001). CONCLUSIONS: In this test of a modified practice model, scribes supported greater patient throughput and improved provider perceptions of documentation burden with no decrement in high patient satisfaction.

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BACKGROUND: Though much is known about the benefits attributed to medical scribes documenting patient visits (e.g., reducing documentation time for the provider, increasing patient-care time, expanding the roles of licensed and non-licensed personnel), little attention has been paid to how care workers enact scribing as a part of their existing practice. The purpose of this study was to perform an ethnographic process evaluation of an innovative medical scribing practice with primary care teams in Veterans Health Administration (VHA) clinics across the United States. The aim of our study was to understand barriers and facilitators to implementing a scribing practice in primary care. METHODS: At three to six months after medical scribing was introduced, we used semi-structured interviews and direct observations during site visits to five sites to describe the intervention, understand if the intervention was implemented as planned, and to record the experience of the teams who implemented the intervention. This manuscript only reports on semi-structured interview data collected from providers and scribes. Initial matrix analysis based on categories outlined in the evaluation plan informed subsequent deductive coding using the social-shaping theory Normalization Process Theory. RESULTS: Through illustrating the slow accumulation of interactions and knowledge that fostered cautious momentum of teams working to normalize scribing practice in VHA primary care clinics, we show how the practice had 1) an organizing effect, as it centered a shared goal (the creation of the note) between the provider, scribe, and patient, and 2) a generative effect, as it facilitated care workers developing relationships that were both interpersonally and inter-professionally valuable. Based on our findings, we suggest that a scribing practice emphasizes the complementarity of existing professional roles, which thus leverage the interactional possibilities already present in the primary care team. Scribing, as a skill, forged moments of interprofessional fit. Scribing, in practice, created opportunities for interpersonal connection. CONCLUSIONS: Our research suggests that individuals will notice different benefits to scribing based on their professional expectations and organizational roles related to documenting patient visits.

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PURPOSE: Increasing demand for more and better documentation as well as digitalization of healthcare entail shifts in competencies and roles of healthcare occupations and professions. As a result of this data-centric technological development, new kinds of work and occupations emerge of which medical scribes are an example. To investigate and provide a case of an emergent occupation focused on 'data work', we describe the emergence, growth and stabilization of medical scribes, outline their history and provide a literature overview. METHOD: We conducted a review of the literature on medical scribes in academic journals until 2017. These publications are categorized according to the country of study, medical specialization, method, focus, attitude to the use of medical scribes, and the reasons given for the use of medical scribes. We outline the history of the emergence of medical scribes and provide a summary of the existing research publications on medical scribes. FINDINGS: We identified 60 papers of which a majority are based on cases from the USA; conducted in emergency departments; based on quantitative methods; focus on economic feasibility and satisfaction; are positive towards the use of medical scribes; and link the use of medical scribes to the implementation of electronic health records (EHR). There is a distinct lack of research on medical scribes themselves and their interaction with physicians, patients, and EHR. CONCLUSIONS: Medical scribes have emerged as a new data-work occupation as a response to increased demands for documentation and digitalization through EHRs. Research on medical scribes has hitherto focused on efficiency and economic feasibility of scribes, and there is a need to look into the interaction of medical scribes with physicians and patients as well as look at opportunities for redesign of EHR. More generally, there is a need to look beyond the most prominent professions such as physicians and nurses in discussions of digitization and datafication of healthcare, and investigate how new and previous tasks are (re)distributed between occupations and professions.

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Background: Studies report the benefit of medical scribes in the emergency department on patient throughput, clinical documentation, patient outcomes, and provider and patient satisfaction. However, studies are silent on the benefits of being a scribe for premedical and medical students. Methods: The senior author interviewed 8 scribes who were applying for medical school and 9 medical students who had been scribes prior to medical school. Discussion was prompted on undergraduate education; scribe recruitment and training; career intentions; experience as a scribe; and the value of being a scribe to themselves, to the doctors with whom they worked, and to the hospital where they were employed. Results: The typical scribe had become a scribe to support his or her chances of entry into medical school. Those already in medical school were not convinced that this experience had actually made a difference in their acceptance. All 17 scribes were emphatic that the role had benefitted them in other ways, specifically, by learning medical terminology, observing communication between doctor and patient, and understanding the practice of medicine in an emergency department. For many scribes, the experience reinforced the desire to become a doctor. The scribes recognized their value in the areas of process and finance. They also recognized that many doctors, particularly those working in academic health centers, derived satisfaction from the training and mentoring that they offered. Conclusion: Scribes perceive the role of a scribe to be highly valuable in terms of their career decision making and future medical education.