Intervention
Section 507 of the MISSION Act specified that four scribes were to be assigned to each of the 10 VAMCs, which increased to 12 upon implementation, with VA hiring two of the scribes as VA employees and the other two as contractors at each site. The hiring of VA and contract scribes began before the official start of the pilot (June 30, 2020), which was pushed back several times due to the onset of the COVID-19 pandemic and continued throughout the duration of the pilot (ended July 1, 2022). Two scribes were to be assigned to two providers each at each VAMC, with providers volunteering to participate. Scribes assisted their assigned provider in documenting relevant patient information from each visit in the VA EHR. The notes made by scribes were tagged with their name as well as the date and time and were approved by the provider before becoming viewable in the EHR—also allowing for identification of visits for research purposes in the VA Clinical Data Warehouse (CDW) that involved scribes.