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 By Neil B. Gailmard, OD, MBA, FAAO, Editor March 17, 2004 - Tip #113 
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Technicians as Scribes


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Additional Information

As optometrists look for ways to become more efficient and save time in the exam process, I'm surprised at how often they overlook or reject the concept of using optometric technicians as exam room scribes. I adopted this technique around 1990, after observing it in an ophthalmologist's office and I can't see ever going back. The use of chairside assistants is fairly common in ophthalmology, but still remains fairly rare in optometry.

I often recommend that doctors take one step up from their current standard of delegation. Doing so can result in a new surge of improved patient flow and practice profitability. If your office currently delegates many clinical procedures, like pre-testing and contact lens insertion, exam recording could be the next step up for you.

Benefits

Here are the major benefits I see by using scribes.
  1. Tremendous time saving by not having to write in the exam record. As optometric practice has evolved, so have our record keeping demands. Just think how much time you spend writing in records - or if you don't, then your records are probably not as complete as they should be. In addition to the case history and all the clinical data, there are notations of drops used, assessments, diagnoses, recommendations, plan, recall date, fee entry, coding, patient exam summary codes, written copies of prescriptions and more. With chairside technicians, I don't write anything down, or have to type and click into a computer in the exam room.
  2. Better records. By having a technician "take notes" while you talk to the patient, virtually everything is recorded. And if you use paper records, the handwriting is probably better than yours.
  3. Scribes can use electronic medical records software or paper records.
  4. Continuity of care. In my practice, one technician stays with the patient throughout the entire visit. The tech calls the patient in for the exam, does all the pre-testing, stays in the exam room for the doctor's exam, takes care of optical dispensing if needed, and writes up all fees. If further testing or contact lenses were indicated, the scribe would take care of that also. The patient is virtually never left alone, and a good relationship develops between the technician and the patient.
  5. Chairside technicians can assist with dilation flow. The tech makes dilation run smoother by instilling the drops at just the right time, performing frame selection or asking the patient to wait, and then working him or her back into an exam room for the dilated fundus exam.
  6. I never have to search for a technician. I remember the days when I would finish an exam and, knowing my next patient was waiting, I'd escort the current patient to optical dispensing. Hoping to hand the patient off to a technician or optician, I'd find no one available. I'd spend more time helping the patient to begin browsing, and I'd have to interrupt a busy technician to tell her what I wanted her to do, when she eventually became free. It was very inefficient.
  7. I don't have to repeat all the recommendations and options that were just decided upon in the exam room to a technician. When my scribe listens to my consultation with the patient at the end of an exam, he or she knows what to do. I just thank the patient and say goodbye and move on to the next exam room.
  8. A technician is available - for whatever reason. There are hundreds of ways she can be of assistance, such as retrieving clinical supplies from another room, entertain a child when Mom's behind the phoroptor, rechecking the Rx on an old pair of glasses, holding an eyelid during Goldmann tonometry, getting the record of a family member, or just being a third party witness when a patient is emotional or unstable.
Worries

Here are some questions and concerns doctors may have when contemplating starting to utilize scribes.
  1. The payroll cost will go up. Well, yes, it might if scribing becomes successful for you, but that cost would be miniscule compared to the increase in revenue you could realize by seeing more patients per day. Using a scribe will cut your exam time considerably. If you won't be comfortable with a shorter exam time, however, then scriibes won't work well. It is wasteful to have a technician sitting in the corner of the room for a half hour or 45 minutes. Using scribes requires an exam philosophy that is problem focused, and assumes much data was gathered during pre-testing.
  2. How will I train technicians to do it properly? It's not that hard. I recommend designing an exam form that works as a guide for the technician and has spots to enter all the usual data, and blank lines to write on. Besides, nothing says that the doctor can't still reach over to the exam form and enter some data himself (or herself). If a notation is too advanced for a specific technician, don't embarrass her, just write it yourself and teach the tech about it later. You'll know what they can handle.
  3. What if I don't want the patient to hear about a finding out loud, verbally? Don't say it - just record it yourself. Patients won't think anything unusual if you just make notes in the chart.
  4. I may be uncomfortable having someone else watching me do an exam and interact with patients. You'll get over it. It becomes natural.
  5. Patients may not like it. Actually, they are generally quite impressed by a doctor who has an assistant present. It calms people and it elevates the importance of the exam process. It will set your practice apart.
  6. What if we don't have enough staff to allow scribing? In the long run, if the technique works for you, you'll want to increase your staff. But in the short term, I always tell my office manager that if she needs a technician because the optical is really busy, or we need to start some exams, she knows where to find one. In my exam room. Just come get her... knock on the door, open it and say, "Mary, can I see you please?" I'll understand and can easily go on without a tech.

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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