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Quality Enhancement Research Initiative

QUERI E-news
Summer 2023

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QUERI Evaluation Results Suggest Medical Scribes Can Help Improve Provider Productivity and Decrease Wait Times in Specialty Care

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 harming patient satisfaction. Part of the VA MISSION Act of 2018 mandated a two-year pilot study of medical scribes in the VA healthcare system, with 12 VA medical centers randomly selected to hire up to four scribes each 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 and was conducted by the Office of Integrated Veteran Care. An article recently published in the Journal of General Internal Medicine discusses an evaluation conducted by investigators with QUERI’s Partnered Evidence-Based Policy Resource Center (PEPReC), which examined the impact of medical scribes on VA provider productivity, wait times, and patient satisfaction in cardiology and orthopedics, as mandated by the MISSION Act.

A Relative Value Unit (RVU) is a value used by the Centers for Medicare & Medicaid Services (CMS) and private payers to determine physician payment. A total RVU is made up of three elements: physician work, practice expense, and malpractice expense. This study used work RVUs, focusing on the physician effort exclusively, to allow productivity comparisons across healthcare institutions and practice locations.


To our knowledge, this was the first study to examine the impact of medical scribes in a multi-center randomized trial within a large integrated healthcare system. QUERI 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) from cardiology and orthopedics. Three measures of provider productivity were assessed: 1) relative value units (RVUs) per provider FTE (full-time equivalent) per pay period, 2) visits per provider 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 in the study.


Study results suggest that scribes have the potential to increase productivity and decrease wait times for VA specialty care. Specifically—

  • 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 into the scribes pilot was associated with increases 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. It 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.

PEPReC prepares policy briefs on important legislative and policy priorities. They recently developed a policy brief on The MISSION Act Scribes Pilot: Implementation and Costs. The brief states that “Scaling up the use of scribes in specialty care may be a cost-effective way to improve access to care in VHA.” Visit the PEPReC website for policy briefs on topics ranging from virtual care to suicide prevention to urgent care delivery.

Given the potential improvements in productivity and wait times with no change in patient satisfaction, results suggest that scribes may be a useful tool to improve access to VA care.

Partnered Evidence-Based Policy Resource Center

QUERI’s Partnered Evidence-Based Policy Resource Center (PEPReC) provides timely, rigorous data analysis to support VA policy, planning, and management initiatives and program evaluations. PEPReC’s goal is to be an engine for VA’s Learning Health System, where research informs practice and practice informs research. PEPReC works closely with VA leaders to inform implementation of key components of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION Act), PACT Act, and Foundations for Evidence-based Policymaking Act.

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