Terry Ciesla is senior vice president of ScribeEMR located in Woburn Massachusetts. 

Terry Ciesla

With telehealth now a permanent healthcare delivery option, the greatest challenge moving forward will be how to maximize remote medical capabilities to benefit both patients and providers.

 released by Doximity say they plan to continue receiving care through telemedicine now that pandemic restrictions are being lifted. The number of clinicians surveyed who are continuing to use telemedicine as part of their practice is also significant. Some experts predict telehealth usage could keep expanding 40% annually for the next five years.

Nevertheless, conducting a medical exam over a screen has limitations. It’s difficult for some patients to navigate. It is limiting for many types of physical evaluations. And it can feel somewhat removed for a mental health visit.

Nor is it ideal for physicians, who are trying to focus on the patient, listen to their issues, and take accurate notes for charting and reimbursement. During telehealth visits, providers don’t have the in-person support of office staff to record patient information, pull up labs and other diagnostic reports, or schedule follow-up visits. This leaves a gap that can be filled by remote administrative support.

Here are 10 simple tips for optimizing telehealth:

Use the most simple, intuitive telemedicine platform, like Zoom or 

With Zoom and other more comprehensive, universal meeting applications, you can simply share a link with the patient and a remote medical scribe who can discreetly log in without video to record information in a patient’s chart and provide support throughout a visit.

2. Upgrade your internet connection and sound

The more megabits per second (Mbps), the better your connection will be. Upgrade to 100 Mbps or more for optimal speed and reliability.

Telehealth appointments need to be conducted in a quiet space without distractions or interruptions. Use a good microphone, not the one on the computer, or consider wearing earbuds that eliminate extraneous noise.

Make sure you’re well lit. Keep the computer camera in line with your face, not too low or too high. Make sure your background is professional and not too busy, especially if you are not in an office setting.

Telehealth can feel disconnected. The last thing a patient wants is to stare at a screen on their computer, tablet or phone while their provider takes notes, types on their keyboard, or looks away to find something.

A remote medical scribe, logged into the EMR during a telemedicine visit, can focus on charting so the provider can maintain eye contact and listen with undivided attention. This is especially important for mental health visits when it is crucial to observe patients carefully.

A virtual scribe can also pull up a lab report or chest x-ray, look up prescription history, or find referral information. Dedicated scribes, who are attuned to a provider’s protocols, can also remind them to check off everything on a telehealth template for more accurate coding and billing.

A well-trained remote medical scribe will use a special template for telemedicine visits which is designed to keep track of billing increments for 5–10-minute visits, 11-20-minute visits, 20–30-minute visits, etc., and other special telehealth coding requirements to maximize receivables.

HCPs are often on their own during a telemedicine visit. A remote scribe can complete administrative tasks ─ including loading up prescriptions and labs, recording diagnostic codes, initiating referrals and scheduling follow-up visits ─ right away, which frees up the physician and the front office. No additional follow-up required.

In many rural areas, practices can’t find professionals skilled in charting, researching insurance eligibility, getting prior authorizations and other crucial administrative tasks.

Telehealth applications make it easy to access trained medical support professionals located anywhere in the United States or overseas.

It’s challenging to produce a good, quality chart when you’re trying to listen and observe a patient onscreen. An experienced, remote medical scribe can capture everything in real time and provide clean, traceable documentation for insurance inquiries. This attention to detail helps coders verify information, close charts faster for billing, and ensure faster reimbursement.

Before the pandemic, healthcare providers were already using telehealth applications to fill in gaps and access specialists in other countries. For example, a radiologist in a different time zone could read diagnostic tests overnight and have reports ready the next morning.

Now, faced with substantial wait times for in-person appointments with specialists, providers can utilize telehealth to expedite care for patients in need of a consult. For example, a dermatologist could examine a rash via telehealth and prescribe medication for immediate relief.

Telemedicine helps providers reach patients who can't make it to the office due to distance or physical limitations.

It is also a significant timesaver for people who need to see a doctor during work hours. Instead of taking an hour or more to drive to a hospital or clinic, check in, and wait for the doctor, they can log in at an allotted time and complete the visit in as little as 15 minutes.

Doctors benefit from telehealth convenience as well, with the ability to do a remote visit from virtually any location at virtually any time.

We're only at the first stage of leveraging telehealth platforms, and can foresee significant improvements over the next several years. Telehealth is moving from a pandemic substitute for an office visit to a standard practice option that will help reduce a provider’s office hours while increasing patient satisfaction.

Articles

The greatest challenge moving forward will be how to maximize remote medical capabilities.

Telehealth 2022: Tips for maximizing telemedicine tools   

Staffing shortages, and high turnover rates in a tight labor market, continue to significantly impact the medical industry.

According to new data released in a Medical Group Management Association 

(41%) said their staff turnover rates increased in the past quarter

, compared to 33% who said it stayed the same and 26% who reported turnover recently slowed.

With no letup in sight, more practices are looking to virtual solutions to fill in gaps, improve workflow and boost their revenue cycle.

COVID-19 has accelerated this shift to more remote and hybrid work arrangements, and medical offices are no exception. The MGMA Stat Poll further revealed that 59% of medical group practices surveyed had shifted workers to permanent remote and/or hybrid work in 2021. This radical recalibration continues to move medical networks forward with more practices, and patients, becoming increasingly open to utilizing remote, and outsourced, services in new ways. Billing/coding, call center, scheduling, and other administrative positions have all been affected.

 can document patient visits virtually, without adding another physical presence to the exam room. Remote 

 and billers, with access to all of the latest technology, updated guidelines, and 

, can help practices avoid delays, errors, and other bottlenecks that delay reimbursement.

Perhaps the greatest untapped opportunity for outsourcing medical office support are virtual assistants, operating remotely, who can handle a myriad of front desk and back-office functions. A 

 is a highly trained person, with excellent organizational and communication skills, who can tap into the EMR and scheduling platforms to provide seamless support.

An outsourced virtual assistant, dedicated to a healthcare network, a practice, or a specific doctor, can handle many time-consuming tasks:

 Patients are tired of waiting on hold, or waiting for someone to call them back. A virtual assistant can be readily available to field calls, schedule patients, retrieve messages, return calls, and keep health records up to date, all within a practice’s EMR platform.

A virtual assistant can route incoming fax requests for medical records, lab orders, diagnostic reports, prescription refills, etc.

Verifying Insurance Eligibility/Prior Authorizations -

 A remote virtual assistant can access insurance portals to verify patient eligibility before visits and call insurance companies to confirm eligibility for tests, procedures, surgeries, and other treatments.

 A virtual assistant can help set up referrals and close the loop with consulting providers after appointments by obtaining consultation reports, labs, diagnostic studies, and other records, and importing them into the referring provider's EMR.

 - There’s no limit to what a virtual assistant can handle. Some practices even delegate tasks on their personal “to do” lists to their trusted assistants. They book airplane tickets, place orders, make appointments ─ whatever a provider needs.This reliable support lets doctors focus on more critical tasks and be more organized, present, empathetic, and effective during patient visits.

Providers like Langley Health Services in Florida; Lone Star Orthopedics in Texas, and Gagon Family Medicine in Utah are all utilizing virtual assistants to ease bottlenecks caused by staffing shortfalls. They have identified new ways virtual assistants can plug into their systems to provide better customer service, reduce call wait times, and avoid staff burnout. 

Technology ─ including virtual access to live, remote workers ─ has grown to the point that outsourcing virtual assistants to cover many of the functions that back up in a busy medical office just makes sense. It is a proven approach for keeping labor costs low, decreasing overhead, and freeing staff to focus on patient care.

As the great resignation continues, technology can help when low on staff.

Virtual medical office assistants overcome staffing shortfalls

Physician burnout was already an issue before COVID-19. Now, during a pandemic, it only continues to become more acute.

One culprit: electronic medical records (EMRs). The increasing demands for making timely EMR entries, and keeping up with additional documentation and coding, is adding hours to an already overloaded practitioner’s workdays and, quite often, nights. EMRs are sapping physician productivity and revenue, hurting patient-physician interactions and relationships, and causing widespread frustration leading to burnout.

Many practices are turning to scribe services to take care of EMR entries and other support services so they can devote more time and attention to their patients, streamline ancillarytasks, and increase revenue - without increasing work time.

found that using scribe services led to significant improvements in overall physician satisfaction, chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Ultimately, the researchers found utilizing scribes to be a promising strategy to improve health care efficiency and reduce physician burnout.

The potential for utilizing scribe services virtually is opening even more opportunities as doctors, and their patients, become more comfortable with telehealth and other remote technologies. Practices large and small have been reporting the benefits of using well-trained, dedicated scribes to supplement staff, overcome labor shortages, and curb the increasing costs of running a healthcare business.

Here are six tips for optimally structuring and leveraging medical scribe services:

: A scribe can be in the room during an exam, and participating as a staff member. They can work from a remote office in the states, or abroad.Using telehealth, scribes at an offshore location can listen to the narrative of an exam while it’s taking place and make real-time entries into the EMR while a doctor focuses exclusively on the patient. U.S. scribes are in high demand, short supply, and they’re costly. Another drawback of an in-person scribe is that social distancing may be an issue with an infected patient, or a patient finds it uncomfortable to discuss certain sensitive medical topics with a scribe present. By outsourcing scribe services, you can get unobtrusive, highly trained, experienced scribes at a more economical cost, which maximizes the revenue boost.

Scribes are more helpful, and productive, when they are working in real- time. Some services merely record a physician and patient talking and listen to the recording later to update charts. The disadvantage is that doctors can’t rely on those scribes to put in orders or process referrals in real-time. A scribe who is connected remotely during an exam can also clarify a doctor’s instructions or a patient’s comments immediately. This speeds the process so that doctors can feel confident about reviewing their charts briefly, without having to spend time trying to recall and clarifying and adding additional information after hours. 

 When a physician can count on their scribe’s capabilities, their relationship can be much more productive. Capturing and entering health information into an EMR is only one aspect of a scribe’s function. Working with a dedicated scribe (or scribes) who understand the practice opens many possibilities. A scribe can plan ahead and prep charts for the next day’s patients. They can help arrange drug lists, vaccine referrals and respond to messages from providers. They can also handle the endless minutiae of generating letters for a patient’s primary care provider, create lab and radiology test results and the myriad of patient education documents. 

 Every practice must report on a range of quality measures pertaining to different diagnoses. It can be difficult for doctors to find the time to do this; however, if they don’t report on these measures accurately, they miss out on opportunities to increase reimbursement via the full portfolio of value-based care programs. While per visit percentages may seem insignificant, they can add up to significant revenue when multiplied by hundreds of patients. A scribe will follow along in the visit and, for example, if a patient is markedly overweight the scribe can prompt the doctor to discuss dietary indiscretion and recommend a dietician as well as print out a nutrition chart.The scribe can document this counseling in the EMR, thereby satisfying tracking and reporting on one of the CMS Quality Measures and improved patient outcomes.

Scribes are a part of the team. Therefore, it’s vital to include them in a practices’ compliance program. They should participate in training and be included in the thought process when developing policies and procedures. They should be closely monitored to ensure accuracy and adherence to guidelines. And they should be audited periodically for continuous improvement of documentation quality, privacy, and security practices.

 If you’re using scribe services, and haven’t begun to benchmark their progress and effectiveness, now’s the time. First, agree on and establish benchmarks to be reviewed monthly. Use them to fine tune how you utilize both scribes and internal staff. This data will clarify the financial benefits of using scribe services, measured by increases in patient visits, reductions in coding and billing mistakes, increased revenue per encounter and eliminating charting backlog, and ultimately optimizing the revenue cycle. Ask your scribe service to help identify these benchmarks, whether they focus on less time working after hours or maximizing revenue. You CAN have it both ways.

The evidence is clear: it has been proven through research, and anecdotally, that scribes are just what the doctor ordered to maintain a more productive, profitable practice. Managing that relationship efficiently will enable a doctor to focus on what is most important: the patient.

Terry Ciesla is senior vice president of ScribeEMR located in Woburn Massachusetts. www.scribeEMR.com

The use of scribes can lower the burnout of maintaining electronic medical records.