• Sivagaminathan Palani, Iman Saeed, Aaron Legler, Izabela Sadej, Carol MacDonald, Susan R Kirsh, Steven D Pizer, and Paul R Shafer.
• Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Boston, MA, USA.
• J Gen Intern Med. 2023 Jul 1; 38 (Suppl 3): 878886878-886.

BackgroundSection 507 of the VA MISSION Act of 2018 mandated a 2-year pilot study of medical scribes in the Veterans Health Administration (VHA), with 12 VA Medical Centers randomly selected to receive scribes in their emergency departments or high wait time specialty clinics (cardiology and orthopedics). The pilot began on June 30, 2020, and ended on July 1, 2022.ObjectiveOur objective was to evaluate the impact of medical scribes on provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act.DesignCluster randomized trial, with intent-to-treat analysis using difference-in-differences regression.PatientsVeterans using 18 included VA Medical Centers (12 intervention and 6 comparison sites).InterventionRandomization into MISSION 507 medical scribe pilot.Main MeasuresProvider productivity, wait times, and patient satisfaction per clinic-pay period.Key ResultsRandomization into the scribe pilot was associated with increases of 25.2 relative value units (RVUs) per full-time equivalent (FTE) (p < 0.001) and 8.5 visits per FTE (p = 0.002) in cardiology and increases of 17.3 RVUs per FTE (p = 0.001) and 12.5 visits per FTE (p = 0.001) in orthopedics. We found that the scribe pilot was associated with a decrease of 8.5 days in request to appointment day wait times (p < 0.001) in orthopedics, driven by a 5.7-day decrease in appointment made to appointment day wait times (p < 0.001), and observed no change in wait times in cardiology. We also observed no declines in patient satisfaction with randomization into the scribe pilot.ConclusionsGiven the potential improvements in productivity and wait times with no change in patient satisfaction, our results suggest that scribes may be a useful tool to improve access to VHA care. However, participation in the pilot by sites and providers was voluntary, which could have implications for scalability and what effects could be expected if scribes were introduced to the care process without buy-in. Cost was not considered in this analysis but is an important factor for future implementation.Trial RegistrationClinicalTrials.gov Identifier: NCT04154462.© 2023. The author(s).

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