Taylor Kimberly A, McQuilkin Deborah, Hughes Ronda G
Naval Health Clinic Corpus Christi, Command Suite, 10651 E Street, Corpus Christi, TX.
University of South Carolina, College of Nursing, 1601Greene Street, Columbia, SC.
Mil Med. 2019 Oct 1;184(9-10):388-393. doi: 10.1093/milmed/usz030.
The electronic health record (EHR) has created additional administrative burdens on providers to perform data entry while trying to engage with the patient during the health care visit. Providers have become frustrated and distracted with the documentation requirements which further hindered connectivity, and communication with the patient. The utilization of medical scribes in the outpatient clinical setting was a strategy shown to enhance patient and provider interaction, decrease clinician's administrative tasks, and promote satisfaction among providers and patients. This was an innovative quality improvement pilot project to improve the patient and provider experience using scribes in an outpatient setting.
Two providers, to include one Family Medicine doctor and one Internal Medicine physician, and four hospital corpsmen participated in this pilot project. The four hospital corpsmen received a 2-week training of the fundamentals of the EHR and their role as scribes prior to the start of the project. Two corpsmen were designated for each provider and worked with their provider throughout the 12-week project period. The two primary aspects evaluated during the implementation of the scribes were the patient experience, and provider experience. Navy Medicine and the University of South Carolina Institutional Review Boards (IRB) considered this project exempt from full IRB review.
The experience questionnaire results indicated a slight mean decrease, but did not negatively impact patient satisfaction or overall patient experience. The local Medical Treatment Facility patient satisfaction, obtained through the Interactive Customer Evaluation, and the Joint Outpatient Experience Survey, indicated that there was no decrease in patient satisfaction or overall experience during the project period. The providers' experience improved with an average 50% decrease in time spent after hours documenting in the EHR, enhanced engagement with patient, staff, and ancillary team members, and improved work life balance. Additional findings of improved clinic efficiencies, completion of notes for both providers and positive qualitative comments from the scribes were identified.
In multiple settings, documentation requirements burden providers. The consideration of scribes could foster work life balance, retention, and wellness. The patient and provider experience was strengthened through the utilization of medical scribes, so future research centered on the provider and patient experience could be beneficial to organizations. Further study of the scribe's experience, especially considering the positive comments from the hospital corpsmen that participated as scribes during the project, could provide beneficial outcomes. Navy Medicine is advancing every opportunity to strengthen clinical and operational readiness, health and partnerships to provide the highest quality care and promote wellness for our patients. This type of quality improvement initiative could positively support readiness, quality and wellness for our organization, providers, and patients.
电子健康记录（EHR）给医疗服务提供者带来了额外的行政负担，即在医疗就诊过程中与患者互动的同时还要进行数据录入。医疗服务提供者对文档记录要求感到沮丧和分心，这进一步阻碍了与患者的沟通和联系。在门诊临床环境中使用医疗抄写员是一种已被证明可以增强患者与医疗服务提供者互动、减少临床医生行政任务并提高医疗服务提供者和患者满意度的策略。这是一个创新的质量改进试点项目，旨在通过在门诊环境中使用抄写员来改善患者和医疗服务提供者的体验。
两名医疗服务提供者，包括一名家庭医学医生和一名内科医生，以及四名医院军士参与了这个试点项目。在项目开始前，四名医院军士接受了为期两周的电子健康记录基础知识及其作为抄写员角色的培训。为每位医疗服务提供者指定两名军士，他们在整个为期12周的项目期间与各自的医疗服务提供者合作。在抄写员实施过程中评估的两个主要方面是患者体验和医疗服务提供者体验。海军医学和南卡罗来纳大学机构审查委员会（IRB）认为该项目可免于IRB的全面审查。
经验调查问卷结果显示平均略有下降，但并未对患者满意度或整体患者体验产生负面影响。通过交互式客户评估和联合门诊体验调查获得的当地医疗治疗机构患者满意度表明，在项目期间患者满意度或整体体验没有下降。医疗服务提供者的体验得到改善，在电子健康记录中记录非工作时间所花费的时间平均减少了50%，与患者、工作人员和辅助团队成员的互动增强，工作与生活的平衡得到改善。还发现了诊所效率提高、两位医疗服务提供者的记录完成情况以及抄写员的积极定性评价等其他结果。
在多种环境中，文档记录要求给医疗服务提供者带来负担。考虑使用抄写员有助于实现工作与生活的平衡、人员留用和健康。通过使用医疗抄写员，患者和医疗服务提供者的体验得到了加强，因此未来以医疗服务提供者和患者体验为中心的研究可能对各组织有益。对抄写员体验的进一步研究，特别是考虑到在项目中作为抄写员参与的医院军士的积极评价，可能会产生有益的结果。海军医学正在抓住每一个机会加强临床和行动准备、健康状况以及合作关系，以便为我们的患者提供最高质量的护理并促进健康。这种类型的质量改进举措可以积极支持我们组织、医疗服务提供者和患者的准备情况、质量和健康状况。
