For a medical practitioner, technology plays many roles: teacher, communicator, and record keeper are just a few. But while technological advances have been critical in the evolution of health care, using technology effectively can be a balancing act between preserving the doctor-patient relationship and ensuring patients receive comprehensive care.

Such is the case for the electronic medical record, which has been evolving since the 1980s when focused efforts were made to use computers for record keeping purposes. Today, medical records are increasingly paperless, patient records are more accessible than ever before, and current refinements in the medical records industry are aimed at the continued specialization of systems to further streamline workflows, boost productivity, and improve doctor-patient interactions.

But these advancements are not without their challenges. The advent of the electronic health record (EHR) has created an overload of documentation and clerical responsibilities for the practitioner that, for some, has resulted in increased physician documentation workload and decreased interaction with patients.¹ A 2017 Medscape Practice Workflow Report indicates that approximately one-third of patients occasionally report frustration over clinician time spent on electronic health records.²

In order to free up clinician time, some practitioners are turning to medical scribe services. A medical scribe is an unlicensed individual who assists the clinician, performs documentation in the electronic health record, gathers information for the patient’s visit, and partners with the physician to deliver efficient patient care.¹

Elizabeth Board, MD, an IFM certified practitioner from Alpharetta, GA, uses medical scribes in her practice.

A 2018 study published in JAMA found that medical scribes were associated with decreased physician documentation burden, improved work efficiency, and improved visit interactions.³ In this study by Kaiser Permanente, researchers analyzed the work of medical scribes for 18 primary care physicians. Investigators spent a year studying one health system, across two medical centers, with physicians going through stretches of time with and without scribes.³

“Our results suggest that the use of scribes may be one strategy to mitigate the increasing electronic health records documentation burden among (primary care physicians), who are at the highest risk of burnout among physicians,” the authors wrote.

Beyond reducing the clerical burden for physicians, scribes may also benefit the patient experience, quality of care, clinic operations, and joy of practice.⁴ A small Canadian pilot study also showed that the use of scribes resulted in an increased number of patients seen per hour per physician.⁶ Scribes may also allow providers to face their patients, rather than the computer, thus restoring some aspects of the patient-provider relationship.⁶ For many Functional Medicine clinicians, scribes could be part of a successful collaborative care team that prioritizes the therapeutic encounter.

References

1. What is a medical scribe? Scribe America. https://www.scribeamerica.com/what_is_medical_scribe.html. Accessed October 1, 2018.
2. Kane L, Levy S. Medscape practice workflow report 2017: physicians’ bottlenecks, challenges, and time. Medscape. https://www.medscape.com/slideshow/physicians-practice-workflow-2017-6009059. Published September 13, 2017. Accessed October 8, 2018.
3. Mishra P, Kiang JC, Grant RW. Association of medical scribes in primary care with physician workflow and patient experience [published online September 17, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.3956.
4. Sattler A, Rydel T, Nguyen C, Lin S. One year of family physicians’ observations on working with medical scribes. J Am Board Fam Med. 2018;31(1):49-56. doi:10.3122/jabfm.2018.01.170314.
5. Graves PS, Graves SR, Minhas T, Lewinson RE, Vallerand IA, Lewinson RT. Effects of medical scribes on physician productivity in a Canadian emergency department: a pilot study. CMAJ Open. 2018;6(3):E360-E364. doi:10.9778/cmajo.20180031.
6. Zallman L, Finnegan K, Roll D, Todaro M, Oneiz R, Sayah A. Impact of medical scribes in primary care on productivity, face-to-face time, and patient comfort. J AM Board Fam Med. 2018;31(4):612-619. doi:3122/jabfm.2018.04.170325.

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