Readers familiar with my practice model know that the doctors in my practice have a scribe assist them with all patient visits. We did this long before we went to electronic records because there are many advantages, but I now see that scribes offer tremendous additional value in a busy practice with an EMR system.
As a side note, we use scribes in a unique way in my practice: the scribe is also pretester, clinical technician and optician all rolled into one. Scribes don't work with specific doctors but rather go wherever they are needed most. We try to schedule three scribe/tech/opticians per working doctor.
How do scribes help with EMRs?
I find scribes to be nearly indispensable with EMRs because I don't want to use my time entering data and I don't want to be distracted by the software. I want the patient to have all my attention during their visit.
The good news is that scribes can make your EMR system a breeze to use. The bad news is that there are a few rough spots that must be worked out as you integrate scribes and EMRs.
How can doctor and scribe both be in the record at the same time?
The short answer is they can't. Databases don't typically allow two users to work in the same file at the same time and that can be difficult for optometrists because of the way we work. When I do an eye exam, I like to have the pretest data in front of me. As I talk with the patient, I'm reviewing the history, current medications and chief complaint. As I refract, I like to see the entrance acuity, habitual eyeglass or contact lens prescription, autorefraction data, patient's age and other information. As I progress through the exam, I look back at today's results for tonometry, field screening, blood pressure, and other findings.
I resolved this issue in my practice by using a paper worksheet for the scribe to record all pretest data. This data is transferred by the scribe into the EMR later (see below). I keep the worksheet with me as I examine the patient and I refer to it as needed (just like I always did in the past). We then discard the worksheet after the patient visit. Yes, a worksheet is a bit of a crutch and it makes us not really paperless, but it really helps us through a rough spot and I see no need to change.
A side benefit of the pretest worksheet is that it helps speed up our pretest process because the technician does not have to enter data at that time. We also don't have to make room for a desktop, laptop or tablet PC. Our pretest rooms have several automated instruments and they can easily become a bottleneck to patient flow. I want our techs to get in and out as quickly as possible so the next patient can enter.
When and where to enter data
When the technician completes all the pretesting, she pages the doctor on a silent numeric pager by pressing the speed dial phone number on our office phone system. She simply hangs up when the call goes through as no message is needed. When the pager vibrates, the doctor knows the next patient is ready. Our doctors are prompt and flexible in their routine, so we keep the internal wait time to a minimum, but typically the technician and patient may wait up to five minutes for the doctor to enter. The tech used to wait outside the exam room, but now we use the time for the technician to enter the pretest data from the worksheet. The patient watches educational videos about eye care during this short waiting period.
The technician could enter the pretest data in the exam room (with the patient) or could do it on a laptop or tablet PC (on our office wireless network) in a work area in the center of the clinic. If the doctor shows up very quickly, the data can be entered anytime while the doctor is refracting or working with the patient.
How do you view the record if you leave the exam room?
We had a challenge when the doctor or tech needed to see the exam record outside of the exam room. One example is when the doctor wants to review the record so she is familiar with the case before entering the room. Another example is when the technician or doctor goes into the contact lens lab to select trial lenses to put on the patient and needs to refer back to today's refraction to select the correct powers. This is where we find that tablet or laptop PCs are a big advantage over desktop PCs that are tied to the exam room.
Training multiple technicians to record exam findings in an EMR was a major task. We had a professional trainer visit our office for three days and that was a key boost in our progress. From then on, we just kept practicing. Fortunately, my staff had a very positive attitude about the concept of EMRs and they wanted to master the skills. In spite of the work involved, I love our EMR system and having scribes to record the data.
Next week I will cover hardware technology that can make EMR implementation easier. Stay tuned.
Email me with your questions about adding scribes to your routine or training scribes to record in your EMR.