Scribes May Help Relieve Physicians Burdened by EHR Tasks

Since primary care physicians spend more than half their workday on electronic health record (EHR) tasks, employing scribes to chart data could alleviate the burden on physicians and improve efficiency.

A new study in Annals of Family Medicine indicates that primary care physicians spend nearly 6 hours each workday in their EHR system, which could put them at risk of dissatisfaction and burnout. However, research published in the same issue finds that using scribes for charting duties can drastically improve physician satisfaction.

The first article asserts that physicians are “tethered to the EHR” based on its review of event logs from an EHR used by 142 physicians in a Wisconsin health system. The logs allowed the researchers to determine the time a user spends interacting with each module of the EHR. The possible events include taking notes during patient visits, billing and coding, remote communication with patients, and entering orders.

On average, physicians spent 5.9 hours (4.5 during clinic hours and 1.4 after) using the EHR per weekday, adding up to a total workday of 11.4 hours. Almost half (44.2%) of the EHR time was spent on clerical tasks, while 23.7% was spent managing their inbox.

The study authors wrote that these findings have important implications for redesigning the workflow of primary care, considering the increased workload and associated burnout that could result from spending too much time on the EHR. Possible solutions included increasing the amount of face-to-face communication between practice staff and physicians, as well as having clinical staff assist with documentation or order entry.

One resource that could be used to help ease the burden of EHR use on clinicians is the use of scribes, according to the second study. It reports the findings of a small trial where 4 physicians in a family medicine clinic were randomly assigned to practice with or without a scribe each week for a year.

The scribe was responsible for attending visits to take notes on patient history, exam findings, laboratory and imaging results, diagnosis, and patient instructions. After being entered into the EHR by the scribe and approved by the physician, the chart was then closed. When practicing without a scribe, physicians would be responsible for these charting and entry duties.

Physician satisfaction as measured through questionnaires was significantly higher when a scribe was assisting. Having a scribe was associated with higher adjusted odds of expressing high satisfaction with the clinic, having enough face time with patients, and expressing high satisfaction with the amount of time they spent charting. Physicians also reported higher satisfaction with the quality and accuracy of their charts, although they were less satisfied with accuracy at first when working with a new scribe.

Scribes did not have a significant effect on patient satisfaction, which was high regardless of their presence, but they did improve the efficiency of charting. Charts made by a scribe had 1.18 times higher adjusted odds of being closed within 48 hours than those entered by a physician.

The study authors acknowledged that while scribes are “an immediate solution that can be implemented," more substantial EHR redesign will be needed to further alleviate physician burden from the "onerous and time-consuming problem" that EHRs represent for physicians.

“By reducing the time that physicians spend on clerical tasks, scribes serve an important function in a multidisciplinary health care team,” the researchers concluded.