Department of Informatics, Donald Bren School of Informatics and Computer Science, University of California, Irvine, Irvine, California, USA.
Medical Scientist Training Program, School of Medicine, University of California, Irvine, Irvine, California, USA.
J Am Med Inform Assoc. 2020 May 1;27(5):808-817. doi: 10.1093/jamia/ocaa020.
Use of medical scribes reduces clinician burnout by sharing the burden of clinical documentation. However, medical scribes are cost-prohibitive for most settings, prompting a growing interest in developing ambient, speech-based technologies capable of automatically generating clinical documentation based on patient-provider conversation. Through a systematic review, we aimed to develop a thorough understanding of the work performed by medical scribes in order to inform the design of such technologies.
Relevant articles retrieved by searching in multiple literature databases. We conducted the screening process following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in guidelines, and then analyzed the data using qualitative methods to identify recurring themes.
The literature search returned 854 results, 65 of which met the inclusion criteria. We found that there is significant variation in scribe expectations and responsibilities across healthcare organizations; scribes also frequently adapt their work based on the provider's style and preferences. Further, scribes' job extends far beyond capturing conversation in the exam room; they also actively interact with patients and the care team and integrate data from other sources such as prior charts and lab test results.
The results of this study provide several implications for designing technologies that can generate clinical documentation based on naturalistic conversations taking place in the exam room. First, a one-size-fits-all solution will be unlikely to work because of the significant variation in scribe work. Second, technology designers need to be aware of the limited role that their solution can fulfill. Third, to produce comprehensive clinical documentation, such technologies will likely have to incorporate information beyond the exam room conversation. Finally, issues of patient consent and privacy have yet to be adequately addressed, which could become paramount barriers to implementing such technologies in realistic clinical settings.
Medical scribes perform complex and delicate work. Further research is needed to better understand their roles in a clinical setting in order to inform the development of speech-based clinical documentation technologies.
使用医疗抄写员分担临床文档记录的负担，从而减轻临床医生的倦怠感。然而，对于大多数医疗机构来说，医疗抄写员的成本过高，因此人们越来越感兴趣的是开发基于环境的、基于语音的技术，这些技术能够基于医患对话自动生成临床文档。通过系统综述，我们旨在深入了解医疗抄写员的工作，以便为这类技术的开发提供信息。
通过在多个文献数据库中检索相关文章。我们按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行筛选过程，然后使用定性方法分析数据，以确定反复出现的主题。
文献检索返回了 854 条结果，其中 65 条符合纳入标准。我们发现，医疗机构对抄写员的期望和职责存在显著差异；抄写员还经常根据提供者的风格和偏好调整自己的工作。此外，抄写员的工作远远超出了在检查室记录对话；他们还与患者和护理团队积极互动，并整合来自其他来源的数据，如先前的图表和实验室测试结果。
这项研究的结果为设计能够基于在检查室中进行的自然对话生成临床文档的技术提供了一些启示。首先，由于抄写员工作存在显著差异，一刀切的解决方案不太可能奏效。其次，技术设计人员需要意识到他们的解决方案可以发挥的作用有限。第三，为了生成全面的临床文档，此类技术可能需要纳入检查室对话之外的信息。最后，患者同意和隐私问题尚未得到充分解决，这可能成为在现实临床环境中实施此类技术的主要障碍。
医疗抄写员从事复杂而微妙的工作。需要进一步研究以更好地了解他们在临床环境中的角色，从而为基于语音的临床文档技术的开发提供信息。
