How does medical scribes' work inform development of speech-based clinical documentation technologies? A systematic review

Abstract

Objective: 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.

Materials and methods: 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.

Results: 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.

Discussion: 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.

Conclusions: 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.

Keywords: Documentation [L01.453.245]; Electronic Health Records [E05.318.308.940.968.625.500]; Health Information Technology; Medical Scribe; Professional Burnout [C24.580.500]; Speech Recognition Software [L01.224.900.889]; Workflow [L01.906.893].

Figure 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) flow diagram.

Figure 2.

Longitudinal trend based on the volume of publications relevant to medical scribing.

Figure 3.

Work Model of Medical Scribes. CoW: computer on wheels; CPOE: computerized physician order entry; EHR: electronic health record; PC: personal computer.