Comparing Scribed and Non-scribed Outpatient Progress Notes

Abstract

Working with scribes can reduce provider documentation time, but few studies have examined how scribes affect clinical notes. In this retrospective cross-sectional study, we examine over 50,000 outpatient progress notes written with and without scribe assistance by 70 providers across 27 specialties in 2017-2018. We find scribed notes were consistently longer than those written without scribe assistance, with most additional text coming from note templates. Scribed notes were also more likely to contain certain templated lists, such as the patient's medications or past medical history. However, there was significant variation in how working with scribes affected a provider's mix of typed, templated, and copied note text, suggesting providers adapt their documentation workflows to varying degrees when working with scribes. These results suggest working with scribes may contribute to note bloat, but that providers' individual documentation workflows, including their note templates, may have a large impact on scribed note contents.

Figure 1:

Difference in mean note length between notes written with and without scribes, by provider.

Figure 2:

Mean number of note characters by source of note text and author for notes written with and without scribes.

Figure 3:

Average (mean) difference in source of note text for providers with the largest increase and largest decrease in note length between notes written with and without scribe assistance.

Figure 4:

Average (mean) difference in source of note text between notes written with and without scribe assistance for providers in the four specialties with the most study encounters.