I'm pleased to see major interest recently in a patient flow system that I pioneered in my practice over 20 years ago. I first published an article on the topic in 1988 and began including it in my lecture seminars as well. It has taken a long time to gain acceptance but I now hear of more doctors using the procedure and practice management speakers talking about it. The technique revolves around the use of scribes in the exam room but it is really much more than that, so let's review the details.
The dual role of the Optometric Technician
In my practice, all optometric technicians are trained to perform duties in both clinical pretesting and optical dispensing. While most eye care practices separate those two functions and assign them to different staff members, it's really not difficult at all to combine the tasks.
Having staff handle both duties can seem like quite a culture shift, but I approach it like it is no big deal and when I adopt that view, the staff does as well. It is not hard to train an optician to do pretesting. Most automated instruments work by just lining them up and pushing a button. It is a bit harder to train a pretester to be a good optician – but we don't need all staff members to be master opticians, they just need to know how to do a frame selection (easy), know how to measure a PD and seg height (fairly easy) and know how to figure out vision plan pricing (not real easy, but doable especially if you make your own in-office worksheet to guide employees through it).
Of course, you should always follow your state law when it comes to licensed opticians and delegation to staff. In many cases, if there is a licensed optometrist on the premises, non-licensed employees can work under his or her supervision.
The benefits of the dual role
There are several benefits to having all technicians able to dispense and fit eyewear.
The practice has twice as many staff members to perform a needed task. For example, if a practice with two opticians and two pretesters were to adopt this system, it would end up with four people who can dispense eyewear. And four people could do an exam work-up.
The cross-training provides better customer service. The work flow in any eye care practice is variable. There are times when the optical gets a rush of people who are picking up glasses or needing an adjustment. These visits are not typically by appointment. There are also times when the clinic side of the office is backed up with patients due to emergencies, late arrivers or complex cases. Having more trained people to direct toward the area of greatest need greatly improves your services and reduces wait times. The staff feels less stress.
Extra personnel allows for depth of coverage when employees are on vacation or out sick.
There is more variety to the work so employees are kept busier and they're less bored on the job.
The dual role allows for a multi-functional scribe, which I will describe below.
Using a scribe with both clinical and optical skills prevents the need for a hand-off from doctor to optician. The only thing better than a good hand-off is no hand-off. The technician who is sitting in on the exam hears the doctor's recommendation for eyeglasses and carries it out in the optical. This seamless transition from my exam room to optical has increased my Rx retention rate.
Scribing is the third role
The ultimate in efficiency occurs when you take staff members who are skilled in pretesting and optical dispensing and train them to scribe. Now you have the ideal situation where a technician calls a patient in from the reception area, introduces herself, does all the pretesting, stays in the exam room during the doctor's portion of the visit, records data and listens to the doctor's recommendations and disposition. At the end of the exam, the doctor says goodbye and leaves the room first. The technician carries out whatever additional services are needed: it could be additional diagnostic testing (like fields or OCT), dilation (work the patient back in to the doctor later), trial contact lens insertion, frame selection, ordering of glasses or referral to outside specialists. The technician also takes care of all coding, billing (doctor can help if needed) and the next appointment date and then turns the patient over to a business office staff for check out.
Scribing is very common among ophthalmology practices, but the clinic and optical are generally completely separate. Optometrists can easily put all three roles together for optimum efficiency. Scribing is not expensive; it pays for itself and is really quite practical. Any practice can do it.
More details to come
Tune in next week for specific instructions on how to introduce the scribing and dual role concept to your staff, train them and jump in and try it. I'll cover how many scribes you should have, how to incorporate EMR, and if multi-functional technicians can still be good at selling in the optical.