WILMINGTON, DE — Healthcare organizations that handle more than half of their document work outside electronic health records were more than twice as likely to report frequent effects on patient care, according to a Documo survey that points to operational and financial costs from manual healthcare workflows.
Documo’s 2026 State of Healthcare Operations report found 48% of respondents said document delays often or always negatively affect patient care, while 45% estimated that more than one-fifth of referrals fail to become completed appointments.
The results indicate that administrative processes surrounding electronic health records remain heavily dependent on manual handling even as hospitals and other providers invest in digital systems. Only 18% of respondents said their organizations are investing in document workflow automation.
Sixty-two percent said more than one-quarter of their document-processing work occurs outside the EHR, and 25% said more than half takes place outside the system.
The manual burden was concentrated among organizations with the greatest amount of off-EHR document work. Among respondents whose organizations handle more than half of document-related work outside the EHR, 74% said more than half of incoming documents require manual review.
The effects extend into revenue-generating processes. Seventy-six percent of respondents estimated that more than 10% of referrals fail to result in completed appointments, while 45% put that figure above 20%.
Respondents also identified claims, referrals, patient intake and prior authorization as among the document workflows with the greatest financial impact on their organizations. Forty percent said document delays affect the revenue cycle, while 46% reported an impact on staff productivity.
The survey also points to demand for greater automation among organizations carrying the heaviest manual workload. Of respondents who said more than half of incoming documents require manual review, 60% estimated that more than half of that work could be automated.
“Healthcare doesn’t have an information problem — it has an action problem,” Documo Chief Executive Officer Denis Whelan said. “Critical information arrives every day, but too much of it still has to be manually reviewed, sorted, re-entered, matched, and routed before anyone can act on it.”
Documo, which develops technology for automating healthcare document workflows, is positioning artificial intelligence as a layer between incoming documents and EHR or downstream systems. Its technology classifies documents, extracts information and routes material to the appropriate workflow while retaining human involvement in consequential decisions.
The company’s findings are based on responses from more than 100 administrators, health information management professionals and IT workers involved in workflow design, intake and routing, purchasing or compliance auditing. Respondents worked at midsize hospitals, clinics, ambulatory care centers, nursing facilities, residential treatment centers, healthcare agencies and surgical centers.
The survey reflects respondents’ estimates of operational performance rather than independently measured referral completion rates, patient-care delays or financial losses.
Documo’s 2026 report follows its 2025 State of Healthcare Operations study, which focused on continued reliance on fax-based healthcare workflows.
More information about Documo’s intelligent document-processing technology is available at https://www.documo.com/intelligent-document-processing/.
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