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Perspectives on Safety > Interview
Safety of Medical Scribes, August 2019
Dr. Smith is Chief Faculty Practices Officer for UCSF Health and a family medicine physician. Over the past 3–4 years, the health system has implemented a robust program using medical scribes in the outpatient setting. We spoke with her about her experience implementing this program, including the benefits and some of the potential patient safety ramifications.
Journal Article > Study
Sinsky C, Colligan L, Li L, et al. Ann Intern Med. 2016;165:753-760.
Time spent with the electronic health record and performing administrative tasks has been linked to physician burnout, an important patient safety problem. This study used direct observation and time diaries to characterize the work of outpatient physicians. Investigators found that physicians spent about one-quarter of their time face-to-face with patients. Nearly half their work day was spent using the electronic health record and doing desk work. Participating clinicians spent 1–2 additional hours on the electronic health record at night. A PSNet interview with lead author Christine Sinsky calls for improving physician work satisfaction in order to improve patient safety.
Wachter R, Goldsmith J. Harv Bus Rev. March 30, 2018.
Increased workload associated with electronic health record (EHR) documentation contributes to physician burnout. Describing challenges associated with poor user interface of EHRs, this magazine article recommends use of artificial intelligence, redesigning workflow, and enhancing alert systems to improve the usefulness of EHRs.
Journal Article > Commentary
Downing NL, Bates DW, Longhurst CA. Ann Intern Med. 2018;169:50-51.
Professional burnout is a pervasive problem among health care workers that can have serious effects on patient safety. Despite the recent focus on how poor design of information technology contributes to burnout, this commentary advocates for a broader approach to addressing the problem. The authors suggest that regulation and the associated billing requirements are the root causes of the documentation burden and offer recommendations to address them.
Journal Article > Commentary
Wachter RM, Howell MD. JAMA. 2018;320:25-26.
The impact of electronic health records has thus far been disappointing for many clinicians, with limited effect on patient safety and growing concern that electronic health records may contribute to physician burnout. This commentary discusses the productivity paradox of information technology—the fact that digitization often initially impedes productivity rather than enhancing it. The authors highlight recent advancements in health care information technology that hold promise to overcome the productivity paradox, such as artificial intelligence, and discuss barriers that must be surmounted in order for health IT to meet its potential.
Gawande A. New Yorker. November 12, 2018.
In this magazine article, Atul Gawande describes a range of frustrations physicians experience as digitization becomes more widespread in health care. He elaborates upon several elements of electronic health record use that can degrade care processes and create conditions for errors, such as burnout, lack of patient-centeredness, and alert fatigue.