Scribes in primary care increase productivity and face time with patients

Since the introduction of electronic medical records (EMRs), primary care physicians (PCPs) have been overwhelmed with data entry, documentation, and paperwork—not to mention that EMRs draw PCPs away from face-to-face encounters with patients. Researchers have now shown that the use of medical scribes in primary care allows physicians to see more patients in a day—and actually see more of the patient rather than a computer screen.

In a recently published study in the Journal of the American Board of Family Medicine, the researchers reported that using medical scribes:

• increased productivity per hour by 10.5% (in work relative value units, RVUs)
• increased patients seen per hour by 8.8%
• increased time spent facing the patient by 57%
• decreased time spent facing the computer by 27%

“Our study is the first to demonstrate increased productivity and time spent facing patients after medical scribe implementation in primary care,” wrote researchers led by Leah Zallman, MD, MPH, assistant director of research, Institute for Community Health, Malden, MA.

Dr. Zallman and colleagues conducted this prospective observational study at a safety-net urban primary care clinic between March 2016 and April 2017. The study included 5 family and internal medicine physicians, as well as 7 scribes. The scribes helped PCPs document clinical encounters, which the physicians later reviewed and edited. Scribes were present for approximately 90% of patient sessions.

At the end of the study period, RVUs per hour had increased (by 10.5%) as did patients per hour (by 8.8%) compared with the time before using scribes. Neither RVUs per patient nor the proportion of charts closed by the end of the day had changed significantly, though.

“Medical scribes could increase productivity through two mechanisms: by allowing more patients to be seen in the same amount of time and by supporting documentation that allows the provider to bill at higher rates per patient,” wrote Dr. Zallman and coauthors. “We found that RVUs per patient did not increase, suggesting that the mechanism for increased productivity was the availability of an additional patient slot per session.”

Although increased productivity is a standout feature of this model, the amount of time providers spend per patient is also important, researchers noted. Their results showed increases in both face-to-face time (by 57%) and the proportion of a visit that a PCP spent face-to-face with a patient (by 39%), as well as a decrease in computer time (by 27%).

From the patient’s perspective, most (69%) said they felt perfectly comfortable with the scribe in the room. The downside: Exam rooms can be small, and the proportion of patients who felt very comfortable with the number of people in the room decreased by nearly one-third (from 93% to 66%).

The researchers acknowledged that their study was limited in size and scope, and thus requires further investigation. “Although the full implications of medical scribe implementation remain to be seen, this initial study highlights the promising opportunity of medical scribe implementation in primary care,” they concluded.