By Dr. Matt Sakumoto, Chief Clinical Product Officer, Nabla
Matt Sakumoto is Chief Clinical Product Officer at Nabla, and a virtualist primary care physician in North Carolina. He is also fellowship-trained in clinical informatics at UCSF, with a focus on virtual care and clinician efficiency tools for the EHR. With prior roles as regional CMIO and as a clinician-advisor to many early-stage health tech companies, he is passionate about exploring and implementing effective and evidence-based AI into clinical workflows.
When healthcare leaders talk about access challenges, the conversation usually centers on physician shortages, reimbursement pressures, or growing patient demand.
Rarely do they talk about unclosed charts.
Yet incomplete documentation creates a ripple effect across the entire organization. It delays billing, obscures operational visibility, increases administrative burden, and ultimately limits how much care a health system can deliver.
The result is a hidden cost that many organizations underestimate.
Unclosed Charts Are More Than a Documentation Problem
An open chart is often viewed as a task left unfinished by an individual clinician.
In reality, it is a lost operational opportunity for patient care.
Until documentation is complete, downstream processes slow down. Coding teams may be unable to assign final codes. Claims may sit unsubmitted. Revenue remains unreconciled. Leaders reviewing operational dashboards are looking at an incomplete picture of clinical activity.
A single open chart is easy to overlook. Hundreds or thousands of open charts create a meaningful backlog across revenue cycle, compliance, and operations. It's also a thousand encounters worth of capacity that the organization doesn't fully understand yet, and capacity you can't optimize is capacity you can't reinvest in patients.
This is why documentation should not be viewed solely as a clinician workflow issue. It is an organizational performance issue.
The Impact on Clinician Capacity
Documentation burden is one of the defining challenges in healthcare delivery.
Studies have consistently shown that clinicians spend substantial portions of their day documenting care, often extending that work beyond scheduled clinical hours.
The consequences go beyond burnout.
Many of my primary care physician colleagues see 18 to 20 patients per day. If documentation requires an additional one to two hours after clinic, those hours come from somewhere: evenings, weekends, family time, or additional patient visits. Novel metrics such as Cumulative Time to Chart Closure (CTCC) show that even if they are not actively in a patient’s chart, that patient continues to weigh on the clinician’s mind.
Over time, clinicians adapt by reducing clinical hours, limiting panel growth, or leaving patient-facing practice altogether.
Health systems often describe this as a workforce shortage. In many cases, it is also a capacity problem. Administrative work consumes time that could otherwise be spent caring for patients.
When documentation remains unfinished, clinicians start the next day with a backlog. Administrative work accumulates. Time that could be spent seeing patients is redirected toward catching up.
The result is a cycle that reduces access, strains clinicians, and limits organizational capacity.
Documentation Debt Impacts More Than Just Financial Performance
The financial consequences are often less visible.
Every open chart represents care that has not yet fully moved through the revenue cycle.
Revenue cycle leaders track metrics such as days in accounts receivable, charge lag, and claim submission timelines. Documentation directly influences all three.
When encounters remain open for days or weeks, coding is delayed. Billing is delayed. Reimbursement is delayed.
Even when revenue is eventually collected, organizations experience slower cash flow, reduced visibility into performance, and additional administrative work to manage aging encounters. When thousands of charts are open, operational dashboards are systematically incomplete. Leaders making decisions only have partial data about where to add clinic capacity, which service lines need more staff, and where to hire or invest. The costs go beyond delayed reimbursement, and lead to misallocated resources based on an inaccurate picture of daily operations.
Improving documentation efficiency is not simply a clinician experience initiative. It is an operational and financial one.
Most clinicians understand the importance of closing charts. The challenge is not awareness. It is capacity.
Documentation becomes one item competing against dozens of other responsibilities, which is why unfinished notes often accumulate despite clinicians' best intentions.
A New Approach
Ambient AI is a key way to address documentation burden at its source.
By reducing the time and effort required to complete notes, organizations can improve chart closure rates, accelerate downstream workflows, and return time to clinicians and staff in the back office.
When documentation happens in real time, clinicians start the next day with fewer unfinished tasks. Coding teams gain faster access to completed encounters. Revenue cycle processes move sooner. Leaders gain a more accurate picture of organizational performance.
The impact compounds over time because every chart completed today is one less chart competing for attention tomorrow.
The benefits extend beyond documentation itself. When charts are completed faster, revenue moves faster. Operational visibility improves. Clinicians spend less time catching up and more time caring for patients.
In other words, improving chart completion is not about closing notes. It is about removing friction from the entire healthcare delivery system.
What Ambient AI Unlocks
Today’s conversation about ambient AI focuses on minutes saved per note. That's the wrong unit of measurement.
The more important question is what becomes visible, and reinvestable, when documentation debt stops accumulating. When charts close faster, operational dashboards reflect reality sooner. Leaders have clearer line of sight on where to add capacity, which panels to grow, or where access gaps exist. They are working from a more complete picture of what their care teams are actually delivering.
Health systems invest heavily in analytics infrastructure to make better decisions. Documentation debt quietly undermines that investment. Closing charts accelerates revenue, and restores the accuracy of the data leaders depend on to reinvest in patients. Another panel. A care coordinator. Extended hours in a community that needs access.
The ultimate goal is not a closed chart. It's unlocking what a health system can do once it can finally see clearly.
