Remote scribes may reduce burnout by cutting time spent on EHR

Using remote scribes may reduce burnout and the time spent in electronic health records (EHR) for primary care physicians.

Doctors working with remote scribes cut their time in EHR by 1.14 hours per eight hours of patient scheduled time, mostly due to less work with patient notes. They cut more than a half hour off their EHR time outside of scheduled work, according to a new study.

Meanwhile, physicians working with remote scribes described a decrease in burnout from 70.3% to 51.4%. At the same time, feelings of burnout increased from 50% to 60.3% for a control group of doctors not working with remote scribes.

The results were part of “The effect of remote scribes on primary care physicians’ wellness, EHR satisfaction, and EHR use,” published in the journal Healthcare.

“A remote scribe program was associated with improvements in physician wellness and reduced EHR use,” the study said. “Health care organizations can consider scribe programs to help improve wellness among their physician workforce.”

Working remotely

The study involved 38 internists, family medicine physicians and general pediatrics and adolescent medicine physicians in primary care clinics of University of Wisconsin Health. The group, including included lead author Mark A. Micek, MD, MPH, used audio-only cellular telephone connections to with off-site scribes to document notes of clinical sessions.

Another 160 physicians continued practicing without using scribes. Second author Brian Arndt, MD, joined the control group.

COVID-19 pandemic lockdowns disrupted the study period, so the researchers compared findings for five-month periods from March to August 2019 and May 31, 2020, through Oct. 31, 2020. After the pandemic lockdowns, the remote scribes assisted with in-person and telemedicine visits.

The EHR system had a built-in time recorder for physicians, who also answered the Mini-Z Burnout Survey. Those with scribes reported improvements in wellness metrics such as joyful workplace, and a 10.4% increase in the percentage of orders with team contribution, the study said.

Factors to consider

The authors said theirs was an early study using remote scribes instead of in-person scribes who accompany clinicians into exam rooms with patients. Remote scribes may be easier to manage logistically and may be less intrusive for physician-patient encounters, the study said.

The scribes did not reduce all physician work. Participating doctors had to review the notes and agreed to see one additional patient per half-day clinic session to offset program costs, the study said.

The scribes did not significantly change physicians’ satisfaction with EHR, and did not alter burnout measured by work exhaustion, interpersonal disengagement, and professional fulfillment. Those “may depend on aspects of work that are not affected by our scribe intervention,” the researchers said.

For the study, physicians working with scribes had a 97.4% response rate for surveys, which was an expectation of the program, but the control group response rate was relatively low at 42.5%, the study said.

The researchers acknowledged the COVID-19 pandemic disrupted clinical operations, but the patient visit volumes at least stabilized, if not normalized to pre-pandemic levels, for the second part of the study. It was unclear if the findings would apply to other academic or nonacademic settings.