Dialing in

By Emily Margosian, assistant editor, January 1, 2021

DermWorld talks to Kerry Lavigne, MD — founder of Camden Dermatology & Mohs Surgery in Rockport, Maine — about how her practice utilized remote staffing during COVID-19.

DermWorld: Tell us about your practice.

Dr. Lavigne: I spent five years practicing in this beautiful mid-coast Maine area, prior to founding Camden Dermatology & Mohs Surgery two and a half years ago. Currently, we have two dermatologists: myself, and a new associate I recently hired, Kimberly Huerth, MD. I also have a very experienced physician assistant, and a new physician assistant we just brought on. Our team also includes seven medical assistants, a referral coordinator, a Mohs lab technician, a scheduler, a front desk receptionist, and an operations manager.

DermWorld: How did your practice reduce the number of clinical staff present in the office during the early stages of the pandemic?

Dr. Lavigne: In the very beginning, we basically sent everyone off-site. I was the only one receiving patients in the office. I’m a fellowship-trained Mohs surgeon, so I do half Mohs and half general dermatology. Most of my general dermatology is skin cancer management, so probably 90% of my patients are getting full-body skin exams when they come in. You can imagine that documenting those exams in such a detailed fashion for one person is challenging, so I depend heavily on my medical assistants to function as scribes.

Initially, my medical assistants were scribing from home through a telelink. I’d dial them in, and they were on speaker audibly listening to what I was finding. I was having to give detailed, anatomic locations and verbally guide them on where to document. That was obviously pretty burdensome.

DermWorld: What technology did you use to better streamline remote scribing?

Dr. Lavigne: I considered an independent virtual scribe service and ended up speaking to another dermatologist in a remote area of Maine, who had been using something similar. He told me that there were several months of active onboarding to train scribes in the typical dermatology language in addition to learning our EMR. I felt like given the time constraints, and the substantial cost, that we had to come up with a better workable option.

We utilize Google’s G Suite (now re-branded as Google Workspace) for our internal business purposes.* Within that system, they offer Google Meet, which is their video meeting option similar to Zoom. We decided to try video-aided virtual scribing. I bought a $10 lanyard off Etsy that allowed me to hang my phone around my neck with the camera facing the patient and linked in my medical assistants working from home on the video call. This way, my medical assistants were able to see what I was seeing in real-time while I was examining a patient. Obviously, I made all our patients aware of this; it’s hard to conceal that you’re wearing your phone around your neck.

DermWorld: How did patients respond?

Dr. Lavigne: They really liked it! Patients didn’t express any degree of reticence whatsoever. I did an exam for a woman who had a vaginal complaint (lichen sclerosis). Again, I went through a rather extensive consent process to make sure that she was comfortable with that. When they were scribing from home, my assistants had to be in an isolated area without any family members around them so I could be confident that they were respecting patients’ privacy. The consensus from most patients was, ‘Thank you for being here and making this work for me. I was so nervous that you weren’t going to be able to see me.’ That was really the overwhelming sense that we got from patients during that time.

“The consensus from most patients was, ‘Thank you for being here and making this work for me. I was so nervous that you weren’t going to be able to see me.’ That was really the overwhelming sense that we got from patients during that time.”

DermWorld: How did remote video scribing affect your practice’s efficiency?

Dr. Lavigne: It was huge. It allowed me to be much more confident that we were correctly documenting what I was seeing. When I was treating pre-cancers, for example, and they were just listening on the telephone, I would have to give highly specific location information and take extra time to pore through that documentation to make sure that everything was accurate. Switching over to video-aided virtual scribing was wonderful, because it basically replicated the same system that we use in the office normally. They could see what was happening, and document just as well as they document for me in real time. It reduced so much anxiety about documentation errors and made everything smoother and faster.

From a legal and personal safety standpoint for me and my patients, it also provided an additional modicum of security because the medical assistant is bearing visual witness to that examination just as they would in the room typically.

DermWorld: How else have you adapted your office’s workflow in the COVID era?

Dr. Lavigne: At the beginning of COVID, one of my medical assistants was functioning as a virtual front desk. Again, Google was sort of the backbone of what we put together. We had a Google Voice number posted on the front door, patients would call that number, and it rang through to my assistant who was remote. She would then send a message out to the team saying that patient X had arrived for their appointment.

We’ve since transitioned back to having almost all our staff back to in-office support. We’ve only just re-hired a front desk person and we only just minimally opened our waiting room with more providers now. We were brainstorming ways to avoid having people in the waiting room, and meeting patients out at their cars to get them checked in was becoming challenging. So, we went to the restaurant remote system — the little buzzers they give you at restaurants if there's a long wait to let you know when your table is ready. Patients buzz in on a video doorbell, the doors unlock, they come to the front desk which has an acrylic drape in the window for shielding. My front desk person wears a mask, obviously. She checks them in, and then she gives them the pager. It makes it a lot more fluid, and our medical assistants aren’t having to utilize their otherwise precious time to go out in the rain and search for people in the parking lot.

DermWorld: Do you plan to resume virtual staffing in the future?

Dr. Lavigne: During the start of the pandemic, a big issue for staff with young children was a lack of access to childcare. Now with cases going up dramatically in Maine, it’s really unclear what’s going to happen if they decide to close schools again. That will be a bit of a game-changer as far as the needs of my staff. More often than not, if you look across the broad spectrum of dermatology practices, many medical assistants and support staff are women. I think that’s a huge piece of this puzzle that many practices struggle with. When the situation changes for childcare, that puts additional pressure on practices. You don’t want to lose your MA with 10 years of experience just because she has an eight-year-old son. I think having these tools available and being able to switch to a virtual workplace is going to be really important.

* Google is able to support HIPAA-compliance requirements, but requires physicians to sign a Business Associate Agreement. Learn more about Google's support for HIPAA compliance.

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