Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study

OBJECTIVE: Scribes have been used in the emergency department to improve physician productivity and patient interaction. There are no controlled, prospective studies of scribe use in the clinic setting. METHODS: A prospective controlled study compared standard 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 standard 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 substudy, 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.