TY - JOUR
T1 - Safe use of the EHR by medical scribes
T2 - A qualitative study
AU - Ash, Joan S.
AU - Corby, Sky
AU - Mohan, Vishnu
AU - Solberg, Nicholas
AU - Becton, James
AU - Bergstrom, Robby
AU - Orwoll, Benjamin
AU - Hoekstra, Christopher
AU - Gold, Jeffrey A.
N1 - Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Objective: Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. Materials and Methods: Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. Results: We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the "technical"dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The "environmental"dimension included the changing scribe industry and need for standards. Within the "personal"dimension, themes included the need for provider diligence and training when using scribes. Finally, the "organizational"dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. Conclusion: Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.
AB - Objective: Hiring medical scribes to document in the electronic health record (EHR) on behalf of providers could pose patient safety risks because scribes often have no clinical training. The aim of this study was to investigate the effect of scribes on patient safety. This included identification of best practices to assure that scribe use of the EHR is not a patient safety risk. Materials and Methods: Using a sociotechnical framework and the Rapid Assessment Process, we conducted ethnographic data gathering at 5 purposively selected sites. Data were analyzed using a grounded inductive/hermeneutic approach. Results: We conducted site visits at 12 clinics and emergency departments within 5 organizations in the US between 2017 and 2019. We did 76 interviews with 81 people and spent 80 person-hours observing scribes working with providers. Interviewees believe and observations indicate that scribes decrease patient safety risks. Analysis of the data yielded 12 themes within a 4-dimension sociotechnical framework. Results about the "technical"dimension indicated that the EHR is not considered overly problematic by either scribes or providers. The "environmental"dimension included the changing scribe industry and need for standards. Within the "personal"dimension, themes included the need for provider diligence and training when using scribes. Finally, the "organizational"dimension highlighted the positive effect scribes have on documentation efficiency, quality, and safety. Conclusion: Participants perceived risks related to the EHR can be less with scribes. If healthcare organizations and scribe companies follow best practices and if providers as well as scribes receive training, safety can actually improve.
KW - Electronic health records
KW - Medical scribes
KW - Patient safety
KW - Qualitative research
KW - Sociotechnical systems
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U2 - 10.1093/jamia/ocaa199
DO - 10.1093/jamia/ocaa199
M3 - Article
C2 - 33120424
AN - SCOPUS:85097387479
SN - 1067-5027
VL - 28
SP - 294
EP - 302
JO - Journal of the American Medical Informatics Association
JF - Journal of the American Medical Informatics Association
IS - 2
ER -