Moving Away from Chaos: Intentional and Adaptive Management of the Non-visit Care River

In modern primary care practice, clinicians face increasing volumes of asynchronous, electronic, non-visit care (NVC). Systems for completing this work, however, remain under-developed and often lack definition around patient and practice expectations for work completion and team member contributions. The resulting reactive, unstructured, and unscheduled NVC workflows cause and exacerbate physicians' cognitive overload, distraction, and dissatisfaction. Herein, we propose that primary care practices take an intentional, holistic approach to managing systems of NVC and offer a conceptual model for managing NVC work, analogizing the flow of these tasks to the flow of water through a river system: (1) by carefully controlling the inputs into the NVC system (the tributaries entering the river system); (2) by carefully defining the workflows, roles and responsibilities for completion of common tasks (the direction of river flow); (3) by improving the interface of the electronic health record (obstacles encountered in the river); and (4) by optimizing effectiveness of primary care teams (the contours of the river determining rate of flow). This framework for managing NVC, viewed from a broader system perspective, has the potential to improve productivity, quality of care, and clinician work experience.

Automated summary

In modern primary care practice, clinicians face challenges in managing increasing volumes of non-visit care (NVC). This can lead to cognitive overload, distraction, and dissatisfaction. To address this, a holistic approach to managing NVC systems is proposed, with emphasis on controlling inputs, defining workflows and roles, improving the electronic health record interface, and optimizing primary care teams. This framework has the potential to improve productivity, care quality, and clinician work experience.