Why Multitasking Is Crucial

Learn how scribes with multiple skills can be most beneficial to your patients and your practice.

Although the general role of scribes is to make exams more efficient by documenting assessments and treatment plans, many of their specific tasks are determined by the needs of practices or physicians. Below is a review of approaches that you may find helpful.

ALWAYS BY YOUR SIDE

Some physicians are most comfortable when the same scribes are always by their side. On any given day, Pravin U. Dugel, MD, managing partner at Retinal Consultants of Arizona, Ltd., travels by plane to at least one of the practice's more than 20 locations. He always takes a scribe with him.

“My clinic has a procedure person and a scribe who is with me throughout every exam and procedure,” says Dr. Dugel. The scribe works closely with Dr. Dugel's technicians to triple check which eye is receiving an injection and coordinate other procedures and exams. The scribe is also critical for record-keeping and documentation, especially since the practice's transition to using EMR.

“There's a very steep learning curve when adopting EMR, but once you've overcome that curve, there's no turning back,” explains Dr. Dugel. “I would never go back to paper now. I see more than 60 patients a day, using two exam rooms. I can keep my attention focused on the patient the entire time because of my scribe. It may not be a long time, but it's significant time that I spend with my patient, while the scribe documents the exam. Patients appreciate the doctor's complete and undivided attention. I don't have to multi-task. I'm completely focused on the patient's needs.

SCRIBES IN WAITING

At the Retina Institute of Hawaii, Dr. Bennett says a scribe typically waits in each of the three “MD rooms” he uses. After doing a work-up, including a history, dilation, vision screening and pressure check, the technician escorts the patient to an MD room, where the scribe pulls up the EMR and appropriate images on screens.

“While I perform my exam, I explain every step, from the slit lamp forward, in the same exact sequence provided in the EMR, so the scribe can efficiently key in the information as the words come out of my mouth,” says Dr. Bennett.

“Once I've finished the exam, I tell the patient in plain English which treatment I recommend, whether it's an intravitreal injection or surgery. The scribe then knows what to pull up—for example, a consent form.”

The scribe manages time-consuming tasks, including repetitive data entry, making sure charts comply with insurance company and Medicare criteria, creating the consent forms for injections and surgical procedures, preparing prescription forms and scheduling surgery.

IMPORTANCE OF MULTI-TASKING

Many physicians and practice managers expect scribes to perform multiple tasks beyond the confines of the exam room. “If you have a clinic that's starting 45 minutes before the physician sees the first patient, scribes can help work up patients initially,” notes Dr. Benz of Houston. “With the right training, some scribes can even learn how to e-prescribe, with the doctor's orders.”

Dr. Benz and many other retina specialists rely heavily on scribes to manage patient education. “It's very helpful for scribes to repeat to the patient what I've just said,” Dr. Benz says. “They can go over how to read the Amsler grid, provide education on diabetes, instruct patients on blood sugar control, review warning signs of retinal detachment in the setting of flashers and floaters and discuss medication issues.”

When Dr. Antoszyk enters his exam room, the patient's chart and images have already been pulled up by his scribe. This time-saving step allows him to review the patient's data quickly so he can assess the patient and determine what additional information needs to be obtained.

“While reviewing the patient's complaints, medical history and medications, the scribe is listening and critically reviewing the chart to make sure that the information I'm obtaining is recorded in the chart,” says Dr. Antoszyk, a partner in the vitreoretinal service at Charlotte Eye Ear Nose and Throat Associates.

Dr. Antoszyk's scribe will have the previous exam results loaded on the screen and will read them to him during the exam. He directs the scribe to change the data based on any new findings. “I dictate interpretations of studies to the scribe, who types them directly into the EMR system,” he continues. “My philosophy is that the less my fingers have to hit the pad or keyboard, the more efficiently I can get through a patient visit and the more time I can spend with patients. With all that they do, scribes help me achieve these goals.”

SINGLE-PASS INJECTIONS

Unless they're still in training, scribes typically work with Dr. Antoszyk one at a time. One scribe can help him perform efficient, “single-pass” intravitreal injections. “Patients who are receiving injections are consented, anesthetized and prepped by the scribes and technicians prior to my entering the room,” he says. “The patient's history, exam and analysis of diagnostic studies have been completed and a decision has been made on whether or not to proceed with an injection. If we need to do the injection, it's done immediately, then the patient is cleaned up by the scribe and instructed on symptoms to be aware of and when to return for follow-up.”

In addition, scribes enter the charges, which are reviewed by Dr. Antoszyk before verification. They gather financial information for ranibizumab (Lucentis, Genentech) reimbursements and make sure patient account balances are updated. “The scribes manage the Lucentis inventory, reconciling it on a daily basis by making sure the number of used vials corresponds with the number of patients injected that day,” says Dr. Antoszyk. “Then, they reconcile that number with the number of remaining vials in the refrigerator.”

SCRIBES WHO HELP MANAGE PATIENT VISITS

In some practices, scribes play a strong role in managing exam room time, freeing the doctor to focus on clinical and patient concerns. Dr. Dugel relies on his scribe to keep track of and inform him of patient flow. For instance, the scribe will quietly signal to the doctor if there's a back-up in OCT testing, so that the patient can be informed.

The same approach applies at Charlotte Eye Ear Nose and Throat Associates. “It's the job of the scribe to make sure the physician stays on schedule,” says Jim Ohlenforst, ophthalmology manager at the practice. “Otherwise, the clinic starts to get a backlog. Each visit needs to be 5 to 8 minutes long. Once the physician exceeds that period, the scribe needs to move things along.” He notes that scribes have even developed cues to signal the end of an exam. “We have one scribe who starts drumming her fingers on the desk,” he explains. “Another one just gets up and opens the door. The doctors know it's time to go.”

COMING AND GOING

More often than not, however, physicians are left to wait on scribes. Because of their wide-ranging responsibilities, these assistants can easily be pulled off course by follow-up tasks in the exam room or at the front desk. For physicians who work with only one scribe, a technician or front desk person can step in to load the exam room and pull up the patient's EMR at these times, allowing the physician to begin the next exam himself.

“The scribe usually catches up with me and I can tell her what I've seen,” says Dr. Freund, a partner at Vitreous Retina Macula Consultants of New York. “I might say, for example, that the hemorrhage superior to the macula from the prior exam has become absorbed, and she can make note of that when she joins me.” RP

Measuring Impact

Retina specialists are quick to point out how much scribes improve the quality of physician-patient interactions. “The patient appreciates the care you can provide when you're working with a scribe,” says Michael Harris, MD, a partner at Associated Retinal Consultants of Kenilworth, NJ. “Even though the exam time may be reduced, the amount of time you spend directly interacting with the patient is increased. You can't use numbers alone to quantify this type of improvement.” Nonetheless, numbers that represent increased productivity and time savings make these improvements possible. Below are average figures reported in these critical areas by several physicians.