Paperwork — I hate it. A couple of weeks ago in clinic, a patient brought in routing forms for home health services that they'd had filled out before. Because of state requirements, the form needs to be renewed every year. Typically, the admin staff handles renewals. That keeps the visit focused and the chart clean.
But the admin team was so short-staffed that these forms landed on my desk. And when physicians are filling out paperwork, it's a signal that the system has run out of bandwidth to protect clinical time.
There are a lot of things to complain about in medicine, but the bureaucracy is what I'll complain about until I die. Spending 20 minutes on chart review, gathering patient information, and tracking down diagnostic codes is time that could be spent on actual clinical care.
I filled out the form, signed it, and handed it over… only to be told I'd done it incorrectly. I don't have high blood pressure, but it was certainly elevated after that. So I filled it out again, this time making sure my handwriting was actually legible. That time, it cleared.
This is the paperwork problem in miniature: redundant processes, fragmented accountability, and physicians absorbing the overflow. We haven't fixed it (yet). We've just decided doctors are the catch-all.
Root Cause Analysis: 5 Whys
The 5 Whys process in root cause analysis involves repeatedly asking "Why?" five times to drill down into the root cause of a problem by exploring the cause-and-effect relationships underlying the issue.
The problem: A physician was pulled away from clinical care to complete routine administrative paperwork.
Why?: The admin team was too short-staffed to manage routine paperwork tasks that typically fall outside physician scope.
Why?: Healthcare organizations chronically underinvest in administrative staffing relative to the volume of regulatory and documentation requirements they face.
Why?: Administrative labor is treated as overhead to be minimized rather than as infrastructure that protects clinical capacity.
Why?: Reimbursement models reward clinical volume, not operational efficiency—so there's no financial signal that admin under-resourcing is costing anything.
Why (root cause)?: The fee-for-service model creates no incentive to protect physician time from non-clinical tasks, so when administrative systems break down, the physician becomes the default catch-all, absorbing the overflow at the highest cost per hour in the building.
Impact Analysis
Impact analysis is the assessment of the potential consequences and effects that changes in one part of a system may have on other parts of the system or the whole.
Patient: Patients are burning a visit just to hand in forms, which can mean time off work, transportation, and a copay, even though the forms could have been handled remotely (e.g., short telehealth visit) or routed through a portal. When an in-person visit is not clinically necessary, requiring one for paperwork is a failure of process design, not a care decision.
Clinician or Provider: Clinical time gets swallowed by tasks that have nothing to do with clinical judgment. Every minute spent hunting down diagnostic codes or re-filling a form incorrectly is a minute not spent at the bedside. It accelerates burnout, erodes morale, and turns physicians into the most expensive administrative assistants in the building.
System: We're already paying for admin staff but chronic understaffing means the work doesn't disappear, it just shifts to physicians, which is both inefficient and expensive. The infrastructure exists to do this better, and AI is increasingly being deployed to do exactly that (see below). The will to implement them is the variable.
Solution
There are two potential solutions.
Add more human resources to handle administrative work, so physicians can focus on patient care.
If that staffing is unattainable, whether because of cost or limited supply, use generative AI.
I’ll focus on the generative AI path.
First, many parts of the form can be streamlined before the visit. Every form has a patient information section (name, DOB, SSN, family history, etc.). In my experience, patients leave these sections blank in about 99% of cases, which pushes the work onto admin staff and physicians. It seems minor, but across dozens or hundreds of forms per week, it adds up.
We can get ahead of this with automating patient intake or form builders. These tools can be patient-facing and physician/admin-facing. On the patient side, the patient enters the basic information required for the form. On the physician/admin side, the team adds the diagnostic codes and medical decision making needed. Once both inputs are complete, the form can be auto-filled. This beats the current workflow of using PDFs, adding text boxes, typing in fields, and copy-pasting boxes for future forms.
A lot of prior auth AI products already work this way, pulling data from the EHR to complete prior auth forms. The core capabilities are auto-populating forms from existing chart data, flagging incomplete documentation before submission, and routing routine renewals without a physician ever touching them. These tools should be more widely available. Epic should ship a native feature that does this.
But they don’t have one quite yet, or at least I’m not aware of it.
In the meantime, I’ve been bootstrapping with clinical AI tools like Doximity. For the form scenario I described above, I uploaded the form to Doximity, provided a prompt, and then uploaded patient information (e.g., prior visits).
Based on information required from the form I uploaded, and using the patient information below, please complete this form for me.
You can watch the video below to see how I do it in real time.
As I mentioned in the video, if you have any cool use cases with generative AI tools, let me know and maybe we can work on something together.
This method, of course, is not perfect. But the cognitive load (chart review, diagnostic code lookup, clinical summarization) is largely handled. At that point, the remaining work is clerical, not clinical.
The broader point is this is a workaround, not a solution. We shouldn't need to bootstrap this. These capabilities should be native to Epic or any major EHR. Until they are, tools like Doximity give us a way to claw back some of that time.
