Efficiency in Healthcare

What is efficiency in healthcare?

Efficiency in healthcare means delivering the same or better care with less wasted time, effort and money. In practice it is measured in clinician time per visit, after-hours charting, wait times, turnaround for authorizations and results, claim rework and staff hours per task, then improved by removing steps that add no value to the patient.

Efficiency is not the same as speed. A shorter visit that leads to a repeat visit, or a faster claim that is denied, makes the system less efficient. The test is whether the total work needed to reach a good outcome went down.

Where does time go in a clinic or hospital?

Time is mostly lost in documentation, messaging, coordination between teams and administrative work tied to payment. Clinical work itself is rarely the bottleneck; the work around it is.

• Documentation: Notes written during and after visits, including the evening and weekend charting clinicians call pajama time.
• Inbox: Patient messages, results, refill requests and system notifications landing on the clinician by default.
• Prior authorization: Forms, portal entries, phone calls and follow-ups for orders and medications.
• Searching: Looking for outside records, images or results that live in another system.
• Hand-offs: Information repeated between front desk, nursing, clinician and billing because it was not captured once.
• Scheduling gaps: No-shows, late cancellations and templates that do not match real visit lengths.
• Rework: Denied claims, returned orders and incomplete referrals sent back for missing details.

The mix differs by setting. A primary care practice may lose most time to the inbox, a surgical clinic to authorizations, and a hospital unit to hand-offs and searching. That is why a general efficiency push rarely works as well as a measured look at one team.

How do you measure healthcare efficiency?

Measure efficiency with a small set of metrics that track time and rework, taken from systems you already run. Pick a baseline period, publish the numbers to the teams involved, and measure the same way after each change.

• EHR time per visit: Active minutes in the record per patient encounter, from EHR audit or usage logs.
• After-hours EHR time: Minutes spent in the record outside scheduled clinic hours, per clinician per week.
• Inbox volume: Messages per clinician per day, and the share a clinician did not need to handle personally.
• Cycle times: Check-in to rooming, rooming to clinician, order to result, and referral sent to appointment booked.
• Authorization turnaround: Days from order to approved authorization, and the share that needed a phone call.
• First-pass claim rate: Claims paid without rework, with denial reasons grouped by cause.
• Schedule use: Filled slots, no-show rate and same-day openings that went unused.

Keep the list short. Five metrics a team watches every week beat thirty that nobody reads. Pair each time metric with a quality check, so faster work that harms care shows up quickly.

How do you find the waste before fixing it?

Find the waste by watching the work, mapping each step and asking why it exists. Most wasted steps were added for a good reason years ago and outlived it.

• Shadowing: Spend half a day with a clinician, a nurse and a front desk lead, and write down every task and interruption.
• Process maps: Draw one workflow end to end, such as a new referral, marking every hand-off, wait and duplicate entry.
• Log analysis: Use EHR usage data to see which screens, clicks and note sections take the most time.
• Five whys: For each costly step, ask why it happens until you reach a rule, a habit or a system limit.
• Staff input: Ask frontline staff which task they would remove first; their answers are usually right.

Classify each finding as a step to stop, a step to simplify, a step to move to someone better placed, or a step to automate. That order matters, because automating a step you should have removed only makes waste run faster.

Write each finding with its owner and the metric it should move. A list of problems without owners turns into a report that sits in a shared drive.

What has federal policy done to reduce burden?

Federal policy has targeted documentation, reporting and prior authorization, the burdens clinicians name most often. Knowing these changes helps you avoid building workarounds for rules that no longer apply.

In February 2020 HHS released its strategy on reducing regulatory and administrative burden relating to health IT and EHRs, written by ONC and CMS. Its three goals were to reduce the time and effort clinicians spend recording health information in EHRs, to reduce the effort of meeting regulatory reporting requirements, and to improve the functionality and ease of use of EHRs. ONC also noted that CMS had revised the documentation and coding framework for office visit evaluation and management services, with the changes starting in January 2021.

Prior authorization is changing too. Under the CMS Interoperability and Prior Authorization final rule, CMS-0057-F, impacted payers must send decisions within 72 hours for expedited requests and seven calendar days for standard requests, starting in 2026, with a possible extension of up to 14 days in some cases. Practices that still track authorizations on spreadsheets should rebuild that workflow around the new timelines and the electronic APIs payers must offer.

Many organizations still carry note templates built for the pre-2021 office visit rules. Reviewing those templates against current requirements is often the quickest documentation win available.

Which fixes remove the most wasted time?

The fixes that remove the most time are usually changes to who does a task and how often, followed by better templates and routing, with new software last. Technology helps most when it supports a workflow that has already been simplified.

• Inbox routing: Send refills, forms and scheduling messages to staff pools, and only clinical questions to clinicians.
• Standing orders: Let nurses and medical assistants act on routine items under approved protocols.
• Team documentation: Let staff capture history, medications and screening before the clinician enters the room.
• Shorter templates: Remove note sections no reader uses, and default to problem-focused notes.
• Pre-visit planning: Gather outside records, overdue screenings and authorizations the day before the visit.
• Scheduling templates: Set visit lengths from real data, and use reminders and waitlists to fill openings.
• Targeted automation: Automate eligibility checks, authorization status and result routing once the manual steps are clean.

What role should technology play?

Technology should remove clicks, re-keying and waiting from a workflow that people have already agreed on. It works best as the last step of an efficiency change, not the first.

• Integration: Bring outside results, images and records into the EHR so nobody searches a second system.
• Data capture once: Let patients complete intake and questionnaires before the visit, and file the answers where staff need them.
• Status visibility: Show authorization, referral and result status in one place instead of in phone calls.
• Documentation support: Use ambient or AI drafting tools only with clinician review and a clear measure of time saved.
• Usage data: Keep EHR usage and cycle-time reports running after the project, so gains that slip are caught early.

Every new tool also adds training, support and another login. Count that cost against the minutes it saves before deciding to buy or build.

Why do healthcare efficiency projects fail?

Efficiency projects fail when they measure the wrong thing, skip the people doing the work or treat a tool purchase as the project. The causes repeat across organizations of every size.

• No baseline: Without before numbers, nobody can show the change worked, and support fades.
• Moved burden: Time saved for clinicians lands on nurses or front desk staff, who were already stretched.
• Tool first: Software is bought before the workflow is understood, then configured to copy the old process.
• Pilot forever: A change works in one clinic and never spreads because nobody owns the rollout.
• Quality blind spot: Speed goes up while follow-up, accuracy or patient experience quietly drops.

How do you run a 90-day efficiency program?

Run a 90-day efficiency program around one or two workflows, a named owner and a weekly metric review. Short cycles show results while leaders are still paying attention.

• Weeks 1 to 2: Pick the workflows, set baselines, and shadow the teams involved.
• Weeks 3 to 4: Map the steps, classify the waste, and agree on the first three changes.
• Weeks 5 to 8: Make the changes in one site, review metrics weekly, and adjust.
• Weeks 9 to 10: Fix what the pilot exposed, write the new standard work, and train the next sites.
• Weeks 11 to 13: Roll out, compare results with the baseline, and choose the next workflow.

Report results in hours returned and rework avoided, not only in percentages. A clinician who gets forty minutes of evening back each week understands that number immediately.

How Agnotic can help

Agnotic Technologies provides fractional CTOs who lead healthcare efficiency work from the technology side: pulling usage and cycle-time data, mapping workflows with clinical leads, choosing between configuration changes and new software, and managing the build of integrations and automation where they pay off.

The engagement keeps the focus on measured time returned, with a baseline at the start and a written result at the end, so leadership can decide what to fund next.

Sources

• ONC: Final report delivers a strategy to reduce EHR burden
• CMS: Improving prior authorization processes FAQ