The Connected Practice

Communication Breakdown in Healthcare: The Missing Workflow

Hosted by Dr. Kevin Halow, MD MBA FACS

S3 · Ep10 · 15:08

What You'll Learn in This Episode

More channels have not meant better communication

EHR messages, portals, referral platforms, texts, email and fax each need checking, so practice teams spend hours reconciling them.

Every system works and the message still fails

Each vendor solved its own piece well. Nobody designed the path that gets the information and its context to the right person.

Patients see the delays, not the fragmentation

Patients see long waits, long drives and appointments where nobody has the notes. Then the blame falls on whoever is nearest.

Safety guidance points to the workflow

ONC's SAFER Guides call for reliable electronic communication inside the clinical workflow, which asks more than adding another tool.

Ask where your information goes after it arrives

Physicians, administrators and health systems can each check whether their communication fits a shared workflow or adds an inbox.

About This Episode

Communication breakdown in healthcare rarely means nobody sent the message. In this episode of The Connected Practice, Dr. Kevin Halow, MD, MBA, FACS, looks at what happens when a specialist note, a discharge summary or a medication change sits unread while the patient waits. Physicians already juggle EHR messages, portals, referral platforms, texts, email and fax, and each works as designed. He follows the gap from the patient's side, in rural Nevada and after a hospital discharge, and explains why the fix is communication built into a structured clinical workflow with clear roles and a next step.

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Transcript

Communication Breakdown in Healthcare: The Missing Workflow

0:04

When we talk about modern medicine, what do we really mean? We've definitely solved a lot of problems. We can diagnose diseases that our former professors and mentors could never have done. We now treat conditions that were severely debilitating or even fatal just a few decades ago. We can send images across the country in seconds. Shall I go on? And yet, we have those moments. Take, for example, when that critical piece of patient information, you know, a specialist note or discharge summary or a medication change, sits on a computer or server somewhere completely unused. Meanwhile, a patient sits in a waiting room, the staff unprepared, because that information never found its way to the person who needed to act upon it.

0:51

Now, ask yourself: how productive will that patient appointment be when they come to the office? Hello again. Welcome back to our podcast. I'm Dr. Kevin Halow, surgeon, co-founder and chief medical officer of ClinicianCore. On today's podcast, I want to reflect upon the importance of having the right tools for the right workflow. You see, we have communication tools that surgeons could not have imagined 20 years ago. Yet, despite this fact, having the right tools is not necessarily the same as having the right workflow. Let's talk about the difference. From my conversations with independent physicians, one

1:37

consistent theme emerges: frustration. My colleagues are frustrated with a system where you can do everything correctly, yet the system still fails the patients that we're trying to help. Physicians and clinicians have it all. They have electronic health records, they have hybrid charts to connect to those EHRs, they have personal cell phones and the ability to text, they have emails, they have patient portals. Some have multiple referral platforms, each one requiring a separate login, each one competing for attention. They even still have fax machines. The problem that no one discussed is that all of these doctors and the clinicians and the non-clinical professionals who work with them are swimming.

2:22

Well, treading water, really. There are plenty of systems, but then you have to check them all. Some physicians can be managing five different systems at once. Each time a message comes into one of those systems that do not necessarily communicate with the other, the physician and their staff are gambling that it will surface before the next patient appointment, before something gets missed or before a patient suffers a consequence for which nobody planned. The cost of that isn't just frustration, it's time. And in modern medicine, time is extremely valuable. How much time are we talking about? A practice administrator that I know actually calculated her team spent an average of four hours a day

3:10

reconciling information that technically already existed somewhere in their system. That's 20 hours a week spent on solving a problem that should not exist. It turns out that the information does not lack channels through which it can travel. It lacks a workflow path to get it to the person who actually needs to see it and act upon it. So why does this fragmentation exist? I don't think that it was intentional. The systems were created with the best of intent. However, this problem is almost invisible to the people who designed these current systems. EHR vendors built messaging into their EHRs. Referral platforms built referral systems.

3:56

Imaging centers built portals. Every company solved their own piece of the problem brilliantly. Each system works. Many work well. They work really well independently. But instead of being an orchestra, there are a group of musicians, each playing different instruments, each playing a different score. For example, the cardiologist can message his patient portal. The imaging center can upload results. The surgeon's office can receive a fax. Yes, we still use fax. And they can file that fax. Every channel performs as designed, yet the information, more importantly the appropriate context for that information, did not reach the right person at the right moment, when it mattered.

4:45

Okay, so we have the technology. The technology works as designed, still the information and context are missing. What's the deal with that? Well, as it turns out, what we're missing is intentional workflow design. The question isn't whether we can send a message. The question is, when that message arrives, will it interrupt the person who can act upon it, in time for them to act upon it, in a way that fits how they actually work? Most of our tools assume someone will notice. Someone will check the inbox. Someone will remember this came in and prioritize it. That's not workflow. That's hope disguised as a system. As a physician, we can get a lot of credit.

5:31

That's nice. We like accolades. We can also get a lot of blame. That's not so great. Call it a hazard of the profession. But the blame is also spread around to our staff and even to the patients. So let's take a moment and try to imagine this from the patient's perspective and see if we can see where the breakdown occurs. More often than not, it's not anyone's personal fault, but a product of the system and the technology that we use to care for patients. Take as an example the patient in rural Nevada. There are many who need a specialist opinion. That's not unusual. What is unusual is the logistics. They likely will have to wait a long time, maybe months, to even get an appointment

6:16

once the referral is sent. And after that wait, they have to drive from Ely or Tonopah or Austin or Battle Mountain, three hours or more, for a consultation. All this time, they're waiting for their care, plagued with the issue that required a specialist's input in the first place. Ironically, all of this could have happened over a secure message, if that secure message had actually reached the specialist's workflow in a timely and coordinated fashion. Now, think about discharge coordination. A patient leaves a hospital in Reno and goes back to their home in Yerington. The discharge note documents everything perfectly. In theory, the patient's primary care should be prepared, assuming that they see the note.

7:02

But the note is buried somewhere. Maybe in the patient portal, maybe in the hospital's EMR system. If the physician or their staff do not see it, then there is no continuity of care. Three weeks later, when the patient shows up in their primary physician's office or calls with a question about medication, the primary care physician and his staff are operating in the dark on outdated information. There was communication. It did happen. It just did not happen inside the workflow of the person who actually needed it. So, neither physician nor the patient sees that fragmentation per se. They just see the results of the fragmentation:

7:48

the delays, the unproductive appointments, and the time spent managing the health system instead of their own health. Then comes the blame game. You know, "My doctor never sent the referral." "That hospitalist probably forgot to dictate a note." "The cardiologist or the dermatologist never called me." "Well, you know, that patient forgot to get their records and imaging." We blame everything and everyone except the real problem: the lack of a proper workflow. That's just more broken logic that probably got us here in the first place. In 2022, the Joint Commission reviewed over 1,400 reportable

8:33

never events. We all know what those are. In a large portion of these cases, the incidents trace back to the same core problem. The information existed, but it did not reach the physician or clinician who needed to act upon it in time. It was not a lack of knowledge. It was not a lack of competence. It was a communication failure. And it was not a freak occurrence. It demonstrates a pattern. Along that same line, researchers also documented a similar pattern with specialist consultations. Many specialist referral loops never fully close. The patient sees the specialist. The specialist writes a note. Yet, the referring physician never receives the consultant's findings.

9:21

It is documented and exists, but simply does not make the journey back to the physician or clinician who started the process in the first place. The end result is duplication, delays, and sometimes patient harm. This is why the CDC and the Office of the National Coordinator released their updated SAFER guidelines in 2025-2026. In that release, they did not name communication tools as a safety priority. They named reliable electronic communication inside clinical workflow as a patient safety imperative. The difference between those two things is everything. So, how do we solve this issue? Well, it's not by adding another communication channel that operates independently. You solve it by creating a real clinical workflow.

10:07

A structured workflow allows the primary physician and their staff to frame the information correctly. It ensures that the information is routed appropriately, quickly and efficiently. It's not buried in a general message queue, or competing with discharge summaries, or scattered amongst patient portal messages. Physicians can receive the information where they're already working, creating actionable guidance and ensuring completion before the patient leaves the office. The same principle applies to coordination with labs, imaging centers, ambulatory surgery centers and more. These are not just contacts in a directory. They're participants in a shared clinical workflow. The relationship between a practice and its clinical partners should be built with

10:54

defined roles, access and expectations for what happens next. And communication that lives inside that structure instead of beside it. It's not a new tool. It's a workflow pathway for the information to take to the right recipient at the right time. This brings me to something I think we should be asking ourselves. Do the tools that we already use actually put you inside the workflow? Or are you just stitching them together in order to make them function? This is an important distinction. As a physician or clinician, every hour that you spend reconciling information is an hour you're not doing

11:41

what you trained to do. And that is a source of burnout. When administrative burden becomes the largest piece of your day, and when a substantial portion of that burden is solving a communication problem that shouldn't exist, something breaks. And that something is you. As an administrator, how many hours is your team spending reconciling information that technically already exists? I'm serious about that question. Calculate it. Find out how much of your operational budget is going to solve a problem that a better workflow would prevent. Then imagine what you could do with that time and money if you actually had it. As a healthcare organization, is your communication with independent physicians built into a shared workflow?

12:27

Or is it one more inbox competing for their attention? If you're a hospital system trying to strengthen relationships with independent physicians, fragmented communication isn't going to do it. The bottom line? Reliable, structured communication inside a workflow that respects a physician's time is the real holy grail. At the beginning of this podcast, I mentioned that clinical information sometimes sits on a computer or server while a patient is waiting in the waiting room or an exam room. I know that because I've been both the person with the information and the person waiting for it. As a surgeon, too often I've walked into the exam room and

13:12

presented my standard greeting: "Hi, Dr. Halow. How can I help you today?" Only to be answered by, "I don't know," or "I have no idea why my doctor even sent me here." Then comes my, what I call, the detective shuffle, as I search for information that never reached me, or try to call a colleague for more input, only to get a voicemail. The frustration that I have felt is not from lacking communication capability. It's about having too much fragmentation to move with the speed and precision that I need to move to care for the patients. We know how to fix this. We have the technology. We have the regulatory guides. ONC's SAFER guidelines spell it right out.

13:59

What we're missing is intentional workflow design, and the decision to build communication into what and how we work, instead of beside it somewhere. That's our podcast for today. Take a moment to reflect on today's topic. In your practice, what's actually happening when clinical information arrives? Is it reaching the right person at the right moment, when it matters most to the patient? Or is it simply lost in another inbox that's already too full? That is the difference that matters. I'm Dr. Kevin Halow, co-founder and chief medical officer of ClinicianCore. To learn more about this topic, and how our HCO Practice HQ and HCC Consult Core move clinical information inside a true workflow

14:46

that you can act upon, visit cliniciancore.com/communication-workflow. Thanks for listening.

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