PRACTICE: IMPOSSIBLE™

031 - My Practice Gamer Changer - What a Virtual Scribe Can Do for You with Ashwin George, COO of VP Scribe

May 19, 2022 Coach JPMD Season 1 Episode 31
PRACTICE: IMPOSSIBLE™
031 - My Practice Gamer Changer - What a Virtual Scribe Can Do for You with Ashwin George, COO of VP Scribe
Show Notes Transcript

In this episode, Coach JPMD continues his quest to find the most impactful guests to help you decrease your stress and teach you the ins and outs of the business of medicine. Coach JPMD interviews Ashwin George, COO of Virtual Physician Scribes. Ashwin’s vision is to simplify healthcare by creating innovative virtual solutions for healthcare organizations. He builds business partnerships with physicians and healthcare professionals to help them enjoy what they do by creating a tailored virtual medical solution for them. He initially founded Virtual Physician Scribes in 2017 to provide live virtual scribing and transcription solutions for healthcare practices. Since then, his company has expanded and is now offering more virtual solutions for clinics such as virtual medical assistant services and chronic care management coordinated services. Tune in to learn more about the possibilities for your practice and how scribe services can help YOU practice impossible.

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Show Notes 



Coach JPMD  0:00  
Welcome to the Practice Impossible Podcast with your host Coach JPMD. And if you've been listening to these podcasts in sequence, you might hear a little difference in the sound quality. And that's because we've just moved into our new home. And we have a room dedicated for recording podcasts not yet set up yet. So there may be an echo. But I think it's going to turn out to really well. And hopefully the quality will continue to improve as we configure this room. Not many things in medical practices can help you decrease your stress and increase your revenue all at the same time. And at Practice Impossible, my goal is to share with you things that can help you do just that. Either it decreases your stress or increases your revenue. So in today's episode, we have a conversation with my medical scribe company that's helped me see more patients and alleviate the stress of having to complete notes in a timely fashion. And you know, I'm not perfect, I still have things to review still have notes and maybe a little bit past due. But I think for the most part, this service that I'm using now has transformed the practice. And I want you to hear how this company works. And I think you'll enjoy it. So here we go.

Intro  1:21  
Welcome to the Practice Impossible podcast, we're your host, Jude Pierre MD, also known as Coach JPMD discusses medical practice topics that will guide you through the maze that is the business of medicine, and teach you how to increase profits and help populations live long. Your mission should you choose to accept is to listen and be transformed. Now, here's your host, Coach JPMD.

Coach JPMD  1:47  
So today, we're joined on the Practice Impossible podcasts by Ashwin, George and he's the Chief Operating Officer at VP scribe. And this is gonna be an interesting conversation because there are many things in there not many things in my practice that actually has transformed the way I do see patients and practice medicine. And there were two things. There's one tasks, I have a medical assistant that actually reviews my tasks, my messages and responds to them for me after we review it. And then the second thing was a scribe and getting a scribe in my practice. And about three three and a half years ago, I hired a scribe that followed me in the room. And unfortunately, after the pandemic or around the pandemic time, I lost the scribe and I had to find another way to help do the things that I do. And so today, I wanted Ashwin to come on the Practice Impossible podcast and kind of tell us what a scribe is. So first of all, introduce yourself and tell us who you are and what you do.

Ashwin George, COO  2:46  
Yeah, hi, I'm Ashwin, I'm CEO of virtual physician scribes. We've been providing virtual scribing solutions for providers since 2018. I started this company about four years ago, and it's grown pretty pretty big since then.

Coach JPMD  3:02  
It's wonderful. So what is what is a scribe? For those that may not know and I know that some physicians already have scribes and but when what is it what is the definition of a scribe?

Ashwin George, COO  3:11  
So pretty much the definition of a scribe is someone that would assist the provider in the documentation of kind of what's going on in the visit. I know a lot of providers, their documentation is a lot of templates, or they might take their or their charts home with them. And they're not necessarily getting all of the details that are going on in the exam. So a scribe is the person that will be in the exam room, or be listening to the audio in the exam room. And pretty much the being documenting everything in as much detail as possible for the provider on the EHR, so that you will have accurate notes for billing and have very good patient history.

Coach JPMD  3:52  
And so you mentioned either in the room or virtually, or at least, you know, they your company is a virtual scribe company. So explain what's the difference between a virtual scribe and the regular scribe.

Ashwin George, COO  4:04  
So yeah, and in person, scribe, it's someone that actually goes in the room with the provider and will be kind of charting on a computer listening in real time. So there'll be another person in the exam room with you, when you're examining the patient with a virtual scribe, pretty much. There's a microphone in the exam room connected to the computer. And we use some HIPAA compliance software so that the scribes could listen in real time what's going on? Nothing's really being recorded during that time. So the scribes have to be kind of actively listening and they'll document in real time on the chart.

Coach JPMD  4:36  
And so this is something you went to school for and you got an MBA and...

Ashwin George, COO  4:41  
No, no actually, I went to UT Austin. I went government route. I worked in parliament in London, so that was actually totally opposite to this, but um, one day my dad came up to Austin for a meeting. He's a physician in South Texas internal medicine. And I think the the scribing concept first got to him then four years ago, so I think it was still pretty big concept than in person scribing. And I know his documentation style is he takes everything home, he doesn't like to be in front of the computer in front of the patient. So usually he would come home and have two to three hours of chart work. I used to be his typist, too, because he used to use chicken finger typing one finger typing, so he would dictate. And I would go through some of his charts with him after school. But um, pretty much that concept came to him. And then we kind of thought through it. And another side piece of information, my sister actually went to medical school in India, where most of my scribes are located. So she was during that time, she was studying for her steps. And it usually takes about a year for someone from a foreign medical graduate to study for a step. So she was kind of in this transitionary period. So we thought that this would be kind of a good opportunity for people like that, that want to learn about how medicine is practiced here in the US. And one actually put some of their knowledge to use. And we kind of got that idea. And then I was on a plane to India, two months later, halfway through my semester, went all online, and started it from there.

Coach JPMD  6:11  
So you went to medical school in India?

Ashwin George, COO  6:15  
I didn't go to medical school, my sister went to medical school, I'm surprised she was able to complete it. She's back now practicing, she actually got a nephrology fellowship. Recently, she did internal medicine as well. But um, I went to India, and I thought I was the first person with this idea that we can get doctors or nurses or people to do virtual scribing work. And I put out an ad and a little delay. No, there was already companies doing this.

Coach JPMD  6:40  
That's, that's a great story. So your father? So did he also was he in part of starting this company or was he...

Ashwin George, COO  6:50  
Definitely he was a guinea pig, to say the least, I didn't have very good software in the very beginning, actually, like right now I'm using zoom to connect all the scribes with their providers, they have a great HIPAA compliance licence. So everything is very secure and encrypted. But back then I didn't know about that. So we were testing different software's and it was very cumbersome. Every time he would go to the exam room, he would have to log into something. So it definitely took a lot of iterations. But finally, I think we've kind of perfected that workflow. And it's been a great use to him. So he's actually had his scribe, she was like, actually maybe like our fourth or fifth employee, and it's one person he can't let go of. He can't practice without her. And we've had other scribes try, and he just gets upset. You know, he loves her.

Coach JPMD  7:38  
So So what did you where do you see the industry going? Because, obviously, you said that people were doing this in 2018. I know that they're obviously US based companies as well doing this. I've looked into them. I know that you guys had a lot of ad time on Facebook, I think that's where I may have seen an ad on and or social media. So So where do you see this going?

Ashwin George, COO  8:02  
So yeah, I think the industry has been usually filled with empty medical transcriptionists. Right. I think previously, people would dictate their notes, and someone would come back and give them the paper text of it, and then they would put it in the paper chart. So that's kind of evolved now people have been displaced from those types of jobs. And now I think scribing, other virtual medical assistants other kinds of periphery, ancillary medical service jobs, they're going to have to evolve to get to there. So we have people in India, all of these companies, actually were probably medical transcription companies, established 20 years ago doing this type of work. And now they're quickly evolving, going into virtual scribing, like live scribing with an actual person. There's even some companies I know Microsoft and nuance, I think they produced Dragon, they have a big team over there that are trying to perfect their AI. So AI scribing. So pretty much they're trying to correct the software. So they have people listening in the software spitting out what the charting would look out. And then right now, some scribes are actually correcting those things to have the software learn, and eventually hopefully become fully automated so that they don't have to have a person in the room. So that's kind of where the industry is going. I'm a little more pessimistic towards that. I think you still need that human touch and sometimes speaking to your scribe, the scribe going over the previous chart with you, there's other added value, other than just the pure documentation.

Coach JPMD  9:28  
Yeah, so So from my standpoint, I know that when, you know, we can talk about the pros and cons. But I think one of the things I've noticed as soon as I lost my scribe was that patients were able to speak to me more freely when they didn't see another person in the room. So I'm not sure what other physicians are, are seeing or are getting from their patients. But by the two, three minute mark, I find that my patients don't even realize that someone is listening and they're able to actually speak to me more freely. Is that something that you see also in the industry?

Ashwin George, COO  10:02  
Definitely. I think that also kind of amplified, I guess, during COVID, you know, when you didn't want to also have an extra person in the room with you. So I think kind of that virtual person there would help. And definitely, most of my providers that, that use the service, they actually, they don't usually speak to the scribe in the room, like you, I'm pretty sure you do as well. You speak to your patient, whenever you're done speaking to your patient, you could let the patient go. And then you could speak to your scribe freely after the visit, or something, that's how most of my providers do. So usually, the patient, they sign that consent form they are aware that someone is listening in, but it's very, the microphone is not too big, it's not too, I guess, cumbersome, or it's not too noticeable. So that they definitely do forget, I used to actually use this other microphone in the past that had a big red light on it. And I had to kind of change that because I felt like some providers or it didn't, it didn't feel comfortable for patients.

Coach JPMD  11:01  
So what are the negatives that you see in having a virtual scribe? I know that this is what you do, but certain things I look at negatives as maybe things that we can improve on, and we can kind of look to see how we can make it better for the patient experience. So

Ashwin George, COO  11:17  
Yeah, I think some of the negative things is um there are other ancillary things that people in person can do for the practice, right? Maybe when you're usually the scribes, they don't fulfil an order. Um, usually, they pre fill orders, like maybe prescriptions or referrals to other providers. But having an in person staff, you usually will have someone that can kind of do that right away. So there's a little bit more coordination that needs to happen between the scribe and the provider and the clinic so that we can get the patient going um in a faster way. But definitely an in person, someone there actually there would actually fulfill the order and kind of have the patient going right away. So I think it kind of cuts a little steps if you have someone in person and but in regards to the, I guess, the documentation, I feel like the people that you're also getting in person, they're also they're kind of you have to look at their job perspective and what what they're looking to get from their career, right? Most of them are in medical school or trying to get to medical school. So you have a certain knowledge level there. The scribes usually from overseas, this is kind of their career. So they had to kind of gather a lot of knowledge. They've been maybe in the industry, transcriptionist for many years, so they've heard or they've seen how, like documentation of charts and how doctors, I guess lingo is, so I think that kind of changes with in person scribing or having a person in person and having a virtual.

Coach JPMD  12:41  
Yeah, and I what you're saying about the end of the visit, I think it happens with us in the in the practice, because I you know, we're fairly busy in the office, and we kind of move patients one after the other. And what I'm finding is that if my scribe is not able to finish the impression and plan, then they're asking me, well, the patient's ready to be checked out. But the patient's like, oh, well, we have lab work that needs to be ordered that we have. So there is there's something that we may have to implement a delay in processes, maybe even I think we gave her instant messaging on our computer on our EMR system, so that she may might be able to communicate with the staff, just as she was there. 

Ashwin George, COO  13:20  
Yeah. So pretty much like in my dad's clinic, what the workaround that we've done, they use ECW. So what the scribe will do, we'll assign, like, do it, like assign an action to an MA that's sitting in the nursing station, and make it urgent, so like a notification will pop up on their EMR. So while like he's speaking to the patient, maybe ordering, or like maybe sending a prescription or ordering some lab, that message is already communicated to the MA through the scribe on the back end. And by the time the patient walks out, everything shouldn't be fulfilled. Every practice is unique. There's a lot of workload that each practice could adopt, but it definitely it helps with communication and knowing what the capabilities of what the scribe can do. And then just kind of tying all those loose ends together to make sure that the patient's getting the best care.

Coach JPMD  14:08  
For sure. And you know, I think one of the other things is language. I've heard doctors say, well, suppose a patient's speaking another language, I speak Spanish, I speak Creole, some of some of my patients and so the scribe doesn't speak that other language. So I'm having to translate what I'm talking to the patient about. And I think it's, I still think the time spent with the patient, kind of trump's at that negative, in my opinion, but I don't know how other providers are.

Ashwin George, COO  14:37  
Yeah, other Spanish speaking providers. One, he told me the way he likes to do it, that saves some time as pretty much he does the whole visit in Spanish. And then when he's kind of doing the physical exam, he lets the patient know that he's going to kind of do a little dictation to the scribe so that they could do the documentation for him. So maybe he's doing some um listening to the lungs and he's kind of just doing a quick summary, dictation of what the visit is, and then he would just continue the whole conversation in Spanish with the patient.

Coach JPMD  15:04  
Yeah. Yeah. That's, that's interesting. And I do that a little bit, but something to consider..

Ashwin George, COO  15:12  
It also depends on Yeah, how you deal with how you deal with speaking like that to your patient. I know some providers, I think it's totally normal that they want the patient to kind of leave the exam room and then speak to the scribe more freely to make the patient feel more comfortable, because it is a little awkward than speaking to the computer when you don't see anyone and then the patient might be thinking what's going on?

Coach JPMD  15:33  
Yeah. And what about compliance issues? Have you? Have you had any issues with compliance? In terms of the documentation, the the HIPAA compliance and things of that nature? What have you seen?

Ashwin George, COO  15:45  
So yeah, we were pretty compliant, we have all HIPAA compliant software. So we do have a BAA signed with Zoom. We do sign BAAS, with all our clients as well. All our scribes when they initially join our company, we undergo a three month they go undergo a three month training. And in that training, they have to do we have like a HIPAA awareness course, that they have to pass like a module. And we have a little safe we have on our computers, our company devices, they have safeguards to make sure there is no screenshotting, none of those things can happen. While the scribes are working on our devices. Usually, there is some problems when we go to bigger clients, hospitals, they'll have to do a lot of security audits. I'm actually going through one right now. So we have multiple meetings with their IT team going through our how we connect in all these things. But usually, it's just a long process. But um, luckily, everything's HIPAA compliant, and everything. We haven't had any problems. So far. 

Coach JPMD  16:42  
Yeah. 

Ashwin George, COO  16:42  
Knock on wood.

Coach JPMD  16:43  
And are you doing any surveys for patients or within the practices that you're you're providing services for? Because I just thought about this, as I'm, as I'm talking to you, you know, what are the patients saying?

Unknown Speaker  16:56  
I actually haven't haven't done that. Usually, I've just, it's been very hard. Usually, I tried to send surveys to providers too none of them answer. So I never really thought to ask the patients how they feel about that. Because definitely, some of them might feel some change. Some of them. I know, some providers told me themselves that they get more of a personal visit, they don't have to sit spend time on the computer. So definitely patients would acknowledge that and notice that difference. So I would be interested probably to see some sort of survey like that, to see how patients feel about it.

Coach JPMD  17:29  
And I did not get a survey from you. So please. 

Ashwin George, COO  17:32  
Okay. I think yeah, so I actually kind of scrapped that when I kept doing it, it was it was kind of negative, and then my scribe team, they would be like, Why is no one giving positive feedback or any feedback to us? Are we doing good? So I was like, Yeah, let's just hold off on this for a while.

Coach JPMD  17:47  
So I have to give a disclaimer, because I probably didn't give a disclaimer at the beginning of this. VP Scribe is my scribe company after I lost my my live scribe. And, like, I like I've, I tell everyone that I that I coach, or that I help, I'm looking to help physicians decrease stress increase revenue. So if we can have them do something for their practices, that allows them to free their time up so that they can care for the patients more powerfully. That's what we're trying to do. And so my idea is to bring in my or our ecosystem of providers of wise counsel, people who can help a physician really practice impossible, right? Because that's what we try to do. We try to help them understand things that they can do, that they certainly weren't taught in medical school, because I was not taught about scribes in medical school. So. So where do we find you? Where, where can we find you if we wanted to learn more about your services? 

Ashwin George, COO  18:44  
Yeah, you can find me on my website, it's VPscribe, So V as in Victor P, as in Paul, and scribe.com. VPscribes.com, you could search us on Facebook, we have our company page there as well. And yeah, you can, once you look on our page, you can pretty much put your information there. And you can schedule a meeting with me to see how scribing services can work for your practice.

Coach JPMD  19:10  
And we'll have some we'll have the links here to the to your websites as well. And I think there there is a at least I don't know if you're still offering it, but I would throw it out there but you you gave us a two week free consultation or free scribe service for providers. And that was really, that was really the key to me converting because it was either I continued the way I was doing things three years ago and seeing you know, 15-20 patients managed care difficult patients, by myself and finishing my notes or hiring another company that can help me do that. So one one thing, one question I like to ask my guests. It's related to the one thing by Gary Keller he wrote a book called The one thing and it's what the what's the one thing you can do such that by doing it, it makes everything else easier or unnecessary, but I'm going to change it around a little bit and ask you what's the one thing you wish that you're that you could change about your father's practice right now?

Ashwin George, COO  20:05  
I think I kind of alluded to this earlier. Right now, it's very difficult for him to live a day without a scribe on he's so so very reliant on it. That scribe, I feel a little bad for her, she got married, and during these three years, and not very much vacation time, I could tell. So I mean, I think he works usually four and a half days a week. So I think he needs to lighten his schedule a little bit more on my brother actually just joined his practice. And he was telling me he's complaining, he's just six months in, that he's already having a full schedule. He's like, needs an MP already. So he's like, I see my my colleagues, my classmates just starting and other in other clinics, and they just see maybe 5-10 patients a day. And he's already at 25 to 30. So he's, he's stressing out too. So definitely love to help them out with the scribing service. But yeah, I mean, they're, they're too busy. They're too busy people, they're scribes are now kind of integrated in their lives. So now whenever my dad's taking vacation, he will let his scribe know year for July 4, I'm going here, plan your vacation accordingly. So pretty much it's hard. I've been trying to pair other people have backup scribes for him, but him and his scribe have a good chemistry and she knows kind of what he means by when he's talking to the patient and what he's looking for. So they have that kind of that same wavelength. So it's hard to kind of change that.

Coach JPMD  21:36  
Well, it's all about stablishing relationship, right? So he's got a great relationship with his scribe. And that's kind of that that goes a long way, in practicing medicine. So...

Ashwin George, COO  21:45  
Yeah, maybe hopefully, his office staff his MAs can do a little bit more.

Coach JPMD  21:53  
Well, thank Ashwin thank you so much for spending some time with us and the Practice Impossible podcasts and, and telling us what you do. And thank you for what you do for us and the practice. And there's anything we can do. There's any feedback that we can give, we're certainly open to doing that. And then send me a survey if you want me to.

Ashwin George, COO  22:09  
 Yeah. 

Coach JPMD  22:09  
To fill something out. But you know, think about doing a survey for patients as well, once I've once I've done this for a little bit, because I you know, we have to we do it for the patients, right? Well, we're not doing this for ourselves. We're doing this so that we can have less stress. So we can practice impossible so we can care for patients and help them live long. Because that's that's what we're as we went to medical school for so.

Ashwin George, COO  22:29  
So yeah, exactly. So that thanks for having me. I'll definitely send you that survey later today. Don't worry about that. But yeah, I'm happy, I'm Hope. I'm glad that you're happy with the service. I'm grateful that the Scribe is helping you out. And hopefully, that lasts a long time.

Coach JPMD  22:46  
Thank you again.

Ashwin George, COO  22:47  
Take care. Have a nice day.

Coach JPMD  22:49  
Bye. I'm so happy that we can have Ashwin on our podcast to share what his company does and what medical scribes can do for medical practices and your practice also. I have to share with you that I do not have received any financial compensation or any affiliate marketing fees for having Ashwin and VP scribe on the practice impossible podcast. And I just wanted to share, share my story and share the things that have helped me in my practice. And I hope they can help you as well. And you may not be ready to have a scribe in your practice. I know that it took me a while to realize the importance of having other people help me in delegating, note writing to them. I think you have to see a certain number of patients for it to make sense. And you have to also have a willingness to trust someone else. Trust someone else to write your notes and also trust someone else to help you in your practice. And I think our goal as medical practitioners is to really treat patients and documentation and all the things that stress us out of the practices or things that should not stress us out when we have companies like this that can help us. So I hope this has helped you and please leave a review. Let us know what you think and maybe even tell us what other topics you might want to hear about and we'd be glad to try to get a guest to fulfil those needs. Thank you and we'll see you in two weeks.