The Most Expensive Queue in Healthcare Isn’t Prior Auth — It’s the IT Backlog

Something is sitting in a queue right now at nearly every health system in the country. It isn’t a prior authorization request or a denied claim. It’s a ticket –  submitted weeks or months ago by an ops manager, a floor supervisor, or a billing lead who spotted a workflow problem and did the right thing. They reported it. They filled out the form. They waited.

Meanwhile, they built a workaround in a spreadsheet to keep things moving.

The queue nobody measures

Healthcare has developed an impressive system for tracking administrative drag. Prior auths, denial rates, claims processing times, length of stay: all of it benchmarked, dashboarded, and reviewed in committee. The IT change request usually lives in a ticket system that nobody outside of IT opens. There’s no denial rate equivalent for the IT backlog. No quality score. No regulatory consequence for how long a workflow fix sits waiting for implementation.

What doesn’t get measured doesn’t get managed. In healthcare, the cost of what goes unmanaged tends to compound quietly.

The rise of the “workaround economy”

When a workflow problem surfaces and the IT queue is backed up, operations teams don’t stop. They adapt. A scheduling conflict gets rerouted through a shared spreadsheet. A billing rule gets managed with a manual checklist passed between team members.

This is usually described as resourcefulness. It’s actually a diagnosis.

The analyst who built the spreadsheet already knows exactly what the EHR needs to do differently. The billing lead managing the manual checklist has already designed the fix. They didn’t need a consultant or a discovery workshop to identify the problem. They live it. 

And it’s not just anecdotal. One systems engineering analysis of diagnostic referrals found that only 21% of process activities added value to the patient. The rest was data entry, verification, rework, reminders, and delays — much of it driven by what the authors describe as low-reliability concepts.

Meanwhile, the system absorbs none of this friction. It shifts it onto people. For every hour physicians spend with patients, nearly two more go to EHR and desk work — and many log another one to two hours each night catching up on documentation. Registered nurses often spend less than a third of their working time with patients; the rest goes to documentation, coordination, and administrative tasks. 

Every workaround a frontline operator builds is a blueprint that never passed the approval process. Every manual checklist is a change request that never got submitted because the person who needed it didn’t believe it would move fast enough to matter.

Healthcare doesn’t need better ideas about what’s broken. It needs to give power to the people who already have them.

Where control over change lives

Two things need to change, and they’re connected.

The first is governance. Most health systems route workflow change decisions through IT prioritization processes designed before operational agility was a clinical necessity. The voices of analysts, process owners, and department leads need formal weight in that process. They should drive what gets scheduled and when. Most health system leaders can tell you their denial rate to the decimal, but very few can tell you the average time-to-resolution for a submitted workflow change request. Bringing those metrics into the same room, reviewed by the same leadership, with the same accountability for variance, would be a great start.

The second is tooling. The constraint is more structural than technical. Platforms built specifically for healthcare are beginning to give analysts, coders, and data scientists the ability to build and deploy governed workflows without heavy IT lift. The gap is no longer between what needs to be fixed and what can be built. It is between who is allowed to build and how long they have to wait. The tooling, for too long, never matched the knowledge operators already carried. Now, the bottleneck is shifting away from capability and toward control.

The real cost of the backlog

Prior auth gets attention. It’s visible, contentious, and has powerful advocates pushing for reform. The IT backlog has none of those things. It’s internal, it’s diffuse, and its costs get absorbed by the people closest to the work and furthest from the budget conversation.

But the math isn’t complicated. Every month a legitimate workflow improvement sits in queue, the organization pays for the problem twice: once in the inefficiency the change was supposed to fix, and again in the workaround everyone built to get through the week. The backlog doesn’t show up as a line item. It shows up everywhere else. 

Healthcare measures almost everything that moves through the system. It rarely measures how long it takes to change the system itself. 

Until that changes, the most expensive queue in healthcare will remain the one no one is accountable for. And the people who know how to fix it will keep building around it.

Photo: Andriy Onufriyenko, Getty Images

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.