Medical Scribes as an Input in Healthcare Production

The use of medical scribes has expanded greatly over the past decade, but there is little empirical research on the actual impact of scribes in the health care sector.  A scribe assists a patient’s care team by providing charting services in real time as the physician visit occurs.  These charts are then later reviewed and annotated by the physician.  Essentially, the labor tasks performed by the physician which require the least amount of human capital – charting - are taken from the highest human capital labor input – the physician – and given to a lower human capital labor input – the scribe. 

Scribes could increase the efficiency of care on several dimensions.  If physicians are relieved of the bulk of charting then they should become better at other production activities via gains from specialization.  This could have a beneficial impact on both the speed and quality of diagnosis, increasing the quality of care and decreasing patient wait times.  On the other hand, scribes could also make care more expensive, as they are an additional input whose cost may not be completely offset by efficiency gains.  Additionally as scribes are charting and coding specialists within electronic medical records (EMRs), it is possible that scribes could increase the value of the codes billed for in typical visits, as scribes have additional time and training in what needs to go into EMRs in order to bill for higher amounts (in fact this is often a selling point used by scribe companies).

This study seeks to answer the question of what is the effect of using scribes as an input in the production of medical services.  This is accomplished by using a randomized experimental design within a nine month scribe pilot in three emergency rooms run by the same emergency physician group. Scribes were randomly assigned to physician shifts in a stratified manner that balances the number of scribe and non-scribe shifts within doctor by weekday and weekend shifts, as well as by day and night shifts.

Preliminary findings show that the presence of a scribe reduces physician overtime – which is often spent completing unfinished charts.  The presence of a scribe also reduces the time between when the electronic medical record is opened and when a decision whether or not to admit the patient (which immediately follows diagnosis) is made.  There is heterogeneity in the results based on the experience of the scribe, and of the scribe/physician pairing.  Billing data has just arrived, and is presently being analyzed.

This study makes a contribution to the basic economic understanding of gains from specialization from splitting jobs apart based on their tasks.  Additionally, this study provides some of the first evidence as to the effect of using medical scribes, a relatively new tool in healthcare production.  Previous work on the topic of scribes is sparse and has been extremely limited; either relying on simple satisfaction surveys, naive before-after analysis of medical records, or small sample sizes.