Medical Record Closure Practices of Physicians Before and After the Use of Medical Scribes.

This study uses electronic health record data to evaluate medical record closure outcomes before and after the use of medical scribes at a large academic medical center.

One Year of Family Physicians' Observations on Working with Medical Scribes.

PURPOSE: The immense clerical burden felt by physicians is one of the leading causes of burnout. Scribes are increasingly being used to help alleviate this burden, yet few published studies investigate how scribes affect physicians' daily work, attitudes and behaviors, and relationships with patients and the workplace. METHODS: Using a longitudinal observational design, data were collected, over 1 year, from 4 physicians working with 2 scribes at a single academic family medicine practice. Physician experience was measured by open-ended written reflections requested after each 4-hour clinic session. A data-driven codebook was generated using a constant comparative method with grounded theory approach. RESULTS: A total of 361 physician reflections were completed, yielding 150 distinct excerpts; 289 codes were assigned. The 11 themes that emerged were further categorized under 4 domains. The most frequently recurring domain was clinic operations, which comprised 51.6% of the codes. Joy of practice, quality of care, and patient experience comprised 22.1%, 16.3%, and 10.0% of the codes, respectively. CONCLUSIONS: Our study suggests that integrating scribes into a primary care clinic can produce positive outcomes that go beyond reducing clerical burden for physicians. Scribes may benefit patient experience, quality of care, clinic operations, and joy of practice.

The Role of Health Information Management Professionals in the Use of Geographic Information Systems.

In recent years the use of geographic information systems (GIS) in healthcare has expanded rapidly. Although the use of GIS has increased quickly, very little consensus has been reached on which healthcare professionals are best suited to be trained in and use GIS. A moderate amount of research has addressed the use of GIS in healthcare, but very little research has addressed selecting and training healthcare professionals in the area of GIS. As the use of GIS becomes more closely tied to electronic health records (EHRs), the thought arises that those best versed in EHRs, health information management (HIM) professionals, would be best suited to take on the GIS role. This mixed-methods study explored the current status of HIM professionals' role in GIS as well as the extent to which GIS is being taught in health information educational programs. Although the findings indicate that few HIM professionals are currently using GIS in their jobs and few HIM programs are currently teaching GIS, there is interest in GIS in the future for HIM professionals and in HIM educational programs.

Impact of scribes on emergency department patient throughput one year after implementation.

OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation. METHODS: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity. RESULTS: Adult: Overall length of stay (LOS) was essentially the same in both groups (214 vs. 215min, p=0.34). In area A where staffing includes an attending and residents, scribes made a significant impact in treatment room time in the afternoon (190 vs 179min, p=0.021) with an increase in patients seen per hour on scribed days (2.00 vs. 2.13). There was no statistically significant changes in throughput metrics in area B staffed by an attending and a nurse practitioner/physician assistant, however scribed days did average more patients per hour (2.01 vs. 2.14). Pediatric: All throughput measurements were significantly longer when the treatment team had a scribe; however, patients per hour increased from 2.33 to 2.49 on scribed days. CONCLUSIONS: Overall patient throughput was not enhanced by scribes. Certain areas and staffing combinations yielded improvements in treatment room and door to provider time, however, scribes appear to have enabled attending physicians to see more patients per hour. This effect varied across treatment areas and times of day.

Integration of Medical Scribes in the Primary Care Setting: Improving Satisfaction.

There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes.

A cost-consequences analysis of a primary care librarian question and answering service.

BACKGROUND: Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). METHODS: We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. RESULTS: The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. CONCLUSIONS: The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

Medical scribes.

Medical scribes and electronic health records (EHRs) are increasingly being introduced into ambulatory clinics with variable outcomes. Characteristics of a successful implementation of medical scribes are described. Tips for optimization of the composition and presentation of the EHR as well as medical processes associated with medical documentation are presented.

A transdisciplinary approach to faculty development in nursing education technology.

The purpose of this article is to describe the creation of a transdisciplinary group, consisting of nurse educators, a medical librarian, lab technologists, and a technology expert. to lead the integration of electronic health technology, including high-fidelity simulation, handheld technology, and electronic health records, within a school of nursing. The use of innovative educational tools by nursing faculty can be daunting because of the steep learning curve. The model described here is effective in developing faculty to use simulation and other technologies as teaching-learning strategies.

Some unintended effects of teamwork in healthcare.

Teamwork has been emphasised as a key feature of health service reform, essential for safe, efficient and patient-centred care. Bringing together literatures from the sociology of healthcare and organizational theory, we examine how the teamwork phenomenon plays out in practice. Drawing upon material from two ethnographic studies, conducted in an operating theatre and a medical-records department in separate UK NHS hospitals, we explore some of the discursive teamwork practices of healthcare staff. Our analysis presents a very different picture from the normative, evangelistic promotion of teamwork within much management and health policy writing. We reveal how the ambiguity of teamwork opens up opportunities for a complex, diverse range of responses to the managerial discourse among diverse occupational groups, mobilizing the discourse to enact identity in different ways. We highlight how teamwork discourse can be instrumentally co-opted in the reproduction of the very occupational divisions it is designed to ameliorate, or simply ignored as irrelevant when compared to more attractive forms of collective identity. These responses challenge both those who believe that teamwork is a solution to problems in healthcare, as well as those concerned about the oppressive effects of pervasive managerialism.

Do you know who's who in your EHR?

Overlay and duplicate records pose a particularly insidious problem today for healthcare organizations--and pediatric hospitals in particular--that are introducing new information systems or upgrading their existing systems. Such erroneous records can be costly and time-consuming to identify and correct, and can lead to lost reimbursement and compromised quality of care. To address the problem, senior financial leaders need to recognize the critical importance of data integrity and take steps to ensure that the people and processes are in place to establish and maintain it.

The role of HIM professionals in quality management.

HIM professionals have always been actively involved in various aspects of healthcare quality management. In the decade since publication of To Err Is Human, the scope and volume of quality management activities have accelerated. Having quality at the forefront of the national agenda has inevitably created employment opportunities as well as expansion of professional responsibilities. This article describes the contemporary quality-related functions of HIM professionals and the core competencies necessary to support these functions.