Abstract
Purpose :
Scribes have been shown to improve patient and provider satisfaction, and decrease documentation burden. Many ophthalmology clinics have adopted their use, but there has not been significant analysis of their impact on documentation. This study examines the effect of scribe use in ophthalmology clinics at Oregon Health and Science University Casey Eye Institute on metrics including office visit length, documentation time, and note length.
Methods :
Encounters from July 2015 to September 2018 for four comprehensive ophthalmologists were classified as having a scribe present or absent based on documentation in EHR progress notes. Metrics were obtained from the EHR audit log using previously published methods: office visit length (patient check in to check out), ophthalmologist documentation time (during and after the visit), time to closure (patient check in to encounter close), and note length. For each provider, the mean value for each metric was calculated for office visits with scribes and without. Means were compared using Welch’s t-test and linear-mixed effect models to determine the fixed effect of scribe presence, controlling for patient and provider.
Results :
A total of 17,608 total office visits analyzed: 13,270 with scribes and 4338 without. Table 1 shows the means for each metric, with and without scribes, for each provider and overall. Both the t-tests and the linear mixed-effect model showed significant decreases in documentation time (during and overall) and significant increases in note length with a scribe. The mixed model determined the use of scribes was associated with a decrease of 1.9 minutes during the visit (p <0.0001), 2.7 minutes overall (p <0.0001), and a 640 character increase in note length (p<0.0001). The linear mixed-effect model showed the use of scribes was associated with decreases in documentation time after the visit (0.79 minutes, p <0.0001) and time to closure (1.8 hours, p=0.0141). Neither model showed significant change in office visit length.
Conclusions :
Scribe use in ophthalmology clinics significant reduction in provider documentation time. While this is promising for EHR burden, our results also suggest that scribe use may have unanticipated consequences such as increased note length raising further questions about accuracy, impact and authorship within the EHR.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.