Clinical Documentation during Scribed and Nonscribed Ophthalmology Office Visits

Purpose: To observe the impact of using scribes on documentation efficiency in ophthalmology clinics. Design: Single-center retrospective cohort study. Participants: A total of 29 997 outpatient visits conducted by 7 attending ophthalmologists between January 1, 2018, and December 31, 2019, were included in the study: 18 483 with a scribe present during the encounter and 11 514 without a scribe present. Methods: Use of a scribe. Main Outcome Measures: Total physician documentation time, physician documentation time during and after the visit, visit length, time to chart closure, note length, and percentage of note text edited by physician. Results: Total physician documentation time was significantly less when working with a scribe (mean +/- standard deviation, 4.7 +/- 2.9 minutes/note vs. 7.6 +/- 3.8 minutes/note; P < 0.001), as was documentation time during the visit (2.8 +/- 2.2 minutes/note vs. 5.9 +/- 3.1 minutes/note; P < 0.001). Physicians also edited scribed notes less, deleting 1.9 +/- 4.4% of scribes' draft note text and adding 14.8 +/- 11.4% of the final note text, compared with deleting 6.0 +/- 9.1% (P < 0.001) of draft note text and adding 21.2 +/- 15.3% (P < 0.001) of final note text when not working with a scribe. However, physician after-visit documentation time was significantly higher with a scribe for 3 of 7 physicians (P < 0.001). Scribe use was also associated with an office visit length increase of 2.9 minutes (P < 0.001) per patient and time to chart closure of 3.0 hours (P < 0.001), according to mixed-effects linear models. Conclusions: Scribe use was associated with increased documentation efficiency through lower total documentation time and less note editing by physicians. However, the use of a scribe was also associated with longer office visit lengths and time to chart closure. The variability in the impact of scribe use on different measures of documentation efficiency leaves unanswered questions about best practices for the implementation of scribes and warrants further study of effective scribe use. Ophthalmology Science 2021;1:100088 (c) 2021 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).