Family practices are rethinking new‑patient intake

Across Canada, family physicians are grappling with a familiar contradiction: many would like to take on more patients, but the administrative burden of onboarding them can make doing so feel more difficult than it should be. With nearly one in five Canadians lacking a regular primary care provider, provinces are pushing to attach patients to physicians and teams, yet the paperwork required to bring someone into a practice can be a problem for already‑stretched clinicians and staff.My Toronto family practice has decided to stop accepting that burden as inevitable.The team’s insight was simple: the first visit should be clinical, not clerical.In my community practice in the North York area in Toronto, we have redesigned the entire intake workflow. The goal: move administrative work out of the first visit and into a digital pre‑visit process, using EMR‑integrated questionnaires that patients complete at home. We are part of the North York Family Health Team, with physicians, nurses, MOAs and administrative support working together.Digitizing intake before patients arriveWe mapped out things typically required for new‑patient onboarding: demographic data, roster enrollment, clinic policies, consent forms and a medical history. Instead of collecting this at the first appointment, we now send patients a secure email package with electronic forms as soon as the physician agrees to accept them into the practice. This package includes a brief welcome message and a set of electronic forms and questionnaires to be completed before the encounter.Patients complete the forms through an EMR‑integrated platform (in our case, Ocean), allowing demographic fields to auto‑populate directly into the chart and consents to be stored before the visit even begins.For patients without email or with limited digital literacy, we print the forms and complete them in person; the workflow stays the same, just analog.A team‑based first visitBy the time the patient arrives, most of the administrative load has already been handled. The visit proceeds in the following way:Medical office assistant: The MOA confirms demographic details, updates the EMR, and records vitals including blood pressure, height, weight and waist circumference. They then room the patient.Nurse (30 minutes): The nurse reviews the cumulative patient profile, introduces interprofessional services, updates preventive care and administers vaccines as needed.Physician (30 minutes): With the history already documented, the physician can focus on clinical priorities: confirming details, performing the physical exam, ordering investigations and beginning relationship‑building rather than data entry.What changed?The redesigned workflow has produced measurable improvements:Less administrative burden for MOAs thanks to automated data entryMore complete information available at the first physician encounterBetter use of team roles, with nurses and MOAs working to full scopeHigher‑quality first visits, with more time for clinical care and rapport buildingThe total volume of required documentation hasn’t changed, but the experience of completing it has. By shifting tasks out of the visit and distributing them across the team, the process becomes more manageable and meaningful.The bigger picture: burnout and system designAdministrative burden is a well‑documented contributor to physician burnout, with Canadian doctors losing millions of hours each year to red tape. Electronic questionnaires and EMR integration help, but they can’t solve the problem alone. At a system level, consolidating consents, clarifying what constitutes “usual care,” and expanding access to digital tools that support pre‑visit planning. Existing initiatives, like OntarioMD’s Peer Leader program, can support expansion of pre-visit questionnaires.Interprofessional teams, especially nursing and administrative roles, are important to making intake efficient and sustainable.Why this matters nowWith provinces pushing to attach more patients to primary care teams, practices need workflows that make onboarding easier. Our approach offers a pragmatic model: use digital tools to gather information before the visit and use the team to make the first encounter truly clinical.It’s a small operational shift with big implications for access, burnout, and patient experience.For more details, see my article on Canadian Family Physician; a full list of forms is available here. Dr. Michelle Greiver is a family physician with North York Family Health Team in Toronto and professor in the department of family and community medicine at the University of Toronto.

Family practices are rethinking new‑patient intake

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