The preceding pieces make a consistent case. Administrative burden is real and measurable, a chunk of it is genuinely reducible, technology helps in specific places, and it carries risks that need managing. This final piece turns all of that into a plan you can actually run, whether you own a small clinic or sit on a hospital's leadership team.

The plan has a spine: measure before you diagnose, subtract before you add, and treat well-being as a system goal rather than a personal one. Every step below sits on that spine, and the order matters. Most failed "digital transformation" efforts got the order wrong, buying software before they understood the problem.

Step 1: Measure, using metrics that already exist

You cannot manage what you refuse to count, and the good news is that you do not have to invent the counting. In 2020 a group of informatics researchers published a standard set of EHR audit-log metrics in JAMIA, designed so that different organisations can measure the same things the same way. The seven metrics, all normalised to eight hours of scheduled patient time, include total EHR time, work outside of work (the pyjama-time measure), time on documentation, time on the inbox, and time on orders. Your EHR is already logging the raw data. The task is to turn it into these metrics and watch them over time.

Add two more gauges. First, a validated read on experience: the KLAS Arch Collaborative benchmarks clinician EHR experience across hundreds of organisations using a standard survey, and its data consistently shows that EHR training and personalisation are among the strongest modifiable predictors of satisfaction. That is a hopeful finding, because training is something you control. Second, from the economics piece, measure your billing and insurance-related cost per encounter. Knowing what a paid visit actually costs you, in staff minutes and dollars, is the only honest way to judge whether any tool earns its keep.

A month of measurement here will tell you more than a year of anecdotes.

Step 2: Subtract before you add

The cheapest administrative work to automate is the kind you stop doing entirely. Before buying anything, go looking for tasks that exist only out of habit, caution, or a long-forgotten requirement.

The model here is a programme at Hawaii Pacific Health, described in a 2018 New England Journal of Medicine piece with the honest title "Getting Rid of Stupid Stuff". Leaders simply asked every member of staff to nominate anything in the EHR that was, in their words, "poorly designed, unnecessary, or just plain stupid". The nominations poured in. Removing a single redundant nursing documentation field was reported to save on the order of 1,700 nursing hours a month across the system's hospitals. No algorithm, no procurement, no integration project. Just the removal of work that should never have existed.

This step routinely produces the best return in the whole plan, because subtraction has no licence fee, no training curve, and no new failure modes. Do it first, and do it before you have spent money you will feel obliged to justify.

Step 3: Attack the biggest transactional drain

Once you have measured and subtracted, target the largest remaining structured burden. For most practices that is prior authorisation. The American Medical Association's 2024 survey of practising physicians put the load starkly: an average of 39 prior authorisations per physician per week, about 13 hours of physician and staff time spent on them weekly, and 40 percent of practices employing staff who work on nothing else. Eighty-nine percent of physicians said prior authorisation increases burnout.

This is exactly the transactional layer where automation earns hard-dollar returns, as the economics piece laid out. Automating eligibility checks, claim submission, and prior-authorisation workflows is legitimate, measurable, and worth doing. Just remember the boundary from earlier in the series: you are automating a burdensome process, not fixing the fragmented system that generates it. Set expectations at the process level and you will not be disappointed.

Step 4: Buy carefully, and measure the same way afterwards

Only now, having measured, subtracted, and identified your real drains, should you evaluate tools. Carry three habits into every purchase:

Pilot against your own baseline. You already have the Step 1 metrics. Run the tool, then measure the same metrics again. A vendor's numbers describe the vendor's setting, not yours.
Decide which outcome you are buying. As the automation piece showed, some tools cut time and some cut burden, and the two do not always move together. Pick the outcome that matters to you and measure that specific one.
Budget for the risks. Everything in the risks piece applies here: keep a human in the loop, preserve source data, watch for skill erosion, and keep accountability with the clinician who signs off. A tool that saves time but quietly degrades a skill or invents content is a bad trade dressed as a good one.

Step 5: Make it a system goal, not a personal one

The last step is the one that determines whether any of the others stick. The National Academy of Medicine was unambiguous that clinician burnout is a systems problem, driven by workload, regulation, and technology design, not a shortfall of individual resilience. The widely used Quadruple Aim makes the same point positively: better care at lower cost is only achievable if you also care for the people delivering it.

In practice that means owning admin reduction at the level of leadership and budgets, not delegating it to individual clinicians' evenings. It means someone senior owns the Step 1 metrics and reports on them like any other operational number. And it means resisting the temptation to declare victory after buying one product, because the burden is structural and the work is continuous.

The point is not a paperless utopia

No clinic will ever hit zero administrative work, and chasing that is its own kind of magical thinking. The realistic and worthy goal is smaller and better: give clinical time back to clinical people. Measure honestly, delete what is pointless, automate the genuinely automatable, respect the risks, and treat the whole thing as the leadership responsibility it is. Do that, and the admin tax stops being an immovable fact of the job and becomes what it always should have been, a cost you actively manage down.

That is the end of the series. If you read one other piece, make it the opening overview, which frames why any of this is worth the effort.

Browse the full Admin Tax series.

References

Sinsky CA, Rule A, Cohen G, et al. Metrics for assessing physician activity using electronic health record log data. Journal of the American Medical Informatics Association. 2020;27(4):639-643. https://academic.oup.com/jamia/article/27/4/639/5728718
Ashton M. Getting Rid of Stupid Stuff. New England Journal of Medicine. 2018;379(19):1789-1791. https://www.nejm.org/doi/10.1056/NEJMp1809698
American Medical Association. 2024 AMA prior authorization physician survey. https://www.ama-assn.org/practice-management/prior-authorization/fixing-prior-auth-nearly-40-prior-authorizations-week-way
National Academies of Sciences, Engineering, and Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press; 2019. https://nap.nationalacademies.org/catalog/25521
Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. 2014;12(6):573-576. https://ik.imagekit.io/assistencialabs/blog/content/12/6/573
KLAS Research. Arch Collaborative reports on clinician EHR experience. https://klasresearch.com/archcollaborative/reports