“Efficiency” is both philosophy and practice at New York-based Northwell Health. It is a carefully thought-out policy designed to align people, processes, and technology in support of improved clinical decision-making and patient care. Then, full integration into interconnected teamwork will be achieved, said Jennifer Berliner, MD, vice president of operational effectiveness and physician well-being, Western Market, at Northwell Health.
“How do we work with IT to identify the right tools and use them to uncover, address and improve inefficiencies in our workflows?” asked Dr. Berliner, who is also a cardiologist. “Then, how do we optimize those workflows to make the best use of those tools, improve patient care and make things easier for caregivers as well?”
It also includes the most effective use of teams in the ambulatory space, added Nancy LaVine, MD, co-chair of the In Basket Council and chief for the Division of General Internal Medicine at Lenox Hill Hospital, Northwell Health.
“Care delivery requires many different skills, not just those of physicians," Dr. LaVine, who is also an internist, said. “We must lean on different team members who have the right training to do their job in such a way that it drives the whole process forward.”
Northwell Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Reducing complexity through workflows, team design
First and foremost, Northwell Health leaders approached efficiency as a team-based construct. Responsibility for care delivery is organized and assigned so that the appropriate members are able to work at the top of their licenses, including clinical and administrative staff who perform tasks that do not require physician-level decision-making.
Technology and digital tools support workflow optimization by reducing redundancies and nonclinical tasks, enabling more consistent, high-quality patient care.
“We’ve piloted a centralized pool of nurses and support staff to assist with prescription refills and phone calls, and to help manage patient messages before a physician ever needs to see them,” explained Deborah Mensch, MD, vice president and chief medical information officer at Northwell Health.
These initiatives and policies were developed to help physicians navigate the increasing demands of the modern healthcare environment. Their day-to-day includes not only more medically complex patients, but patients with more nonclinical factors, all of which had to be addressed in the already tightly scheduled visit times.
“Healthcare has become increasingly complex, but the tools available to help physicians manage that complexity have not evolved quickly enough,” said Dr. Mensch, who is also a pediatric cardiologist. “Patients have many more issues and other situations that need to be managed, whether it's English as a second language, comorbidities or other social drivers of health.”
Standardizing records to improve access and efficiency
One challenge was disparate EHR systems that limited access to patient data.
“Until recently we had multiple electronic health records,” Dr. Berliner said. “A major workflow challenge was that caregivers and physicians did not always have access to the information they needed to provide patient care.”
This fragmentation added both time and stress to everyone’s day-to-day, so Northwell Health consolidated its multiple systems into a single Epic EHR platform, a major enterprise transformation that consolidated dozens of legacy records and transitioned more than 70,000 employees into one system. Access to patient data was unified, and the resulting coordinated workflows improved visibility across the entire health system.
“By standardizing our practices and consolidating medical records, we create a transparent, unified view of patient care,” Dr. Mensch said. “This allows us to generate real-time reports, instantly see what’s been done, and identify opportunities. From there, we can produce more sophisticated, structured documentation to help manage patients.”
Existing workflows did not conform to the new realities of contemporary healthcare delivery. Legacy systems included episodic, in-person visits, but now intermittent care happens through virtual visits, messaging and remote monitoring, a new status quo that existing tools and staffing models did not support.
“The evolution of healthcare over the last 15 years … demanded a lot of new technologies, team members and tools,” Dr. LaVine said. “The newer systems we have now allow us to see the true volume of work and track it.”
Messaging prioritization to improve efficiency
Northwell has also restructured its in-basket messaging system to prioritize those that are actionable and necessary. Even small tweaks in the design, such as redirecting nonclinical messages away from physicians, have increased efficiency measurably.
“One of my favorite examples was suppressing thank you messages,” Dr. LaVine said. Though it is human nature, and good manners, to respond to a message from doctors and care teams with a quick thank you, the team calculated that responding to even a single such message took 16 seconds.
“We tried to follow strict guidelines so that the only messages that reach providers are those needed to advance patient care. This means decreasing ‘FYI’ messages that do not require any action,” she added.
Augmented intelligence-supported tools that manage documentation and prior authorization, as well as ambient listening and scribing, have also helped reduce the volume of documentation that traditionally fell on already busy physicians.
Identifying inefficiencies, shaping solutions
Physicians, the most immediate beneficiaries of these initiatives, were actively engaged in both the design and optimization phases.
“All of our design sessions were chaired or co-chaired by practicing physicians,” Dr. Mensch said. “We’re really mindful about making sure it’s not just physician leaders, but also frontline clinicians helping us define, optimize and design solutions to improve their workflows.”
Rather than imposing top-down changes, implementation and governance include physicians at all levels, ensuring that new policies address their real-world needs. Subsequent focus groups and feedback tools regularly identify gaps and processes are refined as needed.
Physician feedback also drove standardization of medication refills. Nurses were trained on a new, more reliable, process. This ensures all refill messages are addressed and delivered to physicians the same way, every time.
Future priorities for improving practice efficiency
Large-scale data is in the process of being gathered, but early indicators suggest that meaningful progress has been made. Time savings have been observed in after-hours work, and frontline physicians have noted that reducing burdensome, nonclinical tasks has improved how they manage more critical daily responsibilities. Crucially, these gains are cumulative. In isolation, individual improvements may appear small, but together they contribute to a more sustainable and less burdensome practice environment.
Looking ahead, Northwell is focusing on leveraging data and emerging technologies to make even more improvements that enhance efficiencies.
A unified EHR system, and the stability and reliability it provides, has allowed the organization to begin using analytics tools to assess efficiency at both macro and micro levels. This includes identifying variation in workflows, targeting areas for improvement and scaling best practices throughout Northwell Health.
“Now that many of our physicians are comfortable with the new EMR system, we are able to use more complex tools and workflows to optimize our efficiency and understand how we can use these new technologies to drive patient care,” Dr. Mensch said. “Having that data will enable us to allocate resources to provide both education and monitoring of our improvements.”
Areas where additional support or workflow redesign may be needed have already begun to be identified.
“Now that the initial launch has stabilized, we can evaluate our progress and drive targeted change,” Dr. LaVine noted. “I'm really excited for the next step. It’s about figuring out who needs help, training, or resources, identifying who is excelling, and learning how we can share those successes and respond effectively.”
Another priority is improving care coordination as healthcare delivery continues to extend beyond traditional settings. Northwell is exploring better ways to support virtual care, remote monitoring, and patient self-management. This requires integrating new data streams and ensuring that workflows remain manageable for physicians. Ultimately, the focus is shifting from system implementation to optimization that uses data, feedback, and technology to continuously refine practices and processes.
The future of efficiency and new models of care
Several overarching themes emerge from Northwell’s approach to institutional efficiency.
First, technology alone is insufficient. Meaningful improvements require aligning tools with workflows and people. Second, efficiency must be defined in terms of both operational performance and clinician experience. Third, clinicians are not just users. They are essential participants in the design process.
Finally, the evolution of healthcare delivery—particularly the shift toward continuous, rather than episodic, care—demands new standards for efficiency and the models that support it. Organizations must adapt to a landscape where care extends beyond the traditional visit and requires coordinated, technology-enabled support.
Northwell’s ongoing efforts recognize that improving the practice environment is not a one-time initiative, but a long-term process of adaptation, learning, and refinement.
“Using technology can help, but it's really all about the people who take care of our patients,” Dr. Mensch said. “As long as we don't lose focus on our most valuable resources, we can continue to innovate to figure out ways to improve the clinician experience and decrease the burden on our docs.”
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