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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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4146 — Addressing Workforce Development Needs for Scribe Pilot Program Success

Lead/Presenter: Soumya Subramaniam,  VA Northeast Ohio Healthcare System
All Authors: Subramaniam S (VA Northeast Ohio Healthcare System), Wilkerson T (VA Northeast Ohio Healthcare System, Cleveland); Stryczek KC (VA Northeast Ohio Healthcare System, Cleveland); Petrova V (VA Puget Sound Health Care System, Seattle) Firestone C (VA Northeast Ohio Healthcare System, Cleveland); Honsberger M (VA Northeast Ohio Healthcare System, Cleveland); Nahin I (VA Northeast Ohio Healthcare System, Cleveland); Colby L(VA Northeast Ohio Healthcare System, Cleveland; Allegheny Health Network); Kirsh S (Department of Veteran Affairs); Ball S (VA Northeast Ohio Healthcare System, Cleveland)

Objectives:
Medical scribes can improve productivity and satisfaction for medical care teams. However, best practices for use of scribes include a high-quality and consistently implemented scribe training program. With an impending increase in demand for well-trained scribes, it is important to understand how to develop a strong scribe workforce. We sought to explore how scribe training affected implementation of scribes in the U.S. Department of Veterans Affairs (VA).

Methods:
As part of a multi-method evaluation of the Maintaining Interval Systems and Strengthening Integrated Outside Networks (MISSION) Act section 507 Medical Scribe Pilot Program VA providers (n = 21), Scribe Champions (n = 9), and VA-employed and contracted scribes (n = 23) participated in interviews (~40-minutes) focused on experiences working with scribes, including satisfaction with implementation, and perceived effectiveness and efficiency of the hiring, training, and use of scribes. Analyses involved inductive and deductive coding using qualitative data analysis software (ATLAS.ti) to identify themes which were iteratively reviewed by the qualitative team and operational stakeholders for consistency, validity, and quality assurance.

Results:
Scribe training and onboarding emerged as a key finding in relation to perceived effectiveness and successful implementation of scribes in the VA. Most respondents commented on the importance of scribe-provider communication about the provider’s expectations, preferences, and workflow. Providers and champions described observing a range of scribe experience and skill level of hired scribes. Champions and scribes noted that the onboarding and training manual were beneficial, but more information was needed as part of the training. All staff participants discussed key training areas including navigating electronic medical records, adjusting to provider and clinic-specific documentation needs, medical terminology, shadowing prior to scribing, and scribe peer-to-peer training.

Implications:
Appropriate training as part of workforce development is important to supporting successful scribe implementation including basic scribe training as well as on-the-job training facilitated through peer training.

Impacts:
Incorporating time for scribe training can set appropriate expectations and improve provider and scribe satisfaction, as well as maximize efficiency gains. Partnership with operational stakeholders facilitated addressing sites’ training needs. Our findings informed our operational partners in revising and implementing training in the Scribe Pilot Program. Revisions included adaptations to scribe training manual, developing a medical terminology video and materials, and improving the onboarding process to include electronic health record training and meeting with providers to determine preferences and note style