I have written many articles on scribes (just do a key word search for “scribe” in the tip archive), but I continue to receive many questions about the topic, so I know there is a lot of interest. Today I want to focus on the training aspect.
For purposes of this article, I’ll assume you are training an employee who is already a pretester / optometric technician. This means the staff member has at least a basic understanding of the eye, common ocular diseases, refraction, special diagnostic tests, eye care terminology, contact lenses, eyeglasses, and medications. If not, you should train him or her for those job skills first.
If you are just starting to use scribes, it is best for the optometrist to train the first one or two scribes. You may want to start with your best technician and consider it as a pilot program at first. Have the technician assist you with a couple of patients and then learn as you go. Eventually, if scribing becomes the norm in your practice, your existing scribes can help train new ones.
Here are some things to consider:
Review the hardware and workspace. Consider your technology options for how to enter the data. Does your EHR software work well with a tablet or would it be easier on a laptop? Will you use a network cable for better speed and reliability or does wi-fi work well for you? Will the device have enough power to last all day? Where will the scribe sit in the exam room? You may need to modify your countertop or refraction desk to accommodate scribing, but you can test the scribing concept before going into that.
Make an outline of what, when and where the scribe should record exam data. Break down your typical eye exam into sections and keep it in the usual chronological order. List the items you will want the scribe to record and note if the procedure will be performed by the scribe or the doctor. Will the scribe enter items in the pretest room or wait until she gets to the exam room? When and where should the history be taken? There are usually a few minutes between the end of pretesting but before the doctor arrives. The scribe can use this time to enter data collected in pretesting.
You may want to design a cheat sheet form for the tech to quickly jot down a few items in pretesting or to use if he/she can’t find the exact right spot in the EHR record. This worksheet can be shredded after the data is transferred to the EHR. There may be some paper forms used in the exam process that can be scanned before shredding.
Develop your list of abbreviations. This is smart to have in case you are audited by an insurance carrier, but it also helps the scribe know how to abbreviate properly and save time. You may also have macros stored in your exam templates for commonly entered statements.
Meet with the technician for a couple hours to show her the EHR software. Some techs are already using these records, but this training session will go into detail about where everything is recorded and the essential elements of the record. The tech should have a notebook and pen and take her own notes.
Have a technician shadow the doctor in the exam room. In the early going, the scribe-trainee can simply watch the exam and watch closely as the doctor enters the data.
Talk about what the scribe should do. I think it is best for the scribe to remain mostly quiet during the doctor’s part of the exam. Of course, questions are allowed. The scribe should assist the doctor and record everything that is said to the patient.
Discuss what the scribe should do at the end of the exam, including printing or sending prescriptions, doing a handoff to optical, rescheduling for more testing, coding for procedures and diagnoses, setting recall dates, totaling up fees and walking the patient out. The doctor can assist with all of this until the tech is up to speed.
Begin scribing on a few patients. The doctor should remember to take it easy on the new scribe and dictate exam results clearly and slowly. Avoid dictating complex medical descriptions in the beginning and realize that the doctor can still reach over to the scribe’s computer and enter some findings. The doctor should also use caution about speaking some results out loud that might worry the patient prematurely. It is OK to do a test and not say anything at the time and come back to it later after you have talked to the patient about it.
How many scribes do you need? It depends on how many patients you see per day and what else the scribe does. If the scribe is always by the doctor’s side, you only need one. If the scribe also does pretesting, you need at least two, so one can stay with the doctor and another one can start the next patient. If you use supertechs, like I do, you’ll need about three per working doctor because they also go to optical to do dispensing tasks.
The doctor reviews the record, makes changes if needed and teaches the scribe. This can happen between patients. Work toward not making this too burdensome or time consuming.
Using scribes in your practice will create many benefits and efficiencies. Payroll cost may go up slightly with more staff, but the time saved for the doctor more than makes up for it with increased productivity. Once you try it, you won’t want to go back.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.