Deployment of Medical Scribes Improves Provider Productivity and Wait Times in Cardiology and Orthopedics
BACKGROUND:
Medical scribes assist providers in navigating the electronic health record (EHR) and entering patient data. Outside VA, evidence suggests that scribes can increase productivity and reduce time spent on provider clinical documentation without affecting patient satisfaction. Part of the VA MISSION Act of 2018 mandated a two-year pilot study of medical scribes in VHA, with 12 VA medical centers randomly selected to receive scribes in their emergency departments or high-wait time specialty clinics (cardiology and orthopedics). Delayed by the COVID-19 pandemic, the pilot ran from June 30, 2020 to July 1, 2022. This study evaluated the impact of medical scribes on VHA provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act. Investigators compared outcomes in the intervention sites (12 VAMCs) with the comparison sites (6 VAMCs) using baseline (pre-intervention) data (January–December 2019) and pilot period data (June 2020–June 2022). Three measures of provider productivity were assessed: 1) relative value units (RVUs) per FTE (full-time equivalent) per two-week pay period, 2) visits per FTE per pay period, and 3) patients per day per provider. Investigators also evaluated six patient satisfaction outcome measures to better understand Veterans’ experiences and satisfaction with specialty care at the 18 VAMCs included. The scribes pilot was conducted by the Office of Integrated Veteran Care.
FINDINGS:
- Randomization into the scribes pilot was associated with increased productivity in cardiology and orthopedics, decreased wait times in orthopedics, and no changes in patient satisfaction.
- Randomization also was associated with increases over a two-week pay period of 25.2 RVUs per FTE and 8.5 visits per FTE in cardiology, and increases of 17.3 RVUs per FTE and 12.5 visits per FTE in orthopedics. These increases corresponded to a 12-17% increase in visits and somewhat greater increase in RVUs. Randomization was also associated with a decrease of 8.5 days in request to appointment day wait times in orthopedics. No change in wait times for cardiology was observed.
IMPLICATIONS:
- Findings suggest scribes have the potential to increase productivity and decrease wait times for VA specialty care; however, further evaluation and consideration for implementation across VHA and other access-related interventions are needed.
LIMITATIONS:
- Sites were randomly selected from a list of sites that exhibited interest in participating in the scribe pilot rather than being randomly selected from all VA facilities, potentially limiting generalizability.
- Provider participation 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 from providers.
AUTHOR/FUNDING INFORMATION:
This study was partly funded through the Quality Enhancement Research Initiative (QUERI). All authors, except Dr. Kirsh, are part of QUERI’s Partnered Evidence-based Policy Resource Center (PEPReC). Dr. Kirsh is VA’s Deputy Assistant Under Secretary for Health for DEAN.
Palani S, Saeed I, Legler A, Sadej I, MacDonald C, Kirsh S, Pizer S, and Shafer P. Effect of a National VHA Medical Scribe Pilot on Provider Productivity, Wait Times, and Patient Satisfaction in Cardiology and Orthopedics. Journal of General Internal Medicine. 2023 Jul;38(Suppl 3):878-886.
