Long-time readers of this Tip of the Week series know that I’ve been an advocate of using scribes since way before the advent of EHR systems. But EHR is certainly creating a huge increase in the number of doctors interested in the concept of scribes and I’m very pleased to see that. In this article, I’ll share some of the benefits you’ll realize if you adopt the scribing concept and I’ll help you create a plan for training and implementation.
Benefits of scribes
The biggest reason for using scribes in your exam room is the same benefit we derive from most aspects of delegation: we save doctor time. And record-keeping requires a very large segment of time. Many doctors would say that record-keeping takes longer with EHR systems than it did with paper. My experience bears that out as well. With most optometrists trying to keep their exam time with each patient at 15 to 20 minutes, we don’t want to spend 10 of those minutes typing on a keyboard and searching drop-down lists to click on. We care about the patient experience and we need to get rid of the burden of the computer or tablet.
Fortunately, there are several other benefits of using scribes, such as:
Always having a technician available to assist the doctor
Saving time walking patients in and out of the exam room
Contact lens fitting is amazingly fast
Optical dispensing and sales are improved because there is no handoff to an optician (the scribe is the optician)
Records are often more complete and accurate
Patients are impressed with the efficiency and with learning more about the exam data
Having a third person in the exam room can protect the doctor
Presenting the concept
There are two main ways to use scribes: the first is what I call the super-tech concept where the scribe is also an optometric technician, pretester and optician all rolled into one. This technique requires an advanced level of cross-training, but it brings many advantages. With this concept, one technician stays with the patient throughout the entire visit. This system requires several super-techs and any available technician can work with any patient. I find the ideal number of super-techs is three per working doctor, but realize that these employees are also opticians and they do much more than just assist the doctor.
The other method of scribing is to have a staff member trained on the EHR system and the only job is to record the exam data. In this scenario, one scribe could stay with one doctor for the whole day. There is some benefit in that this dedicated scribe learns the doctor’s recording preferences quite well. But it is easier to train a fully qualified technician to scribe than a lay person.
After deciding which approach you want to take, I would hold a staff meeting and explain that you would like to test the concept of scribes with your staff and ask for their feedback. I view this as an opportunity for some of your staff to grow within their careers and I hope they see it that way also. Explain the benefits of the process and reassure the staff about any worries or concerns they may have. The idea is to try it on a small scale and see how it works.
I would begin by training one or two of your best technicians on how to record the exam data in your EHR system. Review some previous patient charts and have them watch you while you record data on a fictitious practice patient. Tell them what tests you will be doing and some of the things you may say out loud. They can just assist you with one or two patients per day to start.
As you work with staff, realize that you do not have to speak all findings out loud if you are not ready to share them with the patient yet. You can wait until you speak to the patient. The tech will learn that if you don’t dictate anything, to simply wait. Also realize that you can still record some things yourself if it is too complex for a technician. If the office is very busy and staff are needed, let the manager or someone else know they can just knock on the exam room door and ask the technician to come out. You can carry on alone if needed.
I always recommend that doctors review all their records fairly soon after the exam and make any changes or additions, before signing the record. This can usually be done between patients and you can work out a routine for listing the patients who are ready to review and finalize.
Depending on the EHR system you have, think about the best way to input data. My current system does not work well with a tablet, but more are going that way and there advantages in portability. But realize that typing and clicking can be faster with a real keyboard instead of the virtual one taking up a third of the screen on a tablet. Be careful to not allow patient flow to slow down because the scribe is inputting data in the pretest room. You may want to hold off on some aspects, like the case history, until the assistant and patient are in an exam room.
In my office, we use a laptop for the scribe and we have a second desktop PC and monitor for the doctor. The scribe works off of the end of the refraction desk. It is generally not possible for two people to make changes to the same data base at the same time on different computers, but one workstation (the doctor’s) can have a read-only version of the exam data for viewing only.
The best approach is to just jump in and try scribing. You will quickly learn as you go along.