Virtual Scribe Services Decrease Documentation Burden Without Affecting Patient Satisfaction: A Randomized Controlled Trial

CATEGORY: Other INTRODUCTION/PURPOSE: Scribes are utilized as a means to reduce administrative burden on surgeons and enhance the physician- patient interaction. Virtual scribe services (VSS) are a contemporary take on the scribe that use a HIPAA-compliant smart device to record patient encounters for transmission, remote transcription, and insertion into the electronic medical record. The purpose of this study was to determine if the use of a VSS could decrease the total time an orthopaedic surgeon spends on documentation without diminishing the patient experience when compared to traditional post-encounter dictation (TD). METHODS: Patients presenting for a first-time visit with an orthopaedic foot and ankle surgeon were consented and randomized to VSS or TD prior to the physician-patient encounter. Time spent with the patient in the exam room and time used to document away from the patient were recorded. A validated post-encounter survey assessed patient satisfaction, perception of physician empathy, understanding of the plan, and perception of the amount of time spent with the physician on scales of 0 to 10. An a priori sample size calculation with an alpha level set at 0.05 and power of 80% estimated that 50 patients were necessitated to demonstrate a 2-minute difference in time spent documenting away from the patient. Comparisons were made using a two-sample Student’s t-test. RESULTS: Of the 50 patients enrolled, 25 were randomized to VSS. No differences in demographic characteristics were identified between cohorts (p>0.05 for each). Time spent documenting away from the patient differed between VSS and TD (1.19±0.65 minutes for VSS versus 5.80±1.70 minutes for TD, p<0.001) as did time elapsed between the end of the visit and the start of dictation (0±0 for VSS versus 123±70 minutes for TD, p<0.001). There was a trend towards more time spent with the patient in the VSS group than in the TD group (14.25±5.86 minutes versus 11.37±5.07 minutes, p=0.069). There were no differences between groups in survey responses regarding satisfaction, empathy, understanding, or perception of sufficient time spent with the physician (p>0.05 for each; Table 1). CONCLUSION: VSS in an orthopaedic foot and ankle practice decreases documentation time by approximately 4 minutes per new patient compared to TD, resulting in 2 hours of reclaimed physician time for every 30 new patients. With VSS, documentation is completed during the visit versus TD which is dictated on average 2 hours later. A validated survey identified no differences in patient satisfaction, perception of physician empathy and sufficient time spent with the physician, or understanding of the plan with VSS versus TD. Orthopaedic surgeons should consider VSS a HIPAA-compliant documentation option with time savings and no measurable difference in patient satisfaction.