Improve Your Ophthalmology Practice with a Scribe

Which is more important – providing high-quality eye care to your patients or making a profit? Both are equally important, but you can’t have one without the other. Now, finding a way to balance these two goals, which are often at odds, is becoming increasingly difficult.

Complicated reimbursement rules, fierce competition, disrupting technologies, and other factors are all creating a difficult environment for many eye care practices. A schedule packed with patients means more revenue but may also mean less — and lower quality — physician-patient face time. The more time a physician spends on documentation and navigating electronic medical records, the less time he or she spends interacting and forming relationships with patients. Luckily for eye care practices, there is a very good solution that almost anyone can use.

Scribes: Best of Both Worlds

What if there was a way to get the best of both worlds: a busy, productive practice and a higher level of patient care? There is, and they’re called scribes. Here’s how they work:

In the most profitable practices, each employee works to his or her highest level of competency. For a physician, that means performing billable exams—not charting. By delegating documentation to a scribe, the physician becomes more productive. Instead of the physician stopping the exam to document as they go, the exam and the documentation happen simultaneously. That means shorter appointments. Shorter appointments mean more appointments. And more appointments mean more revenue.

A scribe can also enhance the quality of physician-patient interactions, leading to higher patient satisfaction. Patient satisfaction is one way to measure the quality of care, and it is gaining significance as we transition to value-based reimbursement. Higher patient satisfaction leads to more referrals, better ratings on websites like healthgrades.com, and a reduction in patient turnover.

“Using a scribe allows the physician to give the patient his or her full attention—the EHR is no longer a distraction,” says Raemarie Jimenez, CPC, CPC-I, CPMA, CANPC, CRHC, of AAPC, a professional association that is currently developing a scribe certification. “A lot of providers are using scribes so that they can focus on the patient. In a lot of instances providers are spending so much time on documentation that they don’t feel like they’re having a genuine face-to-face encounter,” she explains.

 Scribes can also be very helpful for physicians who routinely see older patients. Senior patients are often hard of hearing, and many supplement by lip reading. If the doctor is turned away and looking at the computer, communication is more difficult.

What Is a Scribe?

Scribes today belong to one of the world’s oldest professions. First identified in ancient Egypt, scribes were educated in writing, with many learning the role from a family member. In Egypt, many were considered part of the royal court, and they did not have to pay taxes and were exempt from manual labor requirements. Ancient Jewish scribes were responsible for creating copies of the Torah, and had a list of rules that had to be followed detailing the color of ink to be used and the method of binding manuscripts.

Today, medical scribes have gained prominence with the advent of electronic health records (EHRs), which have generated a large volume of documentation. Medical scribes serve as a type of personal assistant to a physician, gathering information for the patient’s visit and working together with the physical to deliver efficient care. Types of popular medical scribes today include emergency medicine scribes, hospitalist scribes, outpatient scribes, and telescribes.

 Three Ways Scribes Work

At the core, a scribe is someone who specializes in what physicians dislike the most—documentation. But there are multiple ways that a practice can incorporate a scribe:

Data entry: Here, the scribe either follows a single physician or stays in a single exam room all day, writing down each patient’s medical history and documenting the entire appointment, as well as any resulting treatment decisions. “This is typically an entry-level position for med students or those interested in attaining a job in other medical fields,” notes Jimenez. “For someone brand new to the medical field, scribing is a fantastic way to get used to medicine and get a better understanding of what aspect of medicine they’d like to pursue,” she says.

Train a clinical tech to scribe: A scribe-technician conducts all portions of the visit that a tech normally would, including patient history and pre-testing. When the physician arrives, the tech puts their scribe hat on. Practices should tread carefully, says Jimenez. “Using a clinical staff member to both interact with the patient and document is a compliance risk,” she warns.

Go all-in with Scribe 2.0 (aka The Super-Tech): A super-tech is a jack-of-all-trades. He or she is a clinical tech who not only scribes, but stays with the patient throughout the entire visit (instead of with a particular physician or exam room). The super-tech is also an optician—not a master optician, but someone who can do easy cases and leave more complex ones to the ABOM. The super-tech system may also be an opportunity for career advancement for your techs. They’ll learn new skills that make them more valuable and flexible while benefiting your practice at the same time. Win-win!

If you choose to train a current staff member to scribe, you should avoid:

• Non-clinical staff: Clinical knowledge is essential for a competent scribe, so you can’t just pull in a non-clinical employee. If your front desk person decides he or she’d rather scribe, that’s fine. But they’ll need to go through the full scribe training process. That, of course, will involve classroom training, floor training, and testing.
• Mid-level providers: The highest and best use of providers like PAs and NPs is independently seeing other patients. Using them as scribes is counterproductive.

Scribes: More than Just Documentation for the Optometrist and Ophthalmologist

A scribe’s core duty is to capture accurate and detailed documentation of the patient encounter in real time (such as in an exam room). But scribes can have other duties as well, all aiming to free up a physician’s billable time. Jane Shuman, MSM, COT, COE, OCS, CMSS, OSC and Mary Pat Johnson, COMT, CPC, COE, CPMA shared the following duties during their session at the 2018 ASCRS∙ASOA Annual Meeting. A scribe can:

• Help physicians navigate the EHR.A physician who has less facility with computers might struggle to complete these forms as quickly or as accurately as a capable scribe.
• Respond to messages, including queries from coders.
• Locate information for review, such as diagnostic images, lab results, and previous notes.
• Enter information into the electronic health record.
• Research information requested by the provider.
• Assist patients by clarifying and ensuring they understand any instructions of next steps that the provider has directed.

There are also a few things that a scribe can’t (or shouldn’t) do for an optometrist and ophthalmologist:

• Scribes should never make diagnoses, decisions, or treatment suggestions beyond what the provider directs. If a patient or family member assumes that the scribe has a clinical role (and they don’t), the scribe should correct them right away.
• They should not conduct any diagnostic testing, or perform any portion of the exam, including the history interview, unless they are licensed to do so (a scribe-technician, for example).
• Scribes should not enter orders.A scribe may draft orders, but the physicians must review, authenticate them, and submit them.

The Rise of Digital Scribes

Scribes can help implement advanced eye care solutions and lead to better practice management. They can also be a core part of your team responsible for handling EMR technology and engaging with EMR software.

New tools that offer digital scribing capabilities are growing in prominence and can offer a host of benefits to ophthalmology practices, including real-time scribing and integration with EMR software, EMR medical tools, and EMR systems.

However, a human scribe is still preferable to a digital scribe, many ophthalmic providers say. Human scribes are better able to adapt to training, certifying, and managing components of modern practices, and are better at interacting with the provider, the patient, and other members of the care team.

The Bottom Line: Is a Scribe Right for You?

Whether a scribe – whether it is a human scribe or a digital scribe – is right for your ophthalmology practice will come down to the specifics of how you operate and what your goals are. Likely, however, the scribe’s ability to integrate with practice EHR for optometrists and ophthalmologists means they will work in your favor – and for your patients’ wellbeing as well.