Are scribes the answer to physicians’ documentation woes?

Scribes may not be easing the documentation burden of electronic health records (EHRs) as much as doctors had hoped.

A study published as a research letter in JAMA examines how scribe use affected medical record closure times—a standard measure of documentation burden-- among physicians at Oregon Health & Science University over a five-year period. The authors looked at three different record closure metrics: closure times—the amount of time between the patient encounter and when the physician signs off on the encounter’s documentation—the proportion of medical records open 14 days or more, and the proportion closed during non-regular business hours (i.e., 7 p.m. to 7 a.m. on weekdays or anytime on weekends). The study included 1.2 million patient encounters with 430 physicians and 134 scribes across 55 specialties.

The authors used the metrics to conduct three sets of analyses. First, they compared outcome differences between doctors who never used scribes with those who started out not using scribes but then began using them. Second, they compared the performances of scribe users before and after they were assigned a scribe. Third, among doctors who had scribes assigned to them, they looked at performance differences between scribed and non-scribed patient encounters.

The results revealed worse outcomes when scribes were used for every analysis set and every metric. The medical record closure time among doctors using scribes was .69 days versus .14 days for doctors not using scribes. The proportions of delinquent medical records for the two groups were 11.8% and 2.6%, respectively, while proportions of records closed after hours were 28% and 17.4%. Similar performance differences emerged among doctors pre- and post-scribe assignment and scribed and non-scribed patient encounters.

The authors attribute the lack of improved performance among scribe users to the time spent proofreading the scribe’s notes for any documentation errors before closing the record on the visit. Having to do this, they say, “could subsequently increase documentation burden and mitigate potential benefits to scribe use.”

The research letter, “Medical Record Closure Practices of Physicians Before and After the Use of Medical Scribes,” was published online September 1.