title: Physician, Scribe, and Patient Perspectives on Clinical Scribes in Primary Care.
abstract: Extending medical assistants and nursing roles to include in-visit documentation is a recent innovation in the age of electronic health records. Despite the use of these clinical scribes, little is known regarding interactions among and perspectives of the involved parties: physicians, clinical scribes, and patients.
  
  
  
  The purpose of this project is to describe perspectives of physicians, clinical scribes, and patients regarding clinical scribes in primary care.
  
  
  
  We used qualitative content analysis, using Interpretive Description of semi-structured audio-recorded in-person and telephone interviews.
  
  
  
  Participants included 18 physicians and 17 clinical scribes from six healthcare systems, and 36 patients from one healthcare system.
  
  
  
  Despite physician concerns regarding terminology within notes, physicians, clinical scribes, and patients perceived more detailed notes because of real-time documentation by scribes. Most patients were comfortable with the scribe's presence and perceived increased attention from their physicians. Clinical scribes also performed more active roles during a patient visit, leading to formation of positive scribe-patient relationships. The resulting shift in workflow, however, led to stress. Our theoretical model for successful physician-scribe teams emphasizes the importance of interpersonal aspects such as communication, mutual respect, and adaptability, as well as system level support such as training and staffing.
  
  
  
  Both interpersonal fit between physician and scribe, and system level support including adequate training, transition time, and staffing support are necessary for successful use of clinical scribes. Future directions for research regarding clinical scribes include study of care continuity, scribe medical knowledge, and scribe burnout.
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue/NA21, Cleveland, OH, 44195, USA.
authors.forename: Chen
authors.initials: C
authors.lastname: Yan
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue/NA21, Cleveland, OH, 44195, USA.|Department of Bioethics, Center for Ethics Humanities and Spiritual Care, Cleveland Clinic, 9500 Euclid Avenue, JJ60, Cleveland, OH, 44195, USA.
authors.forename: Susannah
authors.initials: S
authors.lastname: Rose
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: Department of Bioethics, Center for Ethics Humanities and Spiritual Care, Cleveland Clinic, 9500 Euclid Avenue, JJ60, Cleveland, OH, 44195, USA.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Mercer
authors.affiliation: Department of Family Medicine, Cleveland Clinic, BD10, 26900 Cedar Road, Beachwood, OH, 44122, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Goodman
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA. misraa@ccf.org.
authors.forename: Anita D
authors.initials: AD
authors.lastname: Misra-Hebert
mesh_terms: D057286:Electronic Health Records / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D066209:Medical Writing / Q000592:standards; D009726:Nurses / Q000592:standards; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods* / Q000592:standards
keywords: doctor–patient relationships; patient centered care; primary care; primary care redesign; qualitative research