JMIR Publications

ABSTRACT

Background:

With the increased adoption of EHR systems, documentation-related burdens have been increasing for healthcare providers. Recent estimates indicate that primary care providers spend about one-half of their workday interacting with the EHR, of which about half is focused on clerical tasks. To reduce documentation burdens associated with the EHR, healthcare systems and physician practices are increasingly implementing medical scribes to assist providers with real-time documentation. Despite the promise of scribes, few studies have investigated their effect on the clinical encounters, particularly in regards to patient-provider communication.

Objective:

The purpose of this study was to understand how patient-physician communication in primary care clinical encounters was affected with and without the use of scribes.

Methods:

We employed a convergent mixed methods design among a sample of three physician-scribe pairs, and 34 patient participants randomly assigned to have a scribe present or not within a clinical encounter. We conducted patient surveys focused on perceptions of patient-provider communication and satisfaction with the encounter, video recorded clinical encounters, and conducted physician interviews about their experiences with scribes.

Results:

Overall, survey results revealed that patients across both arms reported very high satisfaction regarding communication with their physician, their physician’s use of the EHR, and their satisfaction with their care, with very little variability. Video recording analysis supported patient survey data by demonstrating physicians in scribed and non-scribed encounters both had high measures of communication. Furthermore, video recordings revealed that the presence of scribes had very little effect on the clinical encounter.

Conclusions:

From a patient perspective, scribes are an acceptable addition to clinical encounters. Although they do not have much impact on patient perceptions of satisfaction, and their impact on the clinical encounter itself was minimal, their potential to reduce documentation-related burden on physicians is important. Physicians noted important issues related to scribes, including important considerations for implementing scribe programs, the role of scribes in patient interactions, how physicians work with scribes, characteristics of good scribes, and the role of scribes in physician workflow.