Rethinking Administrative Time and the EHR in Modern Medicine
The Misunderstood Role of Administrative Time
Administrative time has a bad reputation in medicine. It’s often framed as a burden, something to escape from, or a symptom of a broken system. While it’s true that clinicians are drowning in work, the goal shouldn’t be to eliminate administrative time entirely—it’s to fix what makes it so inefficient.
For many of us, administrative time is when we finalize our clinical thinking, document thoughtfully, and communicate with colleagues or patients. These are vital parts of care. Without them, the medical system would fall apart. But the processes that support these workflows—documentation, chart review, messaging, and even just basic task management—are so poorly designed that they demand far more time than they should.
The problem isn’t the time itself. It’s the systems and tools we’ve built around it.
The Tragedy of the EHR Commons
The EHR is a perfect example of how our workflows have become unsustainable. By design, the EHR is a shared resource, but it’s treated like a digital landfill. Everyone dumps their information into it—notes, labs, medications, medical problems and symptoms, patient messages—without much thought for organization, clarity, or downstream use.
The result? Primary care physicians often act as the system’s “garbage collectors.” We’re left to sift through piles of unstructured data to piece together a coherent picture of our patients.
This isn’t just frustrating; it’s wasteful. Each clinician, not just PCPs, ends up spending extra time cleaning up the mess left by others. And when nobody takes responsibility for the shared system, we all pay the price with wasted time, inefficiency, and burnout.
A Better Approach: Stewardship Over Garbage Collection
We need to rethink how we approach administrative tasks, especially in primary care:
1. Incentivize Information Stewardship: Clinicians should be empowered—and rewarded—for maintaining clean, organized records that are useful for themselves and others.
2. Redesign Systems for Collaboration: EHRs need to be designed to encourage shared responsibility, not individual dumping. Problem-oriented structures, better tagging, and clear workflows can help. Having 100 different ways to do one task means there are 99 ways to do it that aren’t the most efficient.
3. Focus on Root Cause Solutions: Instead of tools that merely speed up tasks, we need solutions that address the core inefficiencies of our workflows.
The Bottom Line
Administrative work isn’t the enemy. It’s an essential part of modern medicine. The problem is that we’ve saddled clinicians with systems and workflows that make it harder than it should be.
If we want to reduce burnout and improve care, the solution isn’t just to work faster—it’s to work smarter. By fixing the EHR and rethinking how we approach documentation and chart management, we can create a system where administrative time is valuable, efficient, and supportive of patient care.
It’s time to stop being garbage collectors and start being stewards of clinical information.
