I wrote about the concept of using scribes last week and how one technician can be cross-trained to serve as scribe, pretester and optician. In this article I'll present some tips for actually making it happen in your practice.
A pilot program
There are many details to work out as you change your clinical routine and the role of staff members. I'll provide some help with that, but every practice is different and if you try to predict and plan for every consideration, you may never actually start. So, as they say in the Nike ads: “Just do it.” I would tell your staff that you are trying a pilot program to test a new procedure with the use of scribes in the exam room
Hold a staff meeting and explain that the practice is a business and based on the challenges of managed care, new forms of competition and a weak economy, you must re-invent the way your practice provides eye care. Discuss the business challenges with staff and ask for their input on how the practice can increase revenue and efficiency. Discuss that having the doctor work at his or her highest level is a key factor. Explain that seeing more patients per day does not have to be more work or stressful. Remind staff members that taking on new responsibilities are the best way for them to advance their own careers.
Pledge your support
As you describe how the exam process will work with a scribe, try to see the new role from your employees' point of view. If you think about it, you can understand that they may worry that they will have to work harder or that they may not be able to handle the task. Reassure them so they can get beyond those fears. Admit that you don't have all the answers yet and that the system will evolve as you go along, but that you want to try the concept of scribes and cross training. Let the staff know that if it works like you hope it will, you will hire more employees and provide all the support and training they need.
Go on to tell them that you will not embarrass them in front of a patient by using terms they are not familiar with. You can still record the more complex findings yourself – and you may not want to say everything out loud anyway until you've had a chance to counsel the patient first. Tell staff members they can always ask questions during the exam if they didn't hear something. Just go over all the “what-ifs.” You can also tell your office manager or front desk person that if the office is ever running way behind schedule or has a rush of patients; she can just knock on the exam room door and ask the technician to step out for a minute. You can still record the data like you always have.
Think about where the scribe can sit and create a small area with a stool at the end of the refraction desk. I added a small extension of the countertop so there is space for the knees.
Start with paper forms
One of the biggest advantages with scribes is that they can take over all the data entry in the electronic medical record (EMR), but if you are just starting with scribing and if your staff is not familiar with the EMR system, you might be smart to start by using paper exam forms. Paper forms are easier and they can guide the scribe through the process with a specific place to enter data. After the staff is used to scribing for a few weeks, you can then train them to use the EMR.
I found an exam form with two pages worked best. The first page is for the case history and all the pretesting. The second page is for all the tests performed by the doctor. When the doctor begins to work with the patient, he or she will have the pretest form with all the data, which is very helpful to refer to throughout the exam. The scribe keeps the blank form for the doctor tests, which she will fill in. The scribe should just take notes and write down all the findings the doctor says out loud.
Can you afford all those staff members?
In my practice, I try to schedule three scribes/pretesters/opticians for each working doctor. That may seem like a lot, but these staff members also provide optical dispensing services. They do repairs, adjustments and dispensings. Our business office staff uses the telephone paging system to call technicians to the clinic or to the optical as needed. All staff members have secondary jobs to work on if they are not working with patients.
You may need to add some employees to your practice if you introduce scribing, but I see that as a good thing. Additional staff provides more resources and three good things happen:
Customer service improves because you have more staff to take care of people.
You will delegate more because you have more people to delegate to.
Productivity increases because you can see more patients per day and doctors and technicians can spend more time with patients, which causes them to buy more goods and services.
Because of these factors, I doubt that you will notice any increase in payroll cost. Revenue will increase much more than the increase in payroll. To maximize the profitability with scribes, change the appointment schedule to shorter time slots and see a few more patients per day. It should be no problem because scribes save the doctor a great deal of time.
Next week I'll describe how to use scribing technicians in the contact lens fitting process. The advantages are amazing.