Our Take
The waiting room is not a physical constraint; it is a design choice—and for the first time, medicine has the tools to choose differently.
Why it matters
For patients, waiting is already a burden of illness. For health systems, virtual triage and remote monitoring now allow care to begin before someone enters the building. The question is whether hospitals will redesign their front door or keep the queue.
Do this week
Health IT directors: audit your intake pathway this month to identify which patient cohorts could complete triage and labs at home before arrival, then pilot a same-day virtual visit funnel for low-acuity cases.
Telemedicine proved the waiting room is optional
During the Covid-19 pandemic, regulatory barriers to telehealth fell away almost overnight. Telemedicine visits increased more than sevenfold in early pandemic months, with roughly 1 in 5 medical encounters in the United States occurring virtually by 2020 (per the article's source). Although use declined after the peak, it held: 30.1% of U.S. adults reported using telemedicine in the previous 12 months as of 2022.
The proof point is operational. At Emory University, where emergency physician Iyesatta Massaquoi Emeli works, a nurse call line directs lower-acuity patients to same-day virtual visits. During viral illness surges, that line becomes a fast track—bypassing the traditional sequence of registration, insurance verification, triage, labs, and technician work before a physician ever appears.
The insight cuts deeper: patients routed to virtual care who later need in-person evaluation have still skipped part of the traditional process. The waiting room, in other words, is not inevitable. It is a design assumption.
The gap between what medicine does and what it could do is now visible
For generations, emergency departments have operated as a queue. Patients register, wait for triage, wait for a nurse, wait for labs or imaging, then wait to see a physician. That delay has been justified by scarcity: too many patients, too few clinicians, unpredictable surges, and the need to prioritize the sickest first.
None of those constraints have disappeared. But the available tools have changed. Telemedicine, asynchronous messaging, remote monitoring, and emerging AI tools now allow a different architecture: the patient is evaluated and contextualized before arrival. Pre-arrival charts are completed. Labs are ordered. Consultants are informed. When the patient arrives, they are expected and prepared for—not processed as a new problem.
This is not about eliminating delays entirely. Illness, resource scarcity, and unpredictability will always create bottlenecks. But waiting itself—the architectural default that treats delay as inevitable—can be unbuilt. For patients already burdened by illness, that distinction is material.
Rethink intake, not just efficiency
The practical move is not to digitize the waiting room; it is to ask what virtual triage, remote monitoring, and AI-assisted routing can do upstream. Which patient cohorts can complete intake and initial assessment at home? Which lab draws or imaging orders can be placed before arrival? Which transitions of care—from ED to floor, from floor to discharge—can be informed by context that travels with the patient, not lost in the queue?
The systems constraint is real: emergency departments will remain crowded and understaffed. But the design constraint is optional. Hospitals that redesign their front door to begin care at home, complete charts remotely, and use virtual triage to filter acuity will see patients arrive not as a backlog, but as expected visitors. That is a choice, not a prophecy.