Where O&P and CRT Workflows Actually Break (and How to Tell a System Problem from a People Problem)
Every practice has the same workarounds
Walk into ten O&P or CRT practices and you’ll see ten versions of the same picture. Sticky notes on monitors. A shared spreadsheet that started as a temporary fix in 2021 and has somehow become load-bearing infrastructure. A staff member who is the only person who knows how to "do that thing" with prior auths. A clinician finishing SOAP notes at 8pm because the day was too packed to do them between patients.
These workarounds feel like resourcefulness. Smart people, making the best of what they have, keeping the practice running.
They’re actually evidence that the software isn’t doing its job.
That’s the uncomfortable reframe at the heart of this conversation. Most workflow problems in O&P and CRT aren’t caused by lazy staff or bad training. They’re caused by systems that were never built to support the work, forcing people to bridge the gaps with memory, email, and sheer effort. The cost is real, and most leaders are dramatically underestimating it.
The five places workflows actually break
After working inside hundreds of O&P and CRT practices, the breakpoints cluster into the same five categories almost every time. You’ll recognize most of them.
1. Intake and referral handoff
Revenue starts at intake, and so does most rework. When referrals arrive incomplete, when authorization documents go missing, when nobody owns the follow-up call to the referring physician, the patient sits in limbo and the billing team inherits a problem they didn’t create. The most common version of this: a referral comes in by fax, gets entered manually into the chart, and three critical fields get missed. Two weeks later, the claim denies.
2. Documentation
Clinicians are spending 30 to 45 minutes per SOAP note in many practices. Not because they’re slow. Because the templates fight them. Because they have to navigate away from the chart to look up an order, then back, then over to a different tab to check insurance, then back. Every click is friction, and the friction compounds across a day of patients.
3. Task ownership
Who is chasing the signature on the prescription that came in yesterday? Who is calling the patient about the missing measurement? Who follows up if the answer doesn’t come back by Friday? In most practices, the answer is "somebody, probably." Tasks live in inboxes, sticky notes, and verbal handoffs. When something falls through, nobody can quite say why.
4. The clinical-to-billing handoff
This is the breakpoint that costs the most money. When the clinical chart and the billing system are different applications, or different modules with thin connections, information has to be re-entered, codes have to be re-verified, and missing details have to be chased backward through the chain. Jim Grant, Founder & President of Elizur, said it plainly:
“We didn’t know what we didn’t know. Claims would disappear between systems. We weren’t confident we were capturing all the revenue we were generating. That’s not sustainable in a thin-margin business.”
— Jim Grant, Founder & President, ēlizur
5. Leadership visibility
The fifth breakpoint isn’t in a workflow. It’s in the absence of one. Most practice leaders find out about problems in month-end reporting, which means they find out about them weeks after they could have done something. The denial trend that started in week one of the month goes uncorrected until week six. The referral source whose volume dropped 30 percent isn’t flagged until somebody runs the report.
System problem or people problem? A simple test.
When you see a workaround, ask one question: does this workaround exist because the system can’t do something, or does it exist despite the system being capable?
That distinction matters because the fixes are completely different.
If your staff is keeping a shared spreadsheet of pending authorizations because the system has no way to track them, that’s a system problem. More training won’t fix it. Hiring won’t fix it. Telling people to "use the system" won’t fix it. The system is missing the capability.
If your staff is keeping that same spreadsheet despite the system having a perfectly good task management module that nobody uses, that’s a people problem. Or more accurately, a training and change management problem. The capability exists; the adoption doesn’t.
In our experience, the split is roughly 70/30 system problems to people problems. Most leaders assume it’s the reverse, which is why so much energy gets spent on retraining and accountability conversations that don’t actually move the metric.
What "connected" actually looks like
The end state isn’t complicated to describe. When intake feeds documentation feeds tasking feeds billing, and all of it lives in one chart, here’s what changes:
- Fewer handoffs, fewer drops. Information moves with the patient instead of being re-entered at each stage.
- Task ownership becomes explicit. Every required follow-up gets assigned, every deadline gets tracked, every escalation routes automatically.
- Documentation gets faster. Multi-window charting lets clinicians see the order, the history, and the note at the same time. AI-assisted notes cut documentation time substantially.
- Billing has what it needs the first time. Claims go out clean because the documentation, codes, and authorizations were captured upstream.
- Leaders see problems in real time. Real-time dashboards surface trends in days instead of weeks.
The customers we work with talk about getting a full day per week back per clinician, reducing time to publish notes from three days to one, and consistently running denial rates below 5 percent while the industry average sits at 10 to 15 percent.
A practical exercise:
Walk your practice for an hour this week. Write down every workaround you see — every spreadsheet, every sticky note, every "I’ll text you when it’s done." Don’t judge them. Just count them. The number will probably surprise you. That number is your starting line.
Want the full diagnostic?
On Wednesday, June 24, 2026, I’m hosting a 30-minute webinar that goes deeper into each of the five breakpoints, including a live look at what each one looks like resolved in a connected platform. I’ll spend the first 15 minutes on the diagnostic and the second 15 on a demo. There’s a separate Q&A at the end.
This is a working session, not a sales pitch. Bring a notepad. You’ll probably recognize more than you expect.
Register here.
About the author.
Josh Black is a Solutions Engineer at Nymbl with deep hands-on experience inside O&P and CRT practices. Before joining Nymbl, Josh consulted directly with O&P clinics on workflow design and software implementation, work that ultimately shaped the founding vision of the company.
