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

John C. Matulis, Rozalina McCoy, Stephen K. Liu

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)784-788
Number of pages5
JournalJournal of general internal medicine
Issue number3
StatePublished - Feb 2023


  • health care quality
  • patient portals
  • primary health care
  • professional burnout
  • workflow

ASJC Scopus subject areas

  • Internal Medicine


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