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Michelle Hribar, Haley L Dusek, Isaac H Goldstein, Adam Rule, Michael F. Chiang; Documentation Composition and Efficiency During Scribed and Non-Scribed Ophthalmology Visits. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1587.
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There is growing interest in using scribes in outpatient clinics to mitigate the impact of electronic health records on efficiency, provider burnout, and patient-provider interaction. However, little is known about the impact of scribes in ophthalmology clinics. In this study, we examine the impact of scribes on documentation composition and efficiency in ophthalmology clinics.
We computed efficiency and documentation metrics for office visits from 1/1/2018 - 12/31/2018 for 7 ophthalmologists at Oregon Health & Science University Casey Eye Institute. We compared metrics for visits with and without scribes using Welch t-tests and linear mixed-effects models. Efficiency metrics included provider documentation time (total, during and after the visit), visit length, and time to chart closure. Documentation characteristics included note length and percent of note text edited by the provider.
Metrics were computed for a total of 14,149 outpatient visits: 7,990 with a scribe present and 6,159 without. Total provider documentation time was significantly less for visits with a scribe (mean ± SD, 4.7 ± 2.9 vs. 7.6 ± 3.7 minutes/note, P<.001), as was documentation time during the visit (2.7 ± 2.2 vs. 5.9 ± 3.2 minutes/note, P<.001). Providers also edited scribed notes less, deleting 1.7 ± 2.8 percent of scribed notes text and adding 13.6 ± 10.2 percent of final note text, compared to deleting 5.9 ± 7.1 percent (P<.001) and adding 22.1 ± 13.7 percent (P<.001) of text in notes prepared without a scribe. However, provider documentation time after the visit was significantly higher with scribes for 4 of 7 providers (P<.001). Scribe use was also associated with increases in office visit length of 6.0 minutes (P<.001) and time to chart closure of 4.3 hours (P<.001), as predicted by linear mixed-effects models.
Scribe use was associated with decreased total documentation time, documentation time during the visit, and percent of note text edited by providers. However, scribe use was also associated with increased office visit length and time to chart closure. The impact of scribes on workflow and documentation varied, warranting further study of how scribes and physicians might work together most effectively.
This is a 2020 ARVO Annual Meeting abstract.
Figure 1. Mean electronic health record documentation time among 7 ophthalmology providers with vs. without scribes by time of documentation. (* P<.001.)
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