​Use of medical scribes could mitigate the burden related to electronic health record (EHR) documentation and subsequent burnout, according to a study in the November 2018 issue of JAMA Internal Medicine. The authors conducted a crossover study of 18 primary care physicians at two medical facilities with an integrated healthcare system from July 1, 2016, to June 30, 2017. The primary care physicians were randomly assigned to start either with medical scribes or without them then alternate exposure every three months for the year. According to physician self-reports, medical scribes were associated with decreased EHR burden, improved work efficiency, and improved visit quality. The current shortage of primary care physicians will get significantly worse in the next two decades, the authors said, as fewer new doctors enter the field and more leave prematurely because of burnout. Burnout is a complex issue, the authors said, but evidence shows that EHR adoption is leading to increased burnout rates. An accompanying editorial agreed that scribes are an effective option to decrease EHR burden, but that they are costly and should be a short-term strategy. Long-term solutions include finding more efficient ways to document changing billing requirements, the authors said.

HRC Recommends: Nearly all healthcare workers are affected by EHR implementation or transition to a new EHR system. This type of culture change can be more challenging than technology issues or budgetary concerns associated with the transition. Change management techniques are helpful when addressing culture change. Risk managers should help the organization to recruit clinical champions from all provider groups (e.g., physicians, nurses, and other providers) at the outset of the project to offer input into design, workflow, and live support. Encourage using the hands-on method to train staff. Trainers should shadow clinicians so that questions can be answered on the spot. By so doing, lessons learned can be translated immediately into the provider's clinical practice.