How Care Teams Actually Work

The clinical workflow is the environment, not the software.

Pharmaceutical vice presidents, executive directors, brand leads, marketing leads, and commercial leads:

It’s Tuesday in the clinic.

So much of the work of getting a patient onto the therapy their clinician chose happens somewhere other than the EHR.

Walk into a specialty practice on a normal Tuesday. A medical assistant is on hold with a payer, working on a prior authorization that came back denied. A referral has just arrived as a scanned document attached to a fax—the way a great many of them still do—and someone is keying it into the chart by hand. The electronic health record is open on a screen in the corner. It holds the patient’s history. It routed the original prescription. It will capture today’s visit note. But it is one screen in a room full of motion, and the work that turns a written prescription into a therapy the patient actually starts is happening all around it.

The convenient shorthand and why workflow is more than the EHR

There is a widespread impression that the clinical workflow and the EHR are the same thing, and it has been carefully cultivated. A generation of tools has been sold on the promise of living inside the EHR, integrating with it, becoming the single place where the work gets done. The pitch is appealing because part of it is true.

Most hospitals and practices in the country run on an EHR—and have for years.[1] It is where the record lives and, in most clinics, is where the prescription begins. At many institutions, a clinician makes and records the treatment decision in the EHR, selecting the therapy and placing the order there. For that step, the EHR genuinely is the workflow, and a tool that sits inside it is part of the work.

The trouble is what that framing leaves out. The EHR is the floor the workflow stands on, not the whole building. Deciding and ordering is one step. The chasing, appealing, confirming, and coordinating that turn a written prescription into therapy the patient actually starts and stays on are the rest of the workflow; and a lot of it never touches the EHR at all. The workflow is the whole environment a care team works in, not the one piece of software at the center of it.

What the EHR does well and where it stops

The EHR is very good at capturing information, and captured information does real clinical work: It supports the decision at the moment of documentation, backs the case a clinician makes to a payer, and feeds quality reporting.[2] An expanded view of the workflow does not diminish that; it puts it in proportion. Even the effort to make the EHR the clinician’s entire working environment has not gone smoothly. Recent reviews of EHR usability find system design frequently out of step with how clinicians work, producing fragmented information, task switching, and workarounds in which clinicians turn to tools outside the system to finish the job.[3] The EHR holds the part of the work it was built to hold. A large amount of real clinical work happens in the environment around it.

The work that happens off the screen

The connective tissue between practices is still fax and email alongside it. Fax has not gone away. Even as hospitals shift toward electronic methods, fax remains in wide use; and rather than disappearing, it has proven durable enough that newer referral systems are being built to work with it rather than around it.[4] Even then, the handoff is imperfect: One 2024 study of an electronic-fax referral pathway recorded fax failures on roughly a third of attempts before retry logic brought the rate down.[5] These exchanges between practices routinely happen outside any EHR, on the channels the office already lives in.

The friction-heavy work runs on phone and fax, and it runs through staff. Prior authorization is the clearest case. Despite years of pressure to move it online, the AMA’s national survey found that only about a quarter of physicians say their EHR even offers electronic prior authorization for prescriptions, while most prior authorizations for medical services are still handled by phone, and nearly half by fax.[5] The same survey puts the time cost at roughly 13 hours a week per physician and their staff, with many practices employing people whose job is largely this.[5] The AMA’s own president described physicians fighting for patients with, in his words, fax machines as their only available weapon.[5]

That last point is the one that matters most for anyone trying to reach a care team. Much of this work is done by staff, not by the prescriber. The person on hold with the payer, working the fax queue, or running down a rejected claim may not be in the EHR for that task at all.

A message that arrives only where the prescriber happens to look can sit unopened while the actual work waits somewhere else.

Why the handoffs are where it matters

Underneath all of it, what travels between systems is usually a document, not data: a fax, a PDF, an email, a free-text note passed from one system to the next and often re-entered by hand. The places where one system hands off to another are exactly the places where things slow down or fall through.[5]

This is not a minor operational annoyance. It is a well-documented source of administrative burden and clinician burnout, which is why the field expanded the original Triple Aim of better care, better health, and lower cost into a Quadruple Aim that adds the well-being of clinicians and care teams.[6] Burden created in these handoffs lands directly on that fourth aim. Supporting care teams is not only a question of better technology inside the EHR. It is a question of meeting the team across the whole environment they work in, including the unglamorous channels where a surprising share of the real work gets done.

Sometimes the simplest tool is the right one.

It is tempting to treat all of this as a problem waiting for more advanced technology, and sometimes it is. But it is worth asking why fax has outlasted a generation of systems built to replace it. It works as a common layer when more sophisticated integration does not. A faxed document reaches its destination no matter which EHR either practice runs, with no shared platform required.[5] The point is not that older is better. The point is that the right tool is the one that fits how a team already works, which sometimes turns out to be the plain, reliable channel rather than the advanced one. The measure of a good solution is not how modern it is. It is whether it meets the care team where they already are.

Seeing the whole workflow

The EHR is an essential part of the clinical workflow. It is not the entirety of it. The work of getting a patient onto the right therapy and keeping them there runs across an environment far larger than any one screen: the chart and the fax tray, the inbox and the phone, the prescriber and the staff who carry much of the load. For anyone working to take friction out of that journey and keep prescribed therapy reaching patients, the starting point is to see the workflow as it really is—not the software at the center of it but the whole environment around it. That is where care teams work. It is where the friction lives. And it is where help, to be of any use, has to show up.

Being in the EHR works, and so do fax and email. The work moves when the right information reaches the right person at the moment it can change what happens next. That is why we work the way we do at Aventria: reaching clinicians and their teams through the channels they already use so the right clinically relevant information arrives at the right point in the work, when it is needed.

Dave Dierk is Co-President of Aventria Health Group and a 30-year thought leader in pharmaceutical sales and marketing. To learn more about how Aventria can help your brand close the gap between prescription and patient, reach out directly: dave.dierk@aventriahealth.com.

References

1. Office of the National Coordinator for Health Information Technology (ONC). National Trends in Hospital and Physician Adoption of Electronic Health Records. Accessed June 23, 2026. https://healthit.gov/data/quickstats/national-trends-hospital-and-physician-adoption-electronic-health-records/

2. Olakotan O, Samuriwo R, Ismaila H, Atiku S. Usability challenges in electronic health records: impact on documentation burden and clinical workflow: a scoping review. J Eval Clin Pract. 2025;31(4):e70189. doi:10.1111/jep.70189

3. Tian Z, Wierts K, Hyseni L, et al. A unique way to axe the fax through using business automation workflow to expedite eReferral adoptions, bridging eReferral, and fax: proof-of-concept study. JMIR Med Inform. 2025;13:e62983. doi:10.2196/62983

4. Office of the National Coordinator for Health Information Technology. Use of Certified Health IT and Methods to Enable Interoperability by U.S. Non-Federal Acute Care Hospitals, 2019. ONC Data Brief No. 54. February 2021. Accessed June 23, 2026. https://healthit.gov/resources/data-brief-54-use-of-certified-health-it-and-methods-to-enable-interoperability-by-u-s-non-federal-acute-care-hospitals-2019/

5. American Medical Association. 2024 Prior Authorization Physician Survey. Accessed June 23, 2026. https://fixpriorauth.org/2024-ama-prior-authorization-physician-survey

6. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Family Med. 2014;12(6):573-576.