Ophthalmologists and other clinicians often tell us about the love-hate relationship they have with electronic health records (EHRs). To be sure, digital records have their benefits, but one complaint we hear again and again is about how EHRs can make the office visit seem very impersonal. When you are busy entering data into a device and spend more time looking at a screen than the patient, it’s easy to throw off that vibe. EHRs can also potentially distract you from performing a complete and thorough eye exam, especially when you are first learning your way around a system.
One possible solution is employing scribes to enter data, allowing you to focus completely on patient care while in the exam room. That is what the practice of Edward Colloton, MD, CEO and practice administrator at Eye Surgical Associates in Bloomington, IN, did. He recently shared best practices for those who are considering doing the same.
Best practice #1: Use the so-called technician model—have ophthalmic technicians serve as scribes. Be sure they are certified as both workup and scribe technicians.
Best practice #2: Assign a tech liaison to each physician. “This person serves as the physician’s number one scribe and clinic session quarterback,” he says. Each clinic session also has one technician designated as a scribe and 3 to 4 workup technicians across 5 exam rooms.
Best practice #3: A great scribe will possess the following characteristics:
Best practice #4: Physicians need to realize that despite all those desirable characteristics, one thing a great scribe is not is a mind reader. Dr Colloton said physicians should proceed with a workup as if they are actually filling out the electronic form. “Merely saying, ‘everything looks good,’ is not good. When you do that you are going to hear the scribe ask, ‘slit lamp findings?’ and ‘how does the optic nerve look?’”
Best practice #5: Speak the same language. Standard nomenclature ensure that techs hear the same clinical terms from all physicians they are assigned to work with. “Agree in advance what to call things,” Dr Colloton said.
Best practice #6: Use non-narrative bullet point lists for treatment plans, which helps coordinate with major diagnosis codes.
Best practice #7: Before implementing a program, visit a practice that has done so successfully.
Best practice #8: When you actually make the plunge, start with the last few visits of the day for a few weeks. Review the documentation and modify your process as necessary. “Be upfront with patients. Tell them you are experimenting with the concept,” he said. This way they know you are trying something new.
Best practice #9: Review the schedule template you have been using during your pre-scribe days—chances are it will have to be modified once you begin using scribes.
Best practice #10: Reconfigure your exam rooms to make sure there is enough room for everyone.
Dr Colloton explained that in his practice’s experience, the aforementioned team of one physician, 2 scribes, and 3 to 4 workup technicians across 5 exam rooms can see 28 to 36 patients over a half-day session.
Colloton E. Medical scribes in the EHR era: How I implemented scribes in my practice, and scribe workflow. Talk presented at: AAO 2018 annual meeting; October, 26-30 2018; Chicago.