A low-tech method for closing the loop on labs, referrals, and the dozens of small clinical commitments you make every day — and a look at where the tooling is headed.
Who needs help closing the loop on a lab, a referral, or a clinical task they set for themselves?
If you just raised your hand, you’re not alone. Closing the loop is one of the quietest, most persistent problems in outpatient medicine. The pending colonoscopy that never got scheduled. The repeat BMP you meant to check after a medication change. The specialist referral that vanished into the ether. None of these are dramatic failures, but stacked across a panel of hundreds of patients, they add up to real risk: missed diagnoses, delayed care, and the gnawing sense that something is always falling through the cracks.
So how are we supposed to keep track of it all?
The problem with EHR-native task managers
Most EHRs ship with some version of a built-in task manager, reminder list, or “to-do” inbox. In theory, it’s the obvious place to park the things you need to follow up on. In practice, it rarely survives contact with a real clinic day.
Have you tried using your EHR’s native task manager to remind yourself of things to do? I have, and I almost always stop after three or four tasks. There are simply too many to log, and the tooling fights you at every step. Each task lives in a separate module from the note you’re actually writing, so capturing one means breaking your train of thought, clicking into a different part of the chart, typing the same context a second time, and clicking back. Do that for every loose end in a visit and you’ve doubled your documentation time.
The result is predictable. You document the task once in your note because you have to, then you’re supposed to document it again in the task manager so you’ll actually see it later. That duplication is painful, so most of us quietly give up. The task manager becomes a graveyard of half-finished reminders, and the things you really need to remember end up scattered across sticky notes, your memory, and hope.
My workaround: the note becomes the task manager
So I adapted. My note is now my task manager.
At the top of every patient’s note, I keep a short running list of where things stand. I break it into three simple buckets:
- Things we’re working on — for example, doubled furosemide.
- Things outstanding — for example, colonoscopy is scheduled.
- Things to do — for example, RTC for BP + BMP in 2 wks.
That’s it. No separate module, no duplicate data entry, no context-switching. The plan and the follow-ups live in the same place I’m already documenting, which means I write them once and they travel with the chart.
The reason this works comes down to a single principle: one source of truth. When your task list and your note are the same document, you can’t forget to sync them, because there’s nothing to sync. The next time I open the patient’s chart, the running list is right there at the top, telling me exactly what we were chasing last time. It’s low-tech, but it’s resilient, and it has saved me from dropping the ball more times than I can count.
Why this matters more than it sounds
It’s tempting to treat all of this as a personal organization quirk, but closing the loop is a patient-safety issue first and a productivity issue second.
Every uncaptured task is a small bet that you’ll remember. Some of those bets you win. The ones you lose are the abnormal result that goes unaddressed, the titration that never happens, the referral the patient assumed was handled. Reducing the friction of capturing a task isn’t about being tidy. It’s about making sure the right thing happens for the patient at the right time, even when your clinic is running forty minutes behind and you’re seeing your twentieth patient of the day.
The note-as-task-manager approach helps because it meets you where you already are. The lower the cost of writing something down, the more likely you are to actually write it down.
But what if it didn’t have to be this way?
Here’s where it gets interesting. My workaround is good, but it’s still a workaround. I’m doing the resurfacing manually, scanning the top of the note and trusting myself to act on it.
So imagine instead that the technology did the work.
What if everything you did in a visit was captured in your note, and the moment something needed follow-up, it was simultaneously stored as a task — no second click, no duplicate entry? What if those tasks were then resurfaced intelligently: brought back to your attention the next time you saw the patient, or at exactly the right moment between visits when a result came back or a window for action opened?
In that world, the running list at the top of my note wouldn’t be something I maintain by hand. It would maintain itself. The act of documenting good care and the act of tracking it would finally be the same act, instead of two competing demands on the same overstretched hour.
That would be something, wouldn’t it?
This turns out to be one instance of a much larger problem — the enormous, unmeasured labor that stands between a physician and the practice of medicine. I’ve written about that directly in The Work Before the Work.
Closing the loop, for real
Until the tooling catches up, the note-as-task-manager method is a practical, no-cost way to stop losing track of labs, referrals, and the dozens of small clinical commitments you make every day. Try it for a week: three buckets at the top of every note, written once, read first thing every visit.
And keep an eye on where documentation tools are headed. The clinicians who win back their time won’t be the ones who try harder to remember everything. They’ll be the ones whose tools remember for them.
How do you keep track of your clinical to-dos? I’d love to hear what’s working — and what isn’t.