When Southwest Airlines suffered its widely publicized operational meltdown a few years ago, the postmortem revealed a familiar story: decades of systems layered upon systems until the foundation could no longer hold. G. Shah, chief product and strategy officer at NextGen Healthcare, sees healthcare heading down a similar path.

“We don't have a technology problem in healthcare,” Shah stated during a recent conversation with Daniel Williams, senior editor and host of the MGMA Insights Podcast. “We have a workflow problem.”

For Shah, the Southwest story is a blueprint for understanding one of healthcare's biggest operational challenges. Medical groups have spent decades adding portals, billing systems, interoperability tools, documentation platforms, and now AI applications — and the result is often a technology stack that appears modern but sits atop workflows that were never redesigned to sustain them.

As Shah put it, "The best technology is not one that asks for your attention."

The Problem Isn't the Software

Shah's career has taken him through nearly every corner of healthcare: ambulatory care, pharmacy, payer organizations, clinical systems, and health technology. That broad perspective led him to a conclusion that came up repeatedly during his recent MGMA webinar and podcast appearance.

Healthcare organizations have become exceptionally good at solving the problem immediately in front of them.

"We have to do interoperability, so let's buy an interoperability solution," Shah said, or "We've got to do a portal, let's go buy a portal solution."

Individually, those decisions made sense, but collectively, they created a mountain of technology without taking time for the big picture.

"We've gotten really good at just stacking all these things on top of each other," Shah said. "But what we've never done is stepped back and looked at it and said, well, wait a second. What does this end-to-end workflow look like anyway?"

The consequences extend far beyond software architecture: According to an April 28, 2026, MGMA's Stat poll, nearly half of medical group leaders said physician burnout is worsening in their organizations, with administrative burden repeatedly cited as a primary driver. Many respondents pointed specifically to documentation, payer requirements, and fragmented workflows as sources of strain. 

For Shah, those frustrations represent accumulated interest payments on decades of workflow debt.
"When we accept the broken workflows, there's a lot of debt in the system," he said. "They accrue interest that ... is administrative burden. It's staff frustration. It's provider burnout."

Why AI Won't Save a Broken Process

The conversation inevitably turned to artificial intelligence.

Healthcare leaders are facing a flood of AI tools promising faster documentation, improved scheduling, better patient communication, and streamlined operations. Shah believes many organizations are approaching those purchases backward.

"If it's broken, it just means it's broken faster," he said. "And something that's faster that's broken is still broken."
The comment cuts directly against much of the industry's AI enthusiasm.

Shah isn't dismissing AI — in fact, he views it as transformative. The issue is sequencing. Many organizations start by shopping for AI tools before asking what outcome they actually want.

"The rubric here is look at the workflow, redesign it to what you want it to be from an ideal state first, then apply the AI," he said.

Shah's advice to practice leaders evaluating AI vendors is surprisingly simple: Map the entire workflow first.
"If that tool can't integrate from the left side to the right side of the workflow, if it's not transiting data in the right way, if it's not transiting its output to the right place, what have you done?" he asked. "You've just optimized one particular piece."

What Patients Experience But Never See

"The patients almost never see our workflows," Shah said. "But they absolutely experience them." A referral that takes a week to process, or a clipboard that asks for the same information every visit. They may interact with a physician who seems distracted. 

Shah described a common referral example: A primary care physician submits information to a specialist, but disconnected systems slow the handoff. The patient doesn't see the technical failure. "What it feels like is, why is it taking me so long to get to my specialist?"

The same dynamic may happen at check-in. "Why am I getting asked the same question over and over and over again?" Shah said, describing patient frustration with repetitive forms and registration processes.

Behind the scenes, these experiences often point to integration gaps, disconnected databases, or manual workarounds that organizations have normalized over time. "Every one of these broken workflows becomes a patient problem," Shah said.

The Best Technology Is Invisible

Shah lives in the Bay Area, surrounded by AI startups and technology marketing. Yet his vision for healthcare technology sounds almost anti-technology.

"The best technology is not one that asks for your attention," he said. "It's the technology that disappears."

He offered an example that has stayed with him: A child's drawing after a pediatric appointment.
The drawing presented the physician from the side, staring at the computer monitor, rather than facing the patient.

Shah believes that redesigning workflows means restoring the relationship at the center of healthcare. "Really great healthcare happens in that interface," he said. "That interface is not nose to ear. It's nose to nose. It's knee to knee. It's eye to eye."

Trust Is the Missing Layer

Healthcare organizations have access to immense volumes of patient data, but Shah argues much of it remains operationally suspect. "We have more data now than we've ever had before," he said. "And it comes from various places, but it's not trusted."

When clinicians don't trust incoming information, they verify insurance again, repeat patient histories, order duplicate tests, or re-enter data into local systems. And every verification step introduces additional work.

"If I don't trust the data, I'm going to recreate it," he added. "I'm going to re-verify it. I'm going to ask the question over and over and over again."

The solution is to understand where information originated, verify its integrity, and integrate it naturally into workflows. "We have to explain the data is coming from a trusted source," Shah said. "Here's how and why."

A Product Guy Who Thinks About Problems Everywhere

Toward the end of the conversation, Williams shifted away from healthcare operations and asked Shah what he does outside work — and his answer revealed a bit of the mindset behind his approach.

His LinkedIn headline starts with husband and father. His daughter keeps him busy as a self-described "ballet dad." And he enjoys kayaking — but he also admitted something else.

"This is going to sound super nerdy to everybody," Shah said. "I'm a product guy."

Even away from healthcare, he said he finds himself thinking about systems, friction points, and better ways to solve problems. He spends time advising healthcare startups because, as he puts it, he has seen where organizations focus on the wrong things.

That perspective explains why he keeps returning to the same central idea — that technology is rarely the actual challenge. The challenge is designing experiences that allow patients, providers, and staff to accomplish what they need without fighting the system around them.

After decades of adding new tools, healthcare finally has an opportunity to ask a more foundational question.
As Shah put it: "Wait a second. Is this how it should work?"

Resources

• Connect with G. Shah on LinkedIn
• Learn more about NextGen Healthcare
• Healthcare Has Normalized Broken Workflows: How High-Performing Practices Are Redefining What's Possible (G. Shah's on-demand MGMA webinar)
• Register for or access other MGMA webinars.

Email us at dwilliams@mgma.com if you would like to appear on an episode. If you have a question about your practice that you would like us to answer, send an email to advisor@mgma.com. Don't forget to subscribe to our network wherever you get your podcasts!