By Yoongie Min, OD
Using scribes in the exam room lets you view the patient, rather than a clipboard or computer screen. Also, scribes promote efficiency: You can see more patients per day.
CHOOSE CAPABLE SCRIBES. Scribes should have technical knowledge, can also serve as pre-testers and should be comfortable with medical terminology.
EDUCATE. Offer continuing education to keep up with the latest coding and billing.
CONCENTRATE ON PATIENT. While the scribe is inputting information into the EHR, you can keep your full attention on the patient in your exam chair.
Electronic health records (EHR) offer many advantages, but pose a major challenge: Inputting information while keeping your attention on the patient. I use scribes in my office so I can make the most of my electronic records system while still being able to focus on the patient, rather than keeping my eyes glued to a computer screen. In addition to offering an improved patient experience, use of scribes has sped up my patient flow, giving us the ability to see more patients per day.
We have used scribes in our office for about five years now. When we transitioned to EHR several years ago, we found that one of the things we disliked about EHR was that we were spending precious time entering data instead of talking to our patients. We realized that EHR was the future of optometry, but we did not want to give up the personal interaction with patients that has helped build our practice over the years. I believe that using a scribe saves approximately five to seven minutes per exam. If you look at a practice that does 20 exams per day, that is a savings of one-to-two hours of the doctor’s time that could be used to see additional patients.
Dr. Min in the exam room with a patient, and a scribe at the computer inputting patient data and the doctor’s findings.
ROI of Scribes
In our office, we consider our scribes more like technician/scribes because they do everything in pre-test, as well as scribing. If we would hire an additional person, we would teach them to pre-test first and then scribe, in addition, so this could be a “move up” position for someone who already pre-tests.
We compensate this position as a technician because we expect the scribing to be part of their duties.
Scribing in our office pays for itself because, if it saves one hour of time during a day, we can see three additional patients. At an average revenue of $350 per patient, that is over $1,000 of additional revenue per day that could be generated by freeing up more exam slots. I think the real value, though, is that it lessens the stress on the doctor since they do not have to worry about noting every detail in the EHR. The doctor can then spend more time talking to the patient about their recommendations, multiple prescriptions, contact lenses, LASIK, dry eyes and other medical eyecare needs.
Scribes Can Also Serve as Technicians
We have two scribes in our office who also function as technicians. They begin the examination process by pre-testing patients with such tests as visual fields, tonometry, autorefraction, autokeratometry, Optomap, color vision, stereoacuity, medical history and ocular history. They then bring the patients into the exam room, check acuities and set up our phoropters or refracting systems for us. They then inform the doctors of the reasons why the patient is at the office, any changes in medical or ocular health, and any previous pertinent history. Then they sit in the exam room with us at the computer while we start the examination.
Since our scribes are also technicians, we pay them accordingly per hour based on competitive salaries in our area for technicians. We look for employees to serve as scribes who are detail-oriented and able to pick up medical terminology.
It is very important that the scribes become an extension of the doctors. Our scribes not only input into the medical records, but also are trained to discuss treatment plans and options with the patient. For example, if we are going to prescribe Restasis for a dry eye patient, my scribes are trained to discuss the use of Restasis, side effects, costs and benefits. They also know the appropriate time frame to reschedule patients for follow-up. We also give our optical recommendations to the patient in front of our scribes and they then escort the patient to our optical, transfer the patient to one of our opticians, and tell the optician the recommendations we have made in the exam room.
Scribe Inputs Medical Findings
Our scribes are in our exam room the entire time of the examination. While we perform our refraction, they are updating the medical chart with any changes that the patient mentions while we are in the exam room. The information that the scribe inputs into the EHR is as specific as the doctor wants it to be. Our doctors often specify the things that we see very specifically and the scribes are able to input the data while we are performing other tests.
During the exam, our doctors will state our exam findings while the scribes enter the information into the EHR. For example, I might say: “The anterior segment appears normal except for Grade 1 nuclear sclerosis in each eye.” The scribe will then enter “early nuclear cataract development” into the EHR.
Scribe Also Needs to Code Diagnoses
Our scribes are very comfortable with coding both ICD and CPT procedural codes. I then review the coding they have inputted as it is the doctor’s responsibility to ensure all coding is done correctly. The incoming ICD-10 codes will make our scribes even more valuable since they will be inputting the codes into our EHR while we talk to patients. We have begun taking them to continuing education meetings to prepare them for the changes that ICD-10 will create. Early preparation and practice will be key to the smooth transition to ICD-10 in the future.
Scribes Can Help You Keep Up With Increasing OD Demands
Optometry is one of the worst professions as far as utilizing ancillary personnel in efficient ways. Many optometrists are continuing to practice they way they did 30 years ago, doing many tests themselves that could be delegated. Many years ago, when I first started practicing, my first job was with a very busy ophthalmology practice. I saw the value of technicians, scribes and other personnel that ophthalmology has utilized for years in an efficient fashion.
Optometry has changed significantly over the years to become a primary health care profession, but in many ways, has stayed in the dark as far as how we practice. The expanding scope of our practice, changes in health care and electronic records all call for us to change the way we practice. The use of scribes has probably been the biggest and most positive change in the way I have practiced over the past 25 years.
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