***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Physicians dedicate substantial time to documentation . Scribes are sometimes used to improve efficiency by performing documentation tasks , although their impacts have not been prospect ively evaluated . Our objective was to assess a scribe program ’s impact on emergency department ( ED ) throughput , physician time utilization , and job satisfaction in a large academic emergency medicine practice . Methods We evaluated the intervention using pre- and post-intervention surveys and administrative data . All site physicians were included . Pre- and post-intervention data were collected in four-month periods one year apart . Primary outcomes included changes in monthly average ED length of stay ( LOS ) , provider-specific average relative value units ( RVUs ) per hour ( raw and normalized to volume ) , self-reported estimates of time spent teaching , self-reported estimates of time spent documenting , and job satisfaction . We analyzed data using descriptive statistics and appropriate tests for paired pre-post differences in continuous , categorical , and ranked variables . Results Pre- and post-survey response rates were 76.1 % and 69.0 % , respectively . Most responded positively to the intervention , although 9.5 % reported negative impressions . There was a 36 % reduction ( 25%–50 % ; p<0.01 ) in time spent documenting and a 30 % increase ( 11%–46 % , p<0.01 ) in time spent in direct patient contact . No statistically significant changes were seen in job satisfaction or perception of time spent teaching . ED volume increased by 88 patients per day ( 32–146 , p=0.04 ) pre- to post- and LOS was unchanged ; rates of patients leaving against medical advice dropped , and rates of patients leaving without being seen increased . RVUs per hour increased 5.5 % and per patient 5.3 % ; both were statistically significant . No statistically significant changes were seen in patients seen per hour . There was moderate correlation between changes in ED volume and changes in productivity metrics . Conclusion Scribes were well received in our practice . Documentation time was substantially reduced and redirected primarily to patient care . Despite an ED volume increase , LOS was maintained , with fewer patients leaving against medical advice but more leaving without being seen . RVUs per hour and per patient both increased PURPOSE Scribes are increasingly being used in clinical practice despite a lack of high- quality evidence regarding their effects . Our objective was to evaluate the effect of  medical scribes  on  physician satisfaction , patient satisfaction , and charting efficiency . METHODS We conducted a r and omized controlled trial in which physicians in an academic family medicine clinic were r and omized to 1 week with a scribe then 1 week without a scribe for the course of 1 year .  Scribes drafted all relevant documentation , which was review ed by the physician before attestation and signing . In encounters without a scribe , the physician performed all charting duties . Our outcomes were physician satisfaction , measured by a 5-item instrument that included physicians ’ perceptions of chart quality and chart accuracy ; patient satisfaction , measured by a 6-item instrument ; and charting efficiency , measured by time to chart close . RESULTS Scribes improved all aspects of physician satisfaction , including overall satisfaction with clinic ( OR = 10.75 ) , having enough face time with patients ( OR = 3.71 ) , time spent charting ( OR = 86.09 ) , chart quality ( OR = 7.25 ) , and chart accuracy ( OR = 4.61 ) ( all P values < .001 ) . Scribes had no effect on patient satisfaction .  Scribes increased the proportion of charts that were closed within 48 hours ( OR = 1.18 , P = .028 ) . CONCLUSIONS To our knowledge , we have conducted the first r and omized controlled trial of scribes . We found that scribes produced significant improvements in overall physician satisfaction , satisfaction with chart quality and accuracy , and charting efficiency without detracting from patient satisfaction .  Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout PURPOSE The increasing use of electronic medical records during the clinical encounter brings not only benefits but also barriers that may affect the doctor-patient relationship and increase the work burden of the physician . We evaluated whether the use of an electronic medical record scribe in an academic urology program would ameliorate these problems . MATERIAL S AND METHODS We r and omly assigned electronic medical record scribes to the office hours of 5 academic urologists , and using surveys we evaluated patient and physician acceptance and satisfaction . RESULTS Patients were accepting of an electronic medical record scribe  and satisfaction rates were high ( 93 % vs 87 % in the absence of a scribe , p = 0.36 ) . Patients were comfortable disclosing urological information in the presence of the scribe . Physicians were dramatically more satisfied with office hours when a scribe was present ( 69 % vs 19 % , p < 0.001 ) . We were unable to determine whether the presence of a scribe improves productivity . CONCLUSIONS Electronic medical record scribes in a urology practice may be a practical solution to provide documentation while maintaining or improving the doctor-patient relationship because they increase physician satisfaction and do not detract from patient satisfaction Background Use of electronic health records ( EHRs ) is associated with physician stress and burnout . While emergency departments and subspecialists have used scribes to address this issue , little is known about the impact of scribes in academic primary care . Objective Assess the impact of a scribe on  physician and patient satisfaction at an academic general internal medicine ( GIM ) clinic . Design Prospect i ve , pre-post-pilot study . During the 3-month pilot , physicians had clinic sessions with and without a scribe . We assessed changes in ( 1 ) physician workplace satisfaction and burnout , ( 2 ) time spent on EHR documentation , and ( 3 ) patient satisfaction . Participants Six GIM faculty and a convenience sample of their patients ( N = 325 ) at an academic GIM clinic . Main Measures A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout . Physicians used logs to record time spent on EHR documentation outside of clinic hours . A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe . Key Results Of six physicians , 100 % were satisfied with clinic workflow post-pilot ( vs. 33 % pre-pilot ) , and 83 % were satisfied with EHR use post-pilot ( vs. 17 % pre-pilot ) . Physician burnout was low at baseline and did not change post-pilot . Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session ( p = 0.02 ) . Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age , gender , and race . Compared to patients 65 years or older , younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present ( p = 0.03 and 0.02 , respectively ) . Male patients were more likely to report that they disliked having a scribe ( p = 0.03 ) . Conclusion In an academic GIM setting , employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction Objective Scribes have been used in the emergency department to improve physician productivity and patient interaction . There are no controlled , prospect i ve studies of scribe use in the clinic setting . Methods A prospect i ve controlled study compared st and ard visits ( 20 minute follow-up and 40 minute new patient ) to a scribe system ( 15 minute follow-up and 30 minute new patient ) in a cardiology clinic .  Physician productivity , patient satisfaction , physician – patient interaction , and revenue were measured . Results Four physicians saw 129 patients using st and ard care and 210 patients with scribes during 65 clinic hours each .  Patients seen per hour increased ( P < 0.001 ) from 2.2 ± 0.3 to 3.5 ± 0.4 ( 59 % increase ) and work relative value units ( wRVU ) per hour increased ( P < 0.001 ) from 3.5 ± 1.3 to 5.5 ± 1.3 ( 57 % increase ) . Patient satisfaction was high at baseline and unchanged with scribes . In a sub study , direct patient contact time was lower ( 9.1 ± 2.0 versus 12.9 ± 3.4 minutes ; P < 0.01 ) for scribe visits , but time of patient interaction ( without computer ) was greater ( 6.7 ± 2.1 versus 1.5 ± 1.9 minutes ; P < 0.01 ) . Subjective assessment of physician – patient interaction ( 1–10 ) was higher ( P < 0.01 ) on scribe visits ( 9.1 ± 0.9 versus 7.9 ± 1.1 ) . Direct and indirect ( downstream ) revenue per patient seen was $ 142 and $ 2,398 , with $ 205,740 additional revenue generated from the 81 additional patients seen with scribes . Conclusion Using scribes in a cardiology clinic is feasible , produces improvements in physician – patient interaction , and results in large increases in physician productivity and system cardiovascular revenue BACKGROUND Scribes are unlicensed professionals trained in medical data entry . Limited data exist on the impact of scribes on provider time management in the emergency department ( ED ) . Time-motion analysis is a tool utilized in business to capture detailed movements and duration s to task completion . It offers a means to categorize how providers allocate their time during a clinical shift . OBJECTIVE Evaluate the impact of scribes on how ED providers spend their time . METHODS A prospect i ve observational study was conducted to assess scribe impact on provider time utilization .  Four research assistants ( RAs ) observed attending providers on 24 8-h control shifts ( without a scribe ) , and 24 scribed shifts . RAs observed and categorized provider activity . Providers self-reported after-hours documentation times . Two- sample t-tests were used for normally distributed data , and Wilcoxon rank-sum tests were used for skewed data . All tests were two-sided , and p-values < 0.05 were considered statistically significant . RESULTS Scribes decreased total documentation time both on shift ( mean 55.3 vs. 36.4 min , p < 0.001 ) and post shift ( mean 42.5 vs. 23.3 min , p = 0.038 ) . They did not significantly decrease the amount of time spent review ing the medical records or placing orders , nor did they have an impact on provider time spent at patients ' bedside or time spent discussing patient care with team members . CONCLUSION The presence of scribes decreased provider documentation time but did not change the amount of time spent at the bedside or communicating with other team members . Scribes may be a potential strategy to decrease the clerical burden BACKGROUND Medical scribes are frequently incorporated into the patient care model to improve provider efficiency and enable providers to refocus their attention to the patient rather than the electronic health record ( EHR ) . The medical scribe program was based on four pillars ( objectives ): ( 1 ) provider satisfaction , ( 2 ) st and ardized documentation , ( 3 ) documentation components for risk adjustment , and ( 4 ) revenue enhancement . METHODS The medical scribe program was deployed in nine non-resident-supported clinics ( internal medicine , ophthalmology , orthopedics , hematology/oncology , urology ) , with the medical scribes ( who have no clinical duties ) supporting both physicians and advanced practice providers ( nurse practitioners and physician assistants ) . This paper describes a prospect i ve quasi-experimental study conducted at an academic , inner-city , hospital-based clinic system , RESULTS : A pre-post analysis showed positive results ; of the 51 providers , 44 responded to the survey pre and 41 responded post . Respondents in the post-scribe group felt that a scribe was valuable ( 90.2 % ) , that documentation time at the office improved ( 75.0 % poor or marginal pre-scribe , vs. 24 % post ; p < 0.0001 ) , and that time spent on the EHR at home declined ( 63.6 % with excessive or moderately high home EHR time pre vs. 31.7 % post ; p = 0.003 ) . More providers felt satisfied with their role in clinic with the use of scribes , and more providers felt that with scribes they could listen sufficiently to patients ( p < 0.05 ) . CONCLUSION Scribe support was well received across the institution in multiple clinical setting s. Benefits for providers were seen in documentation time and ability to listen to patients .  Scribes appear to be an effective intervention for improving clinician work life Background : Medical scribes are a clinical innovation increasingly being used in primary care . The impact of scribes in primary care remain unclear . We aim ed to examine the impact of medical scribes on productivity , time spent facing the patient during the visit , and patient comfort with scribes in primary care . Methods : We conducted a prospect i ve observational pre-post study of 5 family and internal medicine-pediatrics physicians and their patients at an urban safety net health clinic .  Medical scribes accompanied providers in the examination room and documented the clinical encounter . After an initial phase-in period , we added an additional 20-minute patient slot per 200-minute session . We examined productivity by using electronic medical record data on the number of patients seen and work relative value units ( work RVUs ) per hour . We directly observed clinical encounters to measure the amount of time providers spent facing patients and other visit components . We queried patient comfort with scribes by using surveys administered after the visit . Results : Work RVUs per hour increased by 10.5 % from 2.59 prescribe to 2.86 post-scribe ( P < .001 ) . Patients seen per hour increased by 8.8 % from 1.82 to 1.98 ( P < .001 ) . Work RVUs per patient did not change . After scribe implementation , time spent facing the patient increased by 57 % ( P < .0 
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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 .
First , a one-size-fits-all solution will be unlikely to work because of the significant variation in scribe work .
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 setting s. CONCLUSIONS Medical scribes perform complex and delicate work .