Developing a Medical Scribe Program at an Academic Hospital: The Hennepin County Medical Center Experience

Published:April 23, 2018DOI:https://doi.org/10.1016/j.jcjq.2018.01.001

      Background

      Medical scribes are frequently incorporated into the patient care model to improve provider efficiency and enable providers to refocus their attention to the patient rather than the electronic health record (EHR). The medical scribe program was based on four pillars (objectives): (1) provider satisfaction, (2) standardized documentation, (3) documentation components for risk adjustment, and (4) revenue enhancement.

      Methods

      The medical scribe program was deployed in nine non-resident-supported clinics (internal medicine, ophthalmology, orthopedics, hematology/oncology, urology), with the medical scribes (who have no clinical duties) supporting both physicians and advanced practice providers (nurse practitioners and physician assistants). This paper describes a prospective quasi-experimental study conducted at an academic, inner-city, hospital-based clinic system,

      Results

      A pre-post analysis showed positive results; of the 51 providers, 44 responded to the survey pre and 41 responded post. Respondents in the post-scribe group felt that a scribe was valuable (90.2%), that documentation time at the office improved (75.0% poor or marginal pre-scribe, vs. 24% post; p <0.0001), and that time spent on the EHR at home declined (63.6% with excessive or moderately high home EHR time pre vs. 31.7% post; p = 0.003). More providers felt satisfied with their role in clinic with the use of scribes, and more providers felt that with scribes they could listen sufficiently to patients (p <0.05).

      Conclusion

      Scribe support was well received across the institution in multiple clinical settings. Benefits for providers were seen in documentation time and ability to listen to patients. Scribes appear to be an effective intervention for improving clinician work life.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Joint Commission Journal on Quality and Patient Safety
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Martin S.A.
        • Sinsky C.A.
        The map is not the territory: medical records and 21st century practice.
        Lancet. 2016 Oct 22; 388: 2053-2056
        • Sinsky C.
        • et al.
        Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties.
        Ann Intern Med. 2016 Dec 6; 165: 753-760
        • Beasley J.W.
        • et al.
        Information chaos in primary care: implications for physician performance and patient safety.
        J Am Board Fam Med. 2011; 24: 745-751
        • Sinsky C.A.
        • et al.
        Electronic health records: design, implementation, and policy for higher-value primary care.
        Ann Intern Med. 2014 May 20; 160: 727-728
        • Tarafdar M.
        • et al.
        The impact of technostress on role stress and productivity.
        J Manag Inf Syst. 2007; 24: 301-328
        • HealthIT.gov
        EHR Incentives & Certification: Meaningful Use Definition & Objectives.
        (Updated:)
        • Funk K.A.
        • Davis M.
        Enhancing the role of the nurse in primary care: the RN “co-visit” model.
        J Gen Intern Med. 2015; 30: 1871-1873
        • Misra-Hebert A.D.
        • et al.
        A team-based model of primary care delivery and physician-patient interaction.
        Am J Med. 2015; 128: 1025-1028
        • Blash L.
        • et al.
        Clinics—Medical Assistant Terms Enhance Patient-Centered, Physician-Efficient Care.
        (Research Brief) Center for the Health Professions at UCSF, San Francisco2011
        • Hopkins K.
        • Sinsky C.A.
        Team-based care: saving time and improving efficiency.
        Fam Pract Manag. 2014; 21: 23-29
        • Anderson R.J.
        Optimizing the role of nursing staff to enhance physician productivity: one physician's journey.
        Fam Pract Manag. 2013; 20: 18-22
        • Arya R.
        • et al.
        Impact of scribes on performance indicators in the emergency department.
        Acad Emerg Med. 2010; 17: 490-494
        • Heaton H.A.
        • et al.
        Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis.
        Am J Emerg Med. 2016; 34: 2018-2028
        • Colla C.H.
        • et al.
        Spending differences associated with the Medicare Physician Group Practice Demonstration.
        JAMA. 2012 Sep 12; 308: 1015-1023
        • Imdieke B.H.
        • Martel M.L.
        Integration of medical scribes in the primary care setting: improving satisfaction.
        J Ambul Care Manage. 2017; 40: 17-25
        • Linzer M.
        • et al.
        Worklife and wellness in academic general internal medicine: results from a national survey.
        J Gen Intern Med. 2016; 31: 1004-1010
        • Sinsky C.A.
        • et al.
        Professional satisfaction and the career plans of US physicians.
        Mayo Clin Proc. 2017; 92: 1625-1635
        • Shanafelt T.
        • Goh J.
        • Sinsky C.
        The business case for investing in physician well-being.
        JAMA Intern Med. 2017 Dec 1; 177: 1826-1832
        • Schutte L.
        • Association of Staff Physician Recruiters
        What You Don't Know Can Cost You: Building a Business Case for Recruitment and Retention Best Practices.
        http://www.aspr.org/?696
        Date: 2012
        Date accessed: February 24, 2018
        • Noseworthy J.
        • et al.
        Physician Burnout Is a Public Health Crisis: a Message to Our Fellow Health Care CEOs.
        (Health Aff (Millwood) blog)
        https://www.healthaffairs.org/do/10.1377/hblog20170328.059397/full/
        Date: Mar 28, 2017
        Date accessed: February 24, 2018
        • Helfrich C.D.
        • et al.
        The association of team-specific workload and staffing with odds of burnout among VA primary care team members.
        J Gen Intern Med. 2017; 32: 760-766
        • Shimotsu S.
        • Poplau S.
        • Linzer M.
        Validation of a brief clinician survey to reduce clinician burnout.
        J Gen Intern Med. 2015; 30: S79-S80
        • Linzer M.
        • et al.
        Working conditions in primary care: physician reactions and care quality.
        Ann Intern Med. 2009 Jul 7; 151 (W6–W9): 28-36
        • Press Ganey
        Patient Experience—Patient-Centered Care.
        • Buchbinder S.B.
        • et al.
        Estimates of costs of primary care physician turnover.
        Am J Manag Care. 1999; 5: 1431-1438
      1. The Joint Commission. Standards FAQ Details. Accessed Jul 4, 2017. (No longer available.).

        • US Department of Health and Human Services
        Summary of the HIPAA Privacy Rule.
        • US Department of Health and Human Services
        Summary of the HIPAA Security Rule.

      Biography

      Marc L. Martel, MD, is Emergency Physician, Department of Emergency Medicine, and Co-Director, Medical Scribe Program, Hennepin County Medical Center (HCMC), Minneapolis.

      Biography

      Brian H. Imdieke, MAN, ANP-BC, is Nurse Practitioner and Co-Director, Medical Scribe Program, Division of General Internal Medicine, HCMC.

      Biography

      Kayla M. Holm, BS, formerly Medical Scribe, Department of Emergency Medicine, HCMC, is Lead Medical Scribe, Department of Emergency Medicine, Regions Hospital, St. Paul.

      Biography

      Sara Poplau, BA, is Assistant Director, Office for Professional Worklife, Division of General Internal Medicine, HCMC, and Senior Research Project Manager, Minneapolis Medical Research Foundation.

      Biography

      William G Heegaard, MD, MPH, MBA, is Emergency Physician, and Chief Medical Officer, Department of Emergency Medicine, HCMC, and Chief Medical Officer, Hennepin Healthcare, HCMC, Minneapolis.

      Biography

      Jon L. Pryor, MD, MBA, is a Urologist and Chief Executive Officer, Hennepin Healthcare, HCMC.

      Biography

      Mark Linzer, MD, is Physician, Division of General Internal Medicine, and Vice-Chair for Education, Mentorship and Scholarship in the Department of Medicine, HCMC.