Medical scribes in a community oncology clinic [abstract]
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Background: Recent reports have suggested that scribes may improve clinician satisfaction, productivity, and clinic-related efficiencies, while maintaining patient satisfaction; however, there is limited data on the use of scribes in the oncology setting. Methods: This quality improvement project assessed the practical and financial feasibility of using medical scribes in a community cancer center. Three oncologists utilized scribes for a six-month period. Physician productivity, timeliness and quality of physician electronic health-record (EHR) documentation, patient and physician satisfaction, and overall costs were measured and compared to the same time period for the previous year. Data were extracted and summarized from the EHR data warehouse. Patient and provider satisfaction were surveyed by questionnaire; quality of clinical documentation was evaluated by independent blinded reviewers for best-practices. Results: Physician average work RVU’s per clinic day did not change, but average number of new patient visits/day/physician increased by 29% (from 1.4 to 1.8). After scribe implementation, nearly all encounters were closed within 30 days of the visit (83% pre to 99.8% post). Participating oncologists showed marked improvements in satisfaction with the amount of time spent with patients, ability to complete documentation, and in their work-life balance compared to non-participating colleagues. Patient satisfaction was high at scribe implementation, and remained so through the study period. For patients that had a scribe, 90% were comfortable having a scribe present. Based on scored elements from institutional note optimization guidelines, EHR note quality improved from 76% to 98%. Conclusions: The use of medical scribes in a cancer clinic was well accepted by patients and physicians. Physicians maintained productivity, increased access and improved their workplace quality of life. Timeliness and quality of documentation improved. These outcomes can provide financial and patient safety benefits for the broader health-care organization. However, the use of scribes might be more costly than dictation or voice recognition software, and models for cost sharing should be explored.