Association of medical scribes in primary care with physician workflow and patient experience
Open accessAbstract
Importance: Widespread adoption of electronic health records (EHRs) in medical care has resulted in increased physician documentation workload and decreased interaction with patients. Despite the increasing use of medical scribes for EHR documentation assistance, few methodologically rigorous studies have examined the use of medical scribes in primary care. Objective: To evaluate the association of use of medical scribes with primary care physician (PCP) workflow and patient experience. Design, Setting, and Participants: This 12-month crossover study with 2 sequences and 4 periods was conducted from July 1, 2016, to June 30, 2017, in 2 medical center facilities within an integrated health care system and included 18 of 24 eligible PCPs. Interventions: The PCPs were randomly assigned to start the first 3-month period with or without scribes and then alternated exposure status every 3 months for 1 year, thereby serving as their own controls. The PCPs completed a 6-question survey at the end of each study period. Patients of participating PCPs were surveyed after scribed clinic visits. Main Outcomes and Measures: PCP-reported perceptions of documentation burden and visit interactions, objective measures of time spent on EHR activity and required for closing encounters, and patient-reported perceptions of visit quality. Results: Of the 18 participating PCPs, 10 were women, 12 were internal medicine physicians, and 6 were family practice physicians. The PCPs graduated from medical school a mean (SD) of 13.7 (6.5) years before the study start date. Compared with nonscribed periods, scribed periods were associated with less self-reported after-hours EHR documentation (<1 hour daily during week: adjusted odds ratio [aOR], 18.0 [95% CI, 4.7-69.0]; <1 hour daily during weekend: aOR, 8.7; 95% CI, 2.7-28.7). Scribed periods were also associated with higher likelihood of PCP-reported spending more than 75% of the visit interacting with the patient (aOR, 295.0; 95% CI, 19.7 to >900) and less than 25% of the visit on a computer (aOR, 31.5; 95% CI, 7.3-136.4). Encounter documentation was more likely to be completed by the end of the next business day during scribed periods (aOR, 2.8; 95% CI, 1.2-7.1). A total of 450 of 735 patients (61.2%) reported that scribes had a positive bearing on their visits; only 2.4% reported a negative bearing. Conclusions and Relevance: Medical scribes were associated with decreased physician EHR documentation burden, improved work efficiency, and improved visit interactions. Our results support the use of medical scribes as one strategy for improving physician workflow and visit quality in primary care.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Documentation burden associated with electronic health records is linked to clinician burnout among physicians and nurses.
“Electronic health records (EHRs) are linked with documentation burden resulting in clinician burnout.”
From Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review (2021) · cites this paper as [14]
The paper’s introduction, labeled Abstract in our copy, says EHRs increase clerical workload and physician stress and that EHR-created documentation burden contributes to physician burnout. The Discussion likewise identifies EHR documentation burden as a contributor to burnout. These passages support the citing sentence as printed, but the supplied paraphrase extends the claim to nurses, whom the passages do not address. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001) · Annual Review of Psychology · doi:10.1146/annurev.psych.52.1.397 · Cited by 12,852 · cited 1× · see citing works
“Physician burnout induced bywork-related stress leads to emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment.(11,12) One in every 2 physiciansexperiencesymptomsofburnout,withprimarycarephysicians (PCPs) experiencing the highest rates.”
BackgroundShanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., West, C. P., Sloan, J., & Oreskovich, M. R. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.3199 · Cited by 3,439 · see citing works
Shanafelt, T. D., Hasan, O., Dyrbye, L. N., Sinsky, C., Satele, D., Sloan, J., & West, C. P. (2015) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2015.08.023 · Cited by 2,885 · see citing works
Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties
Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., Westbrook, J., Tutty, M., & Blike, G. (2016) · Annals of Internal Medicine · doi:10.7326/m16-0961 · Cited by 1,494 · cited 2× · see citing works
“For every hour of direct patient care, physicians spend nearly 2 additional hours on unpaid EHR and desk work.(15) Among PCPs, introduction of additional EHR features has been associated with even higher rates of burnout, stress, and desire to leave practice.”
BackgroundShanafelt, T. D., Dyrbye, L. N., Sinsky, C., Hasan, O., Satele, D., Sloan, J., & West, C. P. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.05.007 · Cited by 1,086 · see citing works
Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017) · The Annals of Family Medicine · doi:10.1370/afm.2121 · Cited by 972 · see citing works
Benefits and drawbacks of electronic health record systems
Menachemi, N., & Collum (2011) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s12985 · Cited by 909 · see citing works
15 Design and Analysis of Cross-Over Trials
Kenward, M. G., & Jones, B. C. (2007) · Handbook of statistics · doi:10.1016/s0169-7161(07)27015-4 · Cited by 873 · see citing works
A cost-benefit analysis of electronic medical records in primary care
Wang, S. J., Middleton, B., Prosser, L. A., Bardon, C. G., Spurr, C. D., Carchidi, P. J., Kittler, A. F., Goldszer, R. C., Fairchild, D. G., Sussman, A. J., et al. (2003) · The American Journal of Medicine · doi:10.1016/s0002-9343(03)00057-3 · Cited by 740 · see citing works
Friedberg, M., Chen, P., Van Busum, K., Aunon, F., Pham, C., Caloyeras, J., Mattke, S., Pitchforth, E., Quigley, D., Brook, R., et al. (2014) · RAND Health Quarterly · doi:10.7249/rhq-03-04-01 · Cited by 707 · see citing works
Risk Management and Healthcare Policy
(2020) · Risk Management and Healthcare Policy · doi:10.2147/rmhp · Cited by 523 · see citing works
Design and Analysis of Cross-Over Trials
Jones, B. C., & Kenward, M. G. (2003) · Chapman & Hall/CRC eBooks · doi:10.1201/9781420036091 · Cited by 483 · see citing works
Electronic medical records and physician stress in primary care: results from the MEMO Study
Babbott, S., Manwell, L. B., Brown, R., Montague, E., Williams, E., Schwartz, M., Hess, E., & Linzer, M. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001875 · Cited by 366 · see citing works
Clinical Benefits of Electronic Health Record Use: National Findings
King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2013) · Health Services Research · doi:10.1111/1475-6773.12135 · Cited by 277 · see citing works
Holroyd-Leduc, J. M., Lorenzetti, D., Straus, S. E., Sykes, L., & Quan, H. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2010-000019 · Cited by 227 · see citing works
Factors Affecting Physician Professional Satisfaction
Friedberg, M. W., Busum, K. R. V., Chen, P. G., Aunon, F. M., Pham, C., Caloyeras, J. P., Mattke, S., Pitchforth, E., Quigley, D. D., Brook, R. D., et al. (2013) · RAND Corporation eBooks · doi:10.7249/rb9740 · Cited by 216 · see citing works
Predictors and Outcomes of Burnout in Primary Care Physicians
Rabatin, J. S., Williams, E. S., Manwell, L. B., Schwartz, M. D., Brown, R., & Linzer, M. (2015) · Journal of Primary Care & Community Health · doi:10.1177/2150131915607799 · Cited by 215 · see citing works
Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., Sattler, A., Mahoney, M., & Lin, S. (2017) · The Annals of Family Medicine · doi:10.1370/afm.2122 · Cited by 202 · see citing works
ClinicoEconomics and Outcomes Research
(2020) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor · Cited by 190 · see citing works
A Time-Motion Study of Primary Care Physicians’ Work in the Electronic Health Record Era
Young, R. A., Burge, S. K., Kumar, K. A., Wilson, J. M., & Ortiz, D. F. (2018) · Family Medicine · doi:10.22454/fammed.2018.184803 · Cited by 160 · see citing works
The Use of Medical Scribes in Health Care Settings: A Systematic Review and Future Directions
Shultz, C. G., & Holmstrom, H. L. (2015) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2015.03.140224 · Cited by 139 · see citing works
The Rise of the Medical Scribe Industry
Gellert, G. A., Ramirez, R., & Webster, S. L. (2014) · JAMA · doi:10.1001/jama.2014.17128 · Cited by 110 · see citing works
Bank, A. J., Obetz, C. L., Konrardy, A., Khan, A. H., Pillai, K., McKinley, B., Gage, R., Turnbull, M., & Kenney, B. (2013) · ClinicoEconomics and Outcomes Research · doi:10.2147/ceor.s49010 · Cited by 95 · see citing works
Scribes in an Ambulatory Urology Practice: Patient and Physician Satisfaction
Koshy, S., Feustel, P. J., Hong, M., & Kogan, B. A. (2010) · The Journal of Urology · doi:10.1016/j.juro.2010.03.040 · Cited by 83 · see citing works
Karter, A. J., Moffet, H. H., Liu, J. Y., Parker, M. M., Ahmed, A. T., Ferrara, A. M., & Selby, J. V. (2005) · PubMed · Cited by 80 · see citing works
Heaton, H. A., Castañeda-Guarderas, A., Trotter, E. R., Erwin, P. J., & Bellolio, F. (2016) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2016.07.056 · Cited by 75 · see citing works
Sankar, P. L. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.20.2378 · Cited by 49 · see citing works
Integration of Medical Scribes in the Primary Care Setting
Imdieke, B. H., & Martel, M. L. (2016) · Journal of Ambulatory Care Management · doi:10.1097/jac.0000000000000168 · Cited by 30 · see citing works
One Year of Family Physicians' Observations on Working with Medical Scribes
Sattler, A. L., Rydel, T. A., Nguyen, C. T., & Lin, S. (2018) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2018.01.170314 · Cited by 30 · see citing works
Use of Scribes for Documentation Assistance in Rheumatology and Endocrinology Clinics
Danila, M. I., Melnick, J. A., Curtis, J. R., Menachemi, N., & Saag, K. G. (2017) · JCR Journal of Clinical Rheumatology · doi:10.1097/rhu.0000000000000620 · Cited by 15 · see citing works
Primary Care Careers Among Recent Graduates of Research-Intensive Private and Public Medical Schools
Choi, P. A., Xu, S., & Ayanian, J. Z. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2286-z · Cited by 13 · see citing works
Five Lessons for Working With a Scribe.
Miller, N. S., Howley, I. W., & McGuire, M. (2017) · PubMed · Cited by 11 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Research shows shortage of more than 100,000 doctors by 2030 [press release]. Washington, DC: Association of American Medical Colleges; March 14, 2017.
- Pekham C. Medscape lifestyle report 2016: bias and burnout. Appl Clin Inform. 2018;09(01): 011-014. doi:10.1055/s-0037-1620263 · DOI
Cited by
Sorted by citations
Ambient artificial intelligence scribes to alleviate the burden of clinical documentation.
Tierney, A. A., Gayre, G., Hoberman, B., Mattern, B., Ballesca, M., Kipnis, P., Liu, V., & Lee, K. (2024) · NEJM Catalyst · doi:10.1056/cat.23.0404 · Cited by 400 · see citing works
Moy, A. J., Schwartz, J. M., Chen, R., Sadri, S., Lucas, E., Cato, K. D., & Rossetti, S. C. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaa325 · Cited by 284 · see citing works
“Researchers have often used unstandardized proxies to quantify burden which elucidates why no objective proxies exist.(6,13,14,25) Reinforcing the absence of empirical validation studies, there is a lack of an agreed-upon definition for burden and a plethora of definitions throughout the literature.”
BackgroundMethodElectronic health record usability, satisfaction, and burnout for family physicians.
Holmgren, A. J., Hendrix, N., Maisel, N., Everson, J., Bazemore, A., Rotenstein, L., Phillips, R. L., & Adler-Milstein, J. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.26956 · Cited by 56 · see citing works
Physician EHR Time and Visit Volume Following Adoption of Team-Based Documentation Support
Apathy, N. C., Holmgren, A. J., & Cross, D. A. (2024) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2024.4123 · Cited by 34 · see citing works
Time and Clerical Burden Posed by the Current Electronic Health Record for Orthopaedic Surgeons
Kesler, K., Wynn, M., & Pugely, A. J. (2022) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-21-00094 · Cited by 14 · see citing works
Lin, S., Duong, A., Nguyen, C., & Teng, V. (2021) · Academic Medicine · doi:10.1097/acm.0000000000003757 · Cited by 14 · see citing works
- Authors
- Mishra, P., Kiang, J. C., & Grant, R. W.
- Affiliations
- Kaiser Permanente (US)
- Corresponding author
- Mishra, Pranita
- ORCID
- Grant, Richard W.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2018-11-01
- Volume
- 178
- Issue
- 11
- Pages
- 1467
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6248201
- OpenAlex
- W2890157215
- Cited by
- 136
- References
- 32
- Citations by year
- 2026: 19 · 2025: 20 · 2024: 17 · 2023: 13 · 2022: 11 · 2021: 25 · 2020: 19 · 2019: 11 · 2018: 1
- FWCI
- 17.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK109114)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Diagnosis and Documentation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- medical scribes, electronic health records, patient experience, physician-patient interaction, integrated health system, crossover design, patient satisfaction, patient-physician communication, physician-patient relationship, physician burnout, physician well-being
- MeSH terms
- Documentation, Humans, Primary Health Care, Patient Satisfaction, Efficiency, Organizational, Workflow, Electronic Health Records, Physicians, Primary Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
