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    How to use scribes to get off the computer and in front of patients


    Over a one-month period, 100 patients from Motion Sports MD were randomly asked to participate in an observational study before their visit. The group consisted of 58 men and 42 women. No other demographic information was collected. All visits were recorded with a high-resolution video camera positioned on a tripod in the corner of the room to maximize the view of the physician-patient encounter.

    The videos were later reviewed by a trained research assistant who recorded the times for each measured gaze behavior across the total visit length. The total visit length was defined as the total amount of time both the physician and patient were in the room excluding the physical exam. The physical exam was excluded from the total visit length due to it being a time of minimal communication and direct eye contact as the physician is focusing on examining different aspects of the patient’s body.


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    The gaze behaviors were measured in minutes. These included the amount of time the physician and patient had direct eye contact (direct gaze), the amount of time the physician and patient were both looking at the computer screen (screen sharing), and the amount of time the physician and patient were looking elsewhere (no gaze). Finally, descriptive statistics were reported for each gaze behavior coded using SPSS software.

    The average total visit length was 8.31 ± 3.94 minutes across the 100 patient encounters. Direct gaze occurred for an average of 6.72 ± 3.29 minutes during a patient encounter, which translated into 81.8% of the total visit length. The physician and patient spent an additional 1.13 ± 1.29 minutes of the patient encounter screen sharing (11.88% of the visit). The physician only spent an average of 6.31% of the total visit length gazing elsewhere (0.47 ± 0.54 minutes).


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    This study illustrates the power of the EHR system when combined with the use of scribes. Having an effective EHR design allows physicians to get off of the computer and to have more meaningful encounters with their patients. Yet, many physicians are struggling with how to use EHR and maintain patient satisfaction. Formal education on ways to implement EHR and other technology into a medical practice can prevent the trial and error process the EHR system has become for many physicians.

    Standardized training for scribes can also help physicians transition more easily to an EHR system and spend more of their time focusing on patients. When a scribe has a thorough understanding of how to operate the EHR system and what to expect during a patient encounter, then he or she can be more easily relied upon to do the majority of the physician’s charting. This results in a medical practice that is more profitable, more efficient, and that has a higher patient satisfaction.


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    • Anonymous
      A scribe shouldn't be in the room without patient consent first and foremost. If the patient is there for a physical for example, I'm sure they don't want someone else in the room with them. A scribe in the room will only serve to inhibit the patient so they won't really talk to their physician whereby wasting everyone's time. Not a good idea. Regards, Raffie
    • UBM User
      the authors tell us that emr "promotes quality care by improving provider to provider communication,endorsing pt safety,and promoting pt to pt relationships etc.I have searched high and low for any RCTs that come close to proving this I know that is the intent but other than wishful thinking I ask the authors to show any RCTs that prove this.EMR is are a failure in office practice and are now optional in many countries A nassive waste , burden saves no money and does not improve care except for the bank accounts of vendors ,coders and bureaucrats
    • Anonymous
      Scribes is such a great idea! Who pays for them? Are they reimbursed by insurance companies? Why does my office have to hire a coder to assign special codes for what I do so their insurance company will pay me? Can I get that reimbursed as well? That has nothing to do with medicine. It's just one more overhead/admin item that gets in the way of me treating my patients. Speaking of getting in the way, where will this scribe stand? My exam rooms (I practice in downtown Washington DC where office space is a premium) are already sometimes too tight for the patient and a family member. I feel like so much of the way medicine is heading is not based in practical reality (ie. getting paid based on customer satisfaction). That's like trying to befriend your kid....it's not a popularity contest and often I'm handing down advice my patients do not want to hear or they would already have healthy habits (eat less, stop smoking, move more). Oh well....let's just kick the can for the next generation of doctors and patients to fix, ahem, deal with.

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