title: The use of medical scribes in health care settings: a systematic review and future directions.
abstract: BACKGROUND
  Electronic health records (EHRs) hold promise to improve productivity, quality, and outcomes; however, using EHRs can be cumbersome, disruptive to workflow, and off-putting to patients and clinicians. One proposed solution to this problem is the use of medical scribes. The purpose of this systematic review is to summarize the literature investigating the effect of medical scribes on health care productivity, quality, and outcomes. Implications for future research are discussed.
  
  
  METHODS
  A keyword search of the Cochrane Library, OvidSP Medline database, and Embase database from January 2000 through September 2014 was performed using the terms scribe or scribes in the title or abstract. To ensure no potentially eligible articles were missed, a second search was done using Google Scholar. English-language, peer-reviewed studies assessing the effect of medical scribes on health care productivity, quality, and outcomes were retained. Identified studies were assessed and the findings reported.
  
  
  RESULTS
  Five studies were identified. Three studies assessed scribe use in an emergency department, 1 in a cardiology clinic, and 1 in a urology clinic. Two of 3 studies reported scribes had no effect on patient satisfaction; 2 of 2 reported improved clinician satisfaction; 2 of 3 reported an increase in the number of patients; 2 of 2 reported an increase in the number of relative value units per hour; 1 of 1 reported increased revenue; 3 of 4 reported improved time-related efficiencies; and 1 of 1 reported improved patient-clinician interactions.
  
  
  CONCLUSIONS
  Available evidence suggests medical scribes may improve clinician satisfaction, productivity, time-related efficiencies, revenue, and patient-clinician interactions. Because the number of studies is small, and because each study suffered important limitations, confidence in the reliability of the evidence is significantly constrained. Given the nascent state of the science, methodologically rigorous and sufficiently powered studies are greatly needed.
authors.affiliation: From the Department of Family Medicine, University of Michigan, Ann Arbor. cshultz@med.umich.edu.
authors.forename: Cameron G
authors.initials: CG
authors.lastname: Shultz
authors.affiliation: From the Department of Family Medicine, University of Michigan, Ann Arbor.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Holmstrom
mesh_terms: D001291:Attitude of Health Personnel; D004282:Documentation / Q000379:methods*; D017598:Efficiency, Organizational; D057286:Electronic Health Records; D006801:Humans; D007588:Job Satisfaction; D017060:Patient Satisfaction; D011787:Quality of Health Care; D057188:Workflow
keywords: Electronic Health Records; Information Systems; Medical Economics; Medical Scribe; Review; Systematic