# Creation and validation of a training toolkit to ensure safe and proficient use of EHR by medical scribes

> **NIH AHRQ R01** · OREGON HEALTH & SCIENCE UNIVERSITY · 2020 · $392,005

## Abstract

With the widespread adoption of Electronic Health Records (EHRs) there has been a growing appreciation of the
unintended consequences associated with their adoption and specifically the negative impacts on productivity and
workflow. Consequently, there has been dramatic growth in the use of medical scribes to aid providers by, in essence,
“untethering the provider from the EHR”. In spite of this rapid growth, and the purported benefits on improving
physician efficiency and improved billing, there is little to no regulation on standardization of scribe training, nor any
assessment of their ability to safely interface with the EHR. To better understand the role and functionality of scribes,
we undertook a national survey of health care providers. We found that scribes comprise a wide range of personnel
from college students to Medical Assistants. There is wide variability in their training, with the majority of scribes
receiving job specific training by the hiring practice. In terms of scribe function, again there was wide variability in scribe
activities with relation to the EHR, from simple encounter note creation, to finding information in the EHR for the
physicians to entering orders and responding to patient messages. We directly assessed scribe function at OHSU in a
novel video based virtual simulation. We found that there is tremendous intra-scribe variability in note creation and
structure. This corresponds to significant errors of omission and commission (incorrect information entered into the
system). Specifically, the average scribe captured only 40% of the diagnoses or plans mentioned in the simulation with
less than 40% overlap in documentation between scribes. Further, every scribe documented a number of incorrect plan
and diagnosis items. Combined, these data suggest a new and potentially significant safety issue with scribe use of the
EHR. Therefore the goal of this proposal is to fully assess the scope of scribe use with respect to the EHR and use this
information in conjunction with national experts in EHR safety and medical documentation to establish a series
Entrustable Professional Activities (EPAs) for medical scribes. We will use these as basis to create and validate a toolkit
to allow for organizations to assess the ability of scribe to complete these EPAs. In Aim #1, we will use a combination of
surveys and site visits to assess the landscape of scribe functionality. This information will then serve as the basis for a
consensus conference to define scribe Entrustable Professional Activities (EPAs) with respect to the EHR. In Aim #2 we
will map these EPAs to a set of competencies and create a curriculum to assess these competencies. This curriculum will
contain a series on online EHR didactics and video based simulation exercises with corresponding simulated EHR records
to asses real world performance of scribes. In Aim #3, we will calibrate and validate this curriculum across a variety of
specialties and EHR use expectation...

## Key facts

- **NIH application ID:** 9984377
- **Project number:** 5R01HS025141-04
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** JEFFREY A. GOLD
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $392,005
- **Award type:** 5
- **Project period:** 2017-09-30 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9984377

## Citation

> US National Institutes of Health, RePORTER application 9984377, Creation and validation of a training toolkit to ensure safe and proficient use of EHR by medical scribes (5R01HS025141-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9984377. Licensed CC0.

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