Citation: Kolson, K. (2021 Medical Scribes: A Human Solution to an Informatics Problem. Student Guest Editorial. Online Journal of Nursing Informatics (OJNI), 25(1). https://www.himss.org/resources/online-journal-nursing-informatics
This editorial is part of a graduate-level nursing school assignment challenging students to expand on a review of literature performed in a previous course by writing an article for publication. The manuscript herein offers a solution to the problems created by the rise of the electronic health record (EHR) including provider burnout, inefficiency of workflow, and poor quality of documentation. By building on themes found in the review of literature, the editorial proffers medical scribes as the human solution to what is most certainly an informatics problem.
As a graduate nursing informatics student and registered nurse supporting multiple physicians and advanced practice providers in a busy ambulatory care specialty clinic, I possess a unique vantage point from which to see the unintended consequences of electronic health record (EHR) implementation. Patients access their health records more than they ever had before, and providers readily call up patient records that previously were inaccessible with siloed paper charting. The rise of the EHR however, creates increased documentation burden, which leads to charting delays, lower quality notes, provider burnout, and patient dissatisfaction (Woodcock et al., 2017). While providers are mired in the growing demands of an already-strained system, the weight is also felt by other health professionals—namely nurses—who are delegated tasks below their license, wasting their skills and education, and reducing their career satisfaction. The EHR is here to stay, and solutions are needed to allow clinicians at all levels the ability to work effectively at the top of their license. User interface improvements may only go so far to fix the problem. The informaticist is well-positioned as a workflow analyzer to see bottlenecks and develop solutions. I believe in (and the evidence supports) a human solution to this informatics problem: the use of medical scribes for documentation assistance, information retrieval, and order entry.
I know what you must think: “Why add yet another care team member to a roster which already includes physicians, nurse practitioners, nurses, clinical assistants, and medical administrative assistants?” The answer is simple—because not one of the current members can free up the providers’ time and create efficiencies in the exact way that a medical scribe does. Currently, EHR inefficiencies lead to providers writing only short notes at the time of the patient encounter, leaving thorough documentation for the end of the day, allowing for errors (Heaton et al., 2016). Scribes ensure notes are completed sooner, giving timely access to information for nursing and other support staff (Earls et al., 2017). Scribes also improve note quality and accuracy (Gidwani et al., 2017; Misra-Herbert et al., 2016; Yan et al., 2016)—which is vital when considering the time-consuming discrete data entry required to draw the most information from the EHR. When providers spend less time on notes, more time can be spent on higher-level thinking and addressing patient messages (Gidwani et al., 2017), which is extremely important in today’s climate of patient connectedness. Improved interactions between providers and patients are found with the use of scribes (Shultz & Holmstrom, 2015) in part because real-time documentation interferes with provider-patient collaboration during the visit (Mishra et al., 2018; Yan et al., 2016). Scribes amplify efficiency of patient visits, which allows for more patients to be seen per hour (Heaton et al., 2016), as well as increase the number of “on-time” visits (Miller et al., 2016). Studies reveal that scribes more than pay for themselves (Earls et al., 2017; Miller et al., 2016), so really the better question to ask is: “Why not trial the use of scribes?”
Some argue that scribes are simply a band aid on a broken system, and that they will slow the progression of EHR design (Misra-Herbert et al., 2016). I beg to differ. Artificial intelligence and smartly designed EHRs are not poised to solve this problem anytime soon. No matter how intuitive an EHR is, there are still visit functions that can be parsed out to support staff to allow the provider to focus on higher-level thinking and stop scribing for him or herself (Yan et al., 2016). Studies demonstrate that scribe support enables providers to leave work one hour earlier on average, improving work-life balance, and amplifies physician and nurse morale despite increased patient volumes (Earls et al., 2017). Scribes are our secret weapon against burnout, protecting the well-being of our already-drained clinicians (Gidwani et al., 2017).
The rise of the EHR brings forth many opportunities for improved patient safety and care coordination, however there are unintended consequences. Burnout is on the rise and must be addressed, especially in light of clinician shortages. I suggest the implementation of medical scribes to provide documentation assistance, information retrieval, and order entry. Current literature reports that scribes offer a valuable solution to improve not only provider satisfaction, but also quality of documentation, efficiency, and patient satisfaction. The time has come for informaticists to heed what the evidence advises, and advocate for our clients by bringing a human solution to this informatics problem.
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Earls, S., Savageau, J., Begley, S., Saver, B., Sullivan, K. & Chuman, A. (2017). Can scribes boost FPs' efficiency and job satisfaction? The Journal of Family Practice, 66(4), 206-214.
Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., Sattler, A., Mahoney, M. & Lin, S. (2017). Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: A randomized controlled trial. Annals of Family Medicine, 15(5), 427-433. doi: 10.1370/afm.2122
Heaton, H., Castaneda-Guarderas, A., Trotter, E., Erwin, P. & Bellolio, M. (2016). Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: A systematic review and meta-analysis. American Journal of Emergency Medicine, 34(10), 2018-2028. doi: 10.1016/j.ajem.2016.07.056
Miller, N., Howley, I. & McGuire, M. (2016). Five lessons for working with a scribe. Family Practice Management, 23(4), 23-27.
Mishra, P., Kiang, J. & Grant, R. (2018). Association of medical scribes in primary care with physician workflow and patient experience. JAMA Internal Medicine, 178(11), 1467-1472. doi: 10.1001/jamainternmed.2018.3956
Misra-Hebert, A., Amah, L., Rabovsky, A., Morrison, S., Cantave, M., Hu, B., Sinsky, C. & Rothberg, M. (2016). Medical scribes: How do their notes stack up? The Journal of Family Practice, 65(3), 155-159.
Shultz, C. & Holmstrom, H. (2015). The use of medical scribes in health care settings: A systematic review and future directions. Journal of the American Board of Family Medicine 28(3) 371-81. doi: 10.3122/jabfm.2015.03.140224
Woodcock, D., Pranaat, R., McGrath, K. & Ash, J. (2017). The evolving role of medical scribe: Variation and implications for organizational effectiveness and safety. Studies in Health Technology and Information, 234, 382-388. doi: 10.3233/978-1-61499-742-9-382
Yan, C., Rose, S., Rothberg, M., Mercer, M., Goodman, K. & Misra-Hebert, A. (2016). Physician, scribe, and patient perspectives on clinical scribes in primary care. Journal of General Internal Medicine, 31(9), 990-995. doi: 10.1007/s11606-016-3719-x
Katherine E. A. Kolson is a graduate student at Jacksonville University’s Keigwin School of Nursing finishing her MSN degree in nursing informatics. She graduated summa cum laude from Armstrong Atlantic State University with her BSN degree, after which she started her nursing career at Mayo Clinic in Jacksonville, Florida on the inpatient neurosciences unit. She served as a credentialed trainer during Mayo Clinic’s transition to the electronic health record Epic, sparking her love of nursing informatics. After the close of the project she transitioned to the outpatient neurology clinic where she currently serves the Epilepsy Division. Prior to switching careers to nursing she graduated magna cum laude from Savannah College of Art and Design with her BFA in historic preservation. After obtaining her MSN degree in the summer of 2020, she is excited to pursue a career in nursing informatics.