It’s an understatement to say that the coronavirus crisis has significantly disrupted the U.S. healthcare system. In fact, many in the industry are discovering that their current healthcare workflows have been inadequate to fully respond to the pandemic. 

Hospitals and health systems are having to deal with new challenges on nearly all fronts:

  • a massive influx of patient care and requests
  • an immediate need for virtual intake and services
  • the need to streamline all of the new processes with the increased demand

Patients are demanding digital convenience, remote touchpoints, and telehealth.

Speeding into the digital-first era

Not surprisingly, the demands of the coronavirus pandemic have accelerated more healthcare organizations into the digital-first era. For some, it’s much sooner than they had anticipated.

Now is a perfect time for our health systems to think differently about how they operate. And to explore what digital strategies can be implemented to invoke swift, systematic and smart changes. Changes that ensure if and when a pandemic or other health crises strike again, the system is ready and prepared.

It usually takes any industry a substantial amount of time and resources to inculcate changes. However, the U.S. healthcare system has had to rapidly evolve during this crisis in ways that will set precedent for the future. 

Along with foundational changes to coverage and government assistance services, virtual healthcare interactions through telehealth or telemedicine services, in particular, have skyrocketed. In fact, in response to a March 2020 MGMA poll, 97% of medical practice leaders answered yes to the question: “Has your practice expanded telehealth access amid COVID-19?”

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The continued evolution of healthcare

The healthcare industry, in particular, has had to be vigilant about keeping up with the constant innovations and upgrades related to technological solutions. This is true whether it is staying ahead of ransomware hackers or more efficiently transferring files to work towards true interoperability.

Pointing towards the role of COVID-19 in galvanizing rapid adaptation in the industry further is the recent revisions of regulations, such as the Center of Medicaid and Medicare (CMS)’s expansion of its coverage of telehealth services.

With the help of technology, organizations must also focus on automating routine and redundant processes to boost workflows.

In this next era of digitization, there will be a continued emphasis on:

      • Reducing administrative burden for all medical professionals by creating efficient, smart and integrated systems
      • Adapting to changing patient demands
      • Adopting new staff policies to accommodate a remote workforce

Transformational technologies that we need today

Undoubtedly, technology serves as a catalyst for advancing healthcare and aids all facets of the industry. The global pandemic is already changing healthcare technology and expanding its application across space including,

  • rising telehealth services
  • shifts in billing regulations, and even the
  • use of location tracking to monitor the disease.

These shifts in the healthcare system are indicative of bigger trends that will remain imprinted after the current crisis. Whether it results from patients realizing the convenience of telehealth or providers learning more effective treatment plans, some changes will likely to be irreversible.

Technologies that will endure long after the pandemic are ones that not only integrate with current systems but also promote interoperability and administrative and operational efficiency.

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Automating healthcare administrative workflows 

Most health organizations are pursuing large-scale digital transformation efforts right now. However, many still fail to capture the benefits of foundational digital “basics” like digitizing and automating administrative tasks and workflows.

For example, using electronic medical forms to collect and share healthcare information eliminates tedious paper-based processes and creates exceptional patient experiences. Connecting it with workflow automation allows health organizations to share data with doctors and across departments by streamlining patient onboarding, billing, patient records, and notes.

Here are a few recent examples from my organization, Formstack, of healthcare organizations that are using digital and workflow automation tools to adapt to COVID-19 changes and improve operations:

Using technologies, like these to simplify such tasks can reduce patient wait times and improve staff efficiency by giving them time to focus on higher priority tasks rather than tedious paperwork. Smart technology can also support timely alerts (in advance) and follow up for patients, as well as provide them a holistic view of their visit, treatment, and bills.

The pandemic has spurred the adoption of these technologies in order to help relieve an overloaded system. The changes not only help in the immediate crisis with administration and patient experience but build a stronger foundation for the future.

Beyond COVID-19: Adopting operational efficiency technology for all stakeholders

Most medical records have already been shifted from paper to electronic health records (EHRs). Now, the pandemic has expedited the shift into adopting close to 100% digital communications. This is likely to continue beyond COVID-19.

Patients now expect streamlined experiences to make up for reduced physical interactions. Secure portals that facilitate the transfer of confidential information will become even more important, including, HIPAA-compliant electronic medical forms that encrypt patient data, control access to sensitive information, and track user activity.

A few questions come to mind when thinking through the cost-benefit analysis of various digital tools for manual administrative tasks:

      • What are some of the ongoing and recurring challenges at a particular medical facility?
      • Which departments and functions require the most rapid automated efficiency?
      • What technological tools in the market can be easily integrated into existing systems?

With trying to answer these questions, healthcare organizations’ main priority is to create the best experience for all stakeholders at a reduced cost, specifically:

      • Patients need a better, overall experience which can be created through effective methods to complete paperwork, reduce wait times and more
      • The medical staff needs a more efficient and flexible workplace that optimizes operations
      • Physicians need prompt processes and less administrative burden in order to avoid burnout

Medical facilities and professionals need to invest in digital tools and processes for business continuity, now more than ever. This is necessary to continue to strengthen the foundation of the U.S. healthcare system. It will also help us prepare in case of future disruptions.

Adhering to the best practices above and implementing new technologies is key to improving overall efficiency to drive business and create exceptional patient and clinician experiences.



The Formstack COVID-19 Relief Program

We want to help responders quickly collect essential information during this crisis. Therefore, we’re offering a free Formstack Forms HIPAA plan to all qualified US-based healthcare, government, and nonprofit organizations. This will allow the automation of critical tasks and the collection of data from patients, employees, and volunteers. Our process involves the use of HIPAA compliant forms that can be created and shared anywhere. To learn more and apply, click here.


Financial disclosure: The author is the CEO of Formstack. TDWI has not received any compensation from the company for the publication of this article.

Issues related to clinical workflow are best understood by physicians for an obvious reason. They participate in the delivery of clinical care on a daily basis. When it comes to workflow, they know what works and what doesn’t. This is one of the most persuasive reasons why empowered physician innovators are well-positioned to make meaningful changes in healthcare. 

However, physicians are often left out of the process side of the healthcare system. Instead, these important tasks have fallen to administrators, private industry, and the government. 

Advancements in medical process improvement have been meek at best, significantly trailing behind other industries. Remember, medical practices still use fax machines. Software platforms are dated and it is rare for solutions to communicate with each other. Most practicing doctors feel that the current information technology systems are not meeting their needs, or simply do not understand their world.

Kick the Can Forward

Many of the workflows used in hospitals and offices today were around when I was in medical school (I graduated from medical school in 1995). Back in my day, we knew that some of the processes were ill-designed. However, we went along with it since that was what doctors-in-training were expected to do. Some of the ridiculousness went away on its own, without the need for a full-on revolt.

For example, as a medical student, one of my jobs was to call the lab every morning and write down all of the lab results for the patients on our census list (some of you are shaking your heads in agreement right now). This was, of course, an outrageous waste of resources, even for the lab staff.

Soon lab sheets were faxed to the wards, and now they sit in databases waiting to be accessed via the hospital EMR. This problem corrected itself over time, as technologies became available. Yet many processes today remain in the dark ages despite the abundance of potential modern solutions.

There seems to be a reluctance to change, to pivot, to evolve. With the enforcement of stricter patient information privacy regulations, the ability to function in archaic yet established systems is getting harder and harder. Some of the physician burn-out seen today is a direct result of this process stalemate.

Related reading:
The Burnout Burden: Why Doctors Need Help from Leadership
TAVR, Innovation, and the Future of Healthcare

Change Means More Work for Me

Information technology in medicine was supposed to fix everything. I remember my excitement at the thought of an electronic medical record. Given my experience in coding and system design, I was imagining the endless possibilities.

I wish you could have seen my face when I sat through a demonstration of a very reputable EMR solution that we were going to implement in our office. I could see where they tried to replicate our delicate complex world. But, in the end, this was going to mean way more work for me to get through a patient visit. Yes, some tasks, like calling in prescriptions, became easier. And, I was getting sick of writing out scripts and signing them all by hand.

However, despite minor gains, there were huge losses in my precious time. Day after day I could feel my bitterness growing. Just when I managed to redesign my workday to accommodate poorly designed software (wait, wasn’t this software supposed to accommodate me?), the hospital would roll out its new monster solution. One that required 14 hours of mandatory training.

It felt like these terrible solutions were simply thrust upon me, with no consideration for the disruptive impact on my efficiency or my ability to care for patients. These have been pretty frustrating times, which have left most practicing physicians hesitant to try new innovative solutions.

Corporate Force Feeding

Eager to introduce modern IT solutions into the healthcare space, larger companies sold good concepts to hospitals and large practices. Selling the hope of efficiency, analytics and overall process improvement made a lot of sense. The products they were selling had some physician input in the design phase and were beta-tested to a degree.

Yet when rolled out to real environments, they were met with resistance and user non-acceptance. Despite their displeasure, most doctors were not able to reject these solutions outright. In the end, bitter acceptance was the extent of the unified response.

There was a lot of complaining, foot-stomping, and even the occasional hissy-fit, but to no avail. It seemed like no one was listening. No one cared. The assumption was that eventually the complaining would settle down and people would simply go back to work.

Related Content: TAVR, Innovation, and the Future of Healthcare

Maybe I Can Fix This Myself?

Frustrated by the complexity of rounding at multiple facilities, I decided to design my own solution, HybridChart. My software incorporated the nuances of the medical workflow and was instantly intuitive to the doctors who started using it.

While my initial motivation was to improve my own world, my little solution began to expand to other doctors at my hospital and ultimately to practices across the country.

The satisfaction of solving the issue of hospital workflow for rounds extended beyond improvements in my own quality of life. There was something about solving this problem for others that brought me great joy.

Interestingly, it was also an immediate cure for my physician burn-out. I was actually able to bring about process improvement with my dual personality as a practicing physician and a software developer.

Physician Innovators: Software and Beyond

As I looked for other examples of physician innovators, I came across countless examples of software solutions created by practicing doctors. Using their field-specific knowledge, they were able to identify gaps and propose solutions. They did this with the goal of gaining adoption by the hard-to-please doctors on the front lines of clinical medicine. Medical devices, surgical techniques, wearables with IoT are amongst the endless examples of physician innovation trying to disrupt healthcare.

Many of these approaches aim to improve patient outcomes, while others attempt to modernize the business of practicing medicine. These physician pioneers are taking on the challenge of repairing their own worlds.

I believe this bottom-up approach of problem-solving – starting with the users, perfecting the solution, gaining acceptance from real-world practices, and then commercializing the solution – has the greatest chance to succeed in the long run.

Physician innovators empowered to solve problems are the key to meaningful change in healthcare the years to come.

We’d love to know what you think about physicians leading innovation. Please leave a comment below.

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Once upon a time finding the right candidate for an open position in healthcare meant placing an ad in a newspaper or medical journal. It involved paper applications and in-person interviews. Credential and reference checks were done by mail or telephone. It was a time-consuming and expensive process.

Luckily, that has all changed. Healthcare recruiting, is now largely driven by technology. That’s good because it is critically important for organizations to build strong healthcare teams and hire outstanding healthcare professionals. Recruiting professionals must be skilled in HR basics but also have a high level of engagement, emotional intelligence, and other soft skills. Because of this, it is imperative that hiring personnel are well-versed in technology-based recruiting tools that are designed to help them succeed in the digital age.

The Importance of Recruiting in Healthcare

Healthcare staffing shortages can be critical to the success of any healthcare system. It doesn’t matter if you work at a large academic institution with thousands of employees or a critical access hospital. Not having enough doctors, nurses, respiratory therapists, or patient care assistants can be devastating.

The importance of recruiting in healthcare goes far beyond filling staff vacancies. As experts predict that the physician shortage will peak at around 122,000 physicians by 2032.  More institutions are looking to fill their openings, often strategizing innovative ways to retain staff members into the future.

Physicians aren’t the only ones short in numbers.  Nursing has been experiencing a shortage for several years. And is projected to peak by 2030 as more baby boomers enter retirement. Experts and lawmakers have turned to advanced practice nurses to fill the physician shortage. But with the current state of affairs, nursing is struggling to recruit and retain skilled employees. 

Related Content:  How Healthcare Staff Shortages Will Affect Seniors

You may feel that effective recruiting is paramount due to the lack of qualified applicants or the dire consequences of having open positions. However, it’s clear that healthcare institutions must look to cutting-edge technology when finding new clinical and technical staff members. This also means that candidates need to have a good understanding of how these recruiting practices can impact their ability to get hired.

Here’s a look at some of the newest tech trends in healthcare recruiting

Cloud Computing

For human resources (HR) and other recruitment professionals, cloud computing has become a way of life for finding top healthcare professionals. Some of the best medical facilities are using cloud technology to access data on demand without the need for on-site storage. This means they can access applicant information anytime and from anywhere.

Not only do human resource departments take their operations to the cloud to store information about candidates, but they can also post positions from one portal that can touch multiple platforms to reach both active and passive talent pools. This increases the likelihood of finding the right person for the job.

This is true even if that professional is not actively searching for a new position at the time. Therefore, if a recruiter contacts you via LinkedIn or another platform, you might want to respond and learn what the opportunity is all about. Your skills may be a good fit for the job they’re trying to fill.

Optimized Job Descriptions

Creating a well-written job description is the first step in recruiting and hiring the right healthcare professional for the job. HR departments outline the scope of work in detail so that the applicant knows whether or not they can fulfill the role duties and responsibilities. Technology can help to create engaging descriptions of open positions whether they are for front-line clinicians, support staff, executive level management, or healthcare consultants.

Some tech platforms can even analyze job descriptions to find a potentially biased language. It can then suggest alternatives to the recruiters. Other platforms might work with job postings to optimize the job description and the career pages for search engines. Once the recruiter uploads the information to the platform, it can provide a list of possible keywords so that job seekers can know if they’re a qualified applicant.

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Social Media

It seems everyone is active on multiple social media channels these days. If you’re looking for a new position and you’re coming up empty-handed, consider searching social media sites for employer pages. This is an excellent method employed by large and small healthcare facilities who want to use social media to recruit and hire. Look for videos of current staff sharing testimonials about their job and the company culture. You might also be able to find the name of the HR staff or recruiter so that you can contact them directly to find out what positions they have open. 

Artificial Intelligence

Artificial intelligence (AI) is used in healthcare to treat patients. However, recruiters and human resources staff have also turned to AI to improve candidate sourcing. Instead of spending hours manually screening resumes and searching for new platforms, the HR team can find a large applicant pool in no time, especially for high-volume positions.

Some tech tools can even predict if candidates will fit into the company culture by using analytics and machine learning techniques to project your success in their workforce. The use of AI means that the HR staff spends less time search through profiles and resumes. But it also means a better hiring experience. AI can decrease the number of days it takes to fill a position. And it gives the hiring team more time in the day to build relationships with qualified candidates.

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Automated Interviewing

Once a job seeker has been identified as a qualified candidate, they have to start the tedious and anxiety-inducing task of interviewing. This might mean scheduling and rescheduling appointments, traveling to the potential employer, and multiple hours in face-to-face interviews.

However, technology can automate your interview scheduling and allow you to choose the best time slot from the beginning. Job seekers might also be invited to use digital video technology to conduct the interview when it’s most convenient for them. This technology uses a set of pre-arranged questions while recording the video on a cloud-based application. The HR staff and other hiring team members can review your video when they have time and get back to you with the next steps.

If you’re not located in the same state or country as your potential employer, you may also be asked to conduct an interview over a live video platform. This speeds up the process and minimizes the cost and time spent flying you to the facility until both you and the hiring managers know that you might be the best fit for the job.

Here’s to Finding Top Healthcare Talent!

Filling vacant roles from the top of the healthcare staffing continuum to the bottom is challenging. By using cutting-edge tech, HR departments decrease dollars spent and minimize the number of days positions go unfilled. And, it might even find out if a potential top performer is a toxic employee before they’re even hired.

More by this author: Children’s Screen Time: How Much Is Too Much?

If you’re looking for new healthcare career opportunities, consider these recruiting trends when you start out searching for your next job.



The Health Insurance Portability and Accountability Act (HIPAA) mandates industry-wide standards for proper management of health care information and electronic billing. HIPAA compliance requires protection as well as the confidential handling of all protected health information (PHI). 

According to HIPAA rules, any company that deals with protected information must have a physical network and security measures that are followed to ensure compliance. It may be safe to say that many organizations are still perplexed about HIPAA audits, enforcement, and compliance. 

As a result, the number of organizations that fail to meet compliance each year remains high. In fact, according to the United States Department of Health and Human Services (HHS), approximately 70% of organizations are not HIPAA compliant.

To begin understanding compliance, healthcare organizations would be wise to consider three key recommendations.

Related content: Are you ready for the HIPAA police?

Three key recommendations to improve HIPAA compliance

1. Analyze the past to avoid making the same mistake twice

It is important for hospitals and healthcare facilities to look at some of the common mistakes that are repeatedly observed in HIPAA security reviews. HIPAA states that out of all the reviews completed, there are a number of frequent compliance violations and issues that are found each year.

They include:

    • lack of safeguards to protect health information
    • impermissible uses and disclosures of protected health information
    • lack of patient access to their personal health information
    • lack of administrative safeguards on electronically protected health information
    • use or disclosure of more than the minimum protected health information

Protecting valuable data by analyzing past mistakes is an important step in the compliance process.

2. Perform a risk assessment and GAP analysis of your organization’s HIPAA compliance

Preventative measures to use when assessing an organization’s compliance with HIPAA include:

  • risk analysis
  • GAP analysis.

The confusion and lack of understanding around the two approaches is common among healthcare professionals in the marketplace. Not understanding the differences between the two can be detrimental to an organization. It can put them at a significantly higher risk of a HIPAA violation.

According to the HHS Office of Civil Rights (OCR) guidance materials, healthcare organizations must specifically conduct a risk analysis to be deemed within HIPAA compliance.

–The GAP analysis

A HIPAA GAP analysis can be used to measure the organizations’ information security standing against HIPAA, which is part of HHS audit protocol. Comparing the organization’s current practices to the HHS OCR audit protocol will identify the strengths and weakness of the security program.

From there, the organization can determine whether they have reasonable and appropriate administrative, physical and technical safeguards in place to protect patient health. Performance of the GAP Analysis also allows the organization to develop an audit response toolkit.  This includes the data and documentation that would be able to support compliance with the HIPAA regulations to regulatory agencies.

–The risk analysis

The risk analysis is a required control as defined in the audit protocol. Without conducting a thorough and comprehensive risk analysis, a healthcare organization can not identify applicable threats and vulnerabilities that allow them to take corrective action.

Completing a thorough risk analysis provides insight into the organization’s security position. It also allows for change before an audit takes place.

Risk analyses should be updated at least annually to ensure they reflect current operational practices. The risk assessment should evaluate the security, use, and disclosure of PHI against  HIPAA’s privacy, security and breach notification implementation specifications.

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To begin, an organization should document any ePHI (Electronic Personal Health Information) transmitting or processing services. This includes any business associates or employees that receive and use the ePHI.

Related content: What’s Your Business Associates Commitment to HIPAA

It’s important to evaluate all aspects of the organization’s operation to verify all uses and disclosures of ePHI are identified. Don’t assume that your IT shop is aware of all of your uses and disclosures.  Make inquire into all of the operational areas of your organization.

3. Develop an action plan and a response toolkit

For many healthcare organizations, the question is not if they will receive a HIPAA audit or an OCR investigation, but when. When this happens, the OCR, the part of HHS responsible for completing HIPAA audits, will contact the organization. They ask for a variety of documents and data in preparation for the audit/investigation.

–Review and Determination

Once these documents and data are reviewed, the OCR will send the organization a preliminary copy of its findings. This preliminary report gives healthcare organizations the opportunity to respond to the OCR. And have their responses included in the final report.

From the final report, the OCR will determine if an organization was in compliance with HIPPA.  And, if not, where an organization was lacking. If an organization was not in total compliance, the OCR will provide corrective action. In addition, they will provide technical assistance the organization can use to work toward compliance.

–Be prepared

Develop an action plan. And evaluate the organization’s information security against the OCR audit protocol to develop an audit response toolkit. This will leave organizations with practical actions that serve their best interest, eliminate mistakes, and mitigate risk.

In conclusion, utilizing the help of professionals with expertise in
HIPAA compliance is always recommended.


Medical science has always embraced advancing technology. And, it continues to do so today, changing nursing practice in ways that would have been unimaginable in the past.

Here are just a few of the ways that technology is being used in nursing:

  • Remote monitoring assists in diagnosis, treatment, and monitoring of chronic illnesses.
  • Modern diagnostics, analytics, and informatics help keep nurses abreast of local and global health trends.
  • Electronic nursing tools ensure timely and effective intervention
  • Remote education and training help healthcare professionals stay up to date with advances in science.[mfn]Jones, Diana P.; Wolf, Debra M (2010) Shaping the Future of Nursing Education Today Using Distant Education and Technology[/mfn] 

It is no wonder that new technologies are guiding more and more of what we do.

Delivery of care evolves with advances in technology

Good nursing practice is based on the provision of timely, evidence-based care including for monitoring, diagnosis, and treatment. This ensures the best possible patient outcomes and experience.

It is important to note, however, that the way this nursing care is actually delivered evolves with advances in technology. Technological advances and resultant changes in day-to-day nursing practice are happening faster than ever, bringing benefits (and occasional problems) to everyone.

Related Nursing Content:  The Growing Demand for Nurses in a Variety of Roles

The Internet and the expert patient

This is the information age and there is a lot of it out there. Medical knowledge is no longer the arcane dominion of the professional few.

Everyone now has the ability to easily access information about symptoms, conditions, and medications, and other treatments. There is, in fact, an overwhelming amount of medical information on the Internet.

Some of this information is evidence-based and
up to date but a lot of it is absolutely not.

Nurses with direct patient contact, therefore, have an important new aspect to their role. That is to empower patients to locate and learn from reliable, credible sources.[mfn]Finding Credible Medical Information Online. OpenMD.[/mfn]

Many healthcare professionals are finding that their patients know more than ever about their medical conditions. It is expected that this will continue to increase over time as access to medical information becomes easier and easier.

Many clinicians have found that it can be a very positive experience to work with informed patients and families. This is because it leads to a more equal professional-patient relationship and a more cohesive approach to care and treatment.

Remote healthcare

Advances in technology are already enabling real-time, remote monitoring and investigations. Here are some examples:

  • Medical devices

    • The Implantable Loop Recorder detects heart rhythm disturbances and can relay information to a central monitoring team. This enables diagnoses and, perhaps in the future, immediate emergency responses.
    • Combined continuous blood glucose monitors and insulin delivery systems facilitate optimum diabetes management.
  • Consumer devices

Tracking activity and vital signs has become a part of everyday life for many people. One measure of its popularity is the fact that manufacturers of wearable activity and heart rate trackers.  These include Apple, Samsung, and Fitbit, who are reporting huge profits. Fitbit alone has sold more than 76 million devices.[mfn][/mfn]

  • Home blood tests

Many of the blood tests traditionally processed in labs can now yield almost instant results with just a finger prick at home. For example, in addition to well-known home tests such as blood glucose and pregnancy tests, people can also do home-testing for cholesterol, prothrombin time for blood thinning, hepatitis C, and some drug tests.

The use of these technologies can influence individual diagnoses and treatment plans. It can also show trends and collect demographic data on a scale greater than ever before.

Less time in clinics and fewer admissions

Remote diagnostic tools mean less time in clinics because results clinicians have ready access to results from these monitors. They can then respond to them via virtual consultations by telephone or online.[mfn]Powell, J. et al. (2009) ‘Pilot study of a virtual diabetes clinic: satisfaction and usability’, Journal of Telemedicine and Telecare, 15(3), pp. 150–152. doi: 10.1258/jtt.2009.003014.[/mfn]

Remote healthcare will never replace the need for an acute hospital setting. However, with quicker diagnosis and treatment in the community, a reduction in unplanned admissions to hospitals can be expected.

Communication technology in the hospital is changing nursing practice

Electronic clinical observations have been rolled out on a massive scale in hospitals around the world. These can take the form of individual patient monitors, which record and store all data that was traditionally recorded on paper. These include regular blood pressure readings, heart rate, respiration rate, and temperature. This data can be accessed by remote hand-held devices carried by the healthcare team.

With built-in protocols for alerting members of the team when results are out of a set range, the right people can converge on a sick patient in seconds.[mfn]Peters M, Moore P (2018) Using quality improvement methodology to implement an electronic pediatric early warning system (PEWS) across Great Ormond Street Children’s Hospital (GOSH) Archives of Disease in Childhood[/mfn] This technology also allows clinicians to prioritize their workload and request assistance from specific services at the push of a button or the tap of a screen.

The use of remote patient monitoring devices in hospitals can mean getting the right help for your patients without even leaving their side.

Related Technology Content:  How A.I. and Cybersecurity are Transforming Healthcare

Improving safety

Patient safety is always top priority for nurses.

Electronics devices have long been used to improve patient safety. These range from chair sensors to alert staff when a confused or unsteady patient has stood up to wristband barcode scanners to ensure the right medications get to the right patient.

The World Health Organization has long championed the use of emergent technology to improve patient safety [mfn][/mfn] For example, electronic reporting of incidents aids in the understanding and prevention both at a local and global demographic level. One study found a 250% decrease in drug errors following the implementation of electronic incident reporting in one hospital.

Is health technology the answer to all our problems?

As always, with such a paradigm shift we are met with bumps along the way. Further, much of the technology we’re using is still in its infancy.

With remote and mobile healthcare, we have a huge increase in the amount of cloud-based and remote data storage of sensitive patient information that is, by necessity, identifiable, accessible, and retrospective.[mfn]Dixon J. F. Going Paperless with Custom-Built Web-based Patient Occurrence Reporting. Joint Commission Journal on Quality Improvement.[/mfn]

Privacy is a concern

Legislation exists across the EU[mfn] Health and Social Care, Information Commissioners Office, UK[/mfn] and US[mfn]Health Information Privacy, U.S. Department of Health & Human Services[/mfn] in particular, that aims to govern the use of medical records.  Governing in a way that balances privacy concerns with the sharing of information necessary to prove high-quality care. A robust system for informing patients and gaining consent for any projected use of their information is essential. 

As the public becomes more aware of the cybersecurity and privacy issues faced by organizations that hold large amounts of valuable data, the use of this data will be informed by evolving ethical standards.

Technology and nursing are here to stay

We are undoubtedly in the middle of a technological revolution, nowhere so much as in medicine and nursing. But medical technology is only a tool to make patient care more efficient and effective, to improve safety and speed. 

Robots are not going to replace nurses anytime soon.

One potential benefit of new technologies is that they may eventually free up nursing time for more traditional care and patient-centered activity.

Whatever happens, one thing is clear. Technology is poised to change nursing practice into something that would have been unrecognizable by our predecessors.

The good news for nurses is that some things will never change, Patients and families will always need and want a human touch and a good patient experience.



[1] Jones, Diana P.; Wolf, Debra M (2010) Shaping the Future of Nursing Education Today Using Distant Education and Technology

[2] Finding Credible Medical Information Online. OpenMD. 


[4] Powell, J. et al. (2009) ‘Pilot study of a virtual diabetes clinic: satisfaction and usability’, Journal of Telemedicine and Telecare, 15(3), pp. 150–152. doi: 10.1258/jtt.2009.003014.

[5] Peters M, Moore P (2018) Using quality improvement methodology to implement an electronic paediatric early warning system (PEWS) Across great Ormond Street children’s hospital (GOSH) Archives of Disease in Childhood


[7] Dixon J. F. Going Paperless with Custom-Built Web-based Patient Occurrence Reporting. Joint Commission Journal on Quality Improvement.

[8] Health and Social Care, Information Commissioners Office, UK

[9] Health Information Privacy, U.S. Department of Health & Human Services

Healthcare facilities are continually battling conflicting priorities. Customers demand that hospitals deliver high-quality patient care while ensuring patient safety, meeting regulatory demands, and maintaining facility security.

And they expect them to do it  – with stretched resources. Treating patients is far from the only concern that hospitals are facing today.

Threats in the hospital

Medical facilities are also dealing with ever-growing threats to patients (physical and otherwise) as well as their information. With data and technology now an integral part of healthcare, cyber attacks occur more often than threats of physical violence to patients and staff. But hospitals must be prepared to deal with both.

Patients are more concerned than ever about their personal data security. A report from TRUSTe and the National Cybersecurity Alliance showed that while 74% of consumers trust their information with healthcare providers, up to 90% of them worry about their privacy online and the risks that come with disclosing personal information.

Let’s have a look at some of the threats that hospitals face and how they are moving to protect patients, staff and their valuable data

Physical threats

Hospitals are vulnerable to violence and crime from and directed towards visitors, patients, and occasionally their own staff members. Some of the top physical security issues that hospitals face today include:

  • Abuse and battery towards hospital staff – This is the most common type of abuse that occurs in hospitals, with 80% of serious violent incidents reported caused by interactions between patients and medical staff.
  • Active assailant attacks – Hospitals also face the risk of active assailant attacks that pose a threat to the life of patients, medical staff and visitors. Between the year 2000 and 2015, there were a reported 241 hospital shootings, according to researchers at Brown University.
  • Infant abductions – The National Center for Missing and Exploited children notes that 135 cases of infant abductions from healthcare facilities occurred between 1965 and 2017.  The majority of these (79%) happened in the mother’s hospital room.
  • Property and Supplies Theft – Medical supplies, food, drugs, and equipment are part of the list of items stolen from hospitals by staff, patients and even visitors. The result is often costly for medical facilities. Hospital theft is often a great indication of a vulnerable security system.

Considering that healthcare facilities are often open 24/7, ensuring hospital security must be a priority. The answer to these physical threats lies in understanding the internal and external threats that they could potentially face. This plays a critical step in helping them improve security measures and systems across the facility to ensure everyone’s safety and smooth operations.

Related Content: How to Survive a Hospital Shooting

Steps hospitals can take to help ensure physical safety

Hospitals must, at a minimum, do the following:

  • Invest in professional security camera systems with remote viewing capabilities
  • Equip their security staff with the latest in security devices like two-way radios for easy communication
  • Train their staff to handle physical threats
  • Add ID card security clearance systems for all medical staff, patients, and visitors coming in and out of the facility

Cyber threats

Cyber security graphic 750 x 501

Photo source: Pixabay

Data breaches are a top developing threat

The healthcare industry has quickly embraced electronic records and data tracking innovations to make it easier and faster for consultants, vendors, and third-parties to access patient information efficiently. Unfortunately, this has created new patient privacy and data loss concerns.

Data breaches and network disruptions are the top concern for healthcare facilities today, as they can easily jeopardize security, operations, financial stability, and reputation.

A look at some of the biggest healthcare data breaches of 2018 will show you how serious this issue has become. For instance, UnityPoint Health had 1.4 million patient records breached through a phishing attack. It was the largest biggest healthcare data breach in the U.S. in 2018.

Cybercriminals are becoming more sophisticated.

Related Content: The Preventable Danger of Patient Identity Errors

Steps hospitals can take to protect data

To protect patients and their information against the ever-growing threat of data breaches, hospitals must be ready to embrace the latest data privacy regulations and be aware of the threats that data storage and access to healthcare systems pose.

Here’s what hospitals should do to ensure better data security and improve overall IT security:

  • Conduct a risk assessment of IT systems
  • Provide continuing education about HIPAA regulations to all hospital staff
  • Monitor all electronic devices and records across the facility
  • Encrypt patient data and hardware used to access the data
  • Create sub-networks for more sensitive patient information
  • Manage identity and access more strictly in healthcare systems
  • Develop a strict BYOD policy to prevent internal data breaches
  • Scrutinize service-level medical agreements carefully when moving data to the cloud
  • Establishing an organizational-wide policy of open communication and transparency
  • Hold top executives accountable for IT security policies
  • Establish a reliable legal counsel (in the event of a data breach)

Why cybersecurity matters for hospitals

With growing threats like ransomware and malware, cloud threats, misleading websites, phishing attacks, insider threats from employees, encryption blind spots, and vulnerabilities in IoT medical devices, it’s easy to see why cybersecurity matters for healthcare facilities.

Data breaches can cause huge financial losses, cost hospitals their reputation and lead to heavy penalties for non-compliance.

The frequency of cyber attacks is increasing every day – it’s no longer a matter of “if” but “when” they’ll happen to your facility. To protect patients and their information, hospitals need to embrace cybersecurity best practices.

Cybersecurity best practices

These practices include:

  • Establishing a strong security culture across the organizational structure
  • Protecting all mobile devices that access sensitive patent information
  • Planning for the unexpected, such as having backups of all information
  • Having a firewall and investing in the best antivirus software
  • Using strong passwords and embracing options like two-factor authentication
  • Limiting network access to authorized personnel only
  • Controlling physical access through surveillance monitoring
  • Having a skilled cybersecurity team and the resources they need in place
  • Staying up-to-date with evolving cybersecurity threats
  • Investment in detection and mitigation tools to protect against unknown threats

The bottom line

Healthcare facilities continually face both physical and cyber threats even as they gather and store more patient data than ever before. Hospitals must be prepared to protect both patients and their information.

The truth is, most healthcare facilities are not keeping up with the latest security standards and infrastructure. Despite the industry promising a lot in terms of innovative technology, medical advances, telemedicine, healthcare apps, and AI-driven diagnosis, we still have a long way to go to boost patient confidence in health facilities and the way they handle both safety and privacy.

By ensuring more transparency when handling patient data, communicating security measures to patients, establishing strict behavioral policies for all personnel, emphasizing on employee education, and developing data security and breach response policies, hospitals can be better equipped to deal with any threats, and ultimately protect patients and their information.

It’s a lot to do, but it must be done.

Let’s face it—healthcare is increasingly going digital with electronic record-keeping and cloud storage, telemedicine and artificial intelligence, among other applications for technology in the sector.

However, with this continued growth and the incorporation of technology within the health systems, the importance of healthcare data security is now looming more than ever before. Even with technology significantly benefitting the healthcare sector, it is also not short of some drawbacks, and one of the most prominent downsides is the difficulty in safeguarding personal patient data.

Currently, healthcare data is undoubtedly among the most sensitive types of personal information in existence. As such, it is no surprise that it ranks high among the most sought after, not to mention frequently breached, type of data. Healthcare records are gradually becoming a more attractive target for hackers, making patient data security an increasingly challenging task.

With this in mind, to adequately safeguard patient data from cybercriminals and data breaches, healthcare organizations and relevant stakeholders need to implement comprehensive security measures to protect patient data from these looming security risks.

So how can they improve on patient data security? By adopting a complex and multi-faceted approach to security.

5 Ways to Improve Patient Data Security

Below are five useful tips to assist health systems and hospitals in reinforcing and better enhancing the safety of their healthcare data. These security practices and measures aim to help these organizations address imminent risks to data privacy, keep pace with continually evolving threats and also effectively protect patients’ personal information.

  1. Educate Personnel on Security Best Practices

The “human element” remains among the biggest security threats across multiple industries, healthcare included. According to recent statistics, most security breaches are a consequence of human factors. Negligence or simple “human” error can wreak havoc and produce expensive repercussions for healthcare organizations. Additionally, although only a select few practice staff would directly steal PHI (Protected Health Information), they could however unsuspectingly introduce malware into their network by succumbing to phishing email attacks among other social engineering hacking tactics.

Nonetheless, in many instances, security training can help prevent such types of breaches. Security awareness training not only equips healthcare staff with the essential knowledge necessary for making wise decisions, but it also ensures that they use appropriate precautionary measures when handling patient data.

Healthcare organizations can either purchase HIPAA online security training or subsequently get training from other medical organizations and hospitals for free.

  1. Routine Risk Assessment

Experts recommend that healthcare organizations perform risk assessment sessions on a regular basis to determine the vulnerabilities of their systems. By identifying weak links within their data security systems, healthcare organizations can effectively fix any issues before they arise. HIPAA compliance rules mandate for healthcare organizations to conduct a security risk assessment annually or as changes to electronic systems occur.

Similarly, healthcare organizations should also initiate such practices to adhere to the criteria of MIPS (Merit-Based Incentive Payment System).

It is a good idea for healthcare providers to even consider conducting these assessments more than once yearly-perhaps monthly or quarterly for maximum safety.

Related Content: How To Properly Protect Patient Data

  1. Access Control: Restricting Access to Applications and Data

Controlling access to private health records is also another crucial way of enhancing the overall security of patient data. How can organizations do this? By ensuring that only the certified and essential personnel are granted access to sensitive data. This reduces the risks of data breaches and theft.

When you implement access control, you can effectively reinforce healthcare data security. This is by restricting access to specific applications and sensitive patient information only to the individual needing access to carry out their duties. Access restrictions require user authentication, and this ensures that authorized users only gain access to protected healthcare data.

Multi-factor authentication, which mandates for users to verify their identities through two or more methods of validation, is among the most-recommended approaches you can use.

Furthermore, whenever possible, healthcare organizations can engage this essential personnel in their two-factor authentication. You can incorporate thumb scanning and retina scanning technology or subsequently adopt a mobile authentication system for all the staff with access to sensitive records and then log them into the security system.

Some security systems can even allow you to create distinct passwords and logins for every staff member you would like to allow access to confidential data. By diversifying access keys in such a manner, these organizations make it more difficult for any hackers or outside individuals to crack and breach their code.

  1. Encryption, Encryption, Encryption!

Encryption is undoubtedly among the most effective methods of data protection across all industries, not just in healthcare. Data, either in-transit or stored, needs to be encrypted on every device within the system. This includes computers, cell phones, USB drives, tablets, and laptops.

Encrypting data allows healthcare organizations and stakeholders to minimize their susceptibility to data breaches and cyber attacks effectively. Encryption ideally makes it harder (virtually impossible) for a hacker to decipher personal patient data even if they manage to breach and subsequently gain access to the information.

While HIPAA offers recommendations, it does not precisely mandate health organizations to adopt data encryption approaches in their rules. It instead leaves room for healthcare organizations and related stakeholders to decide on the appropriate type of encryption methods along with other necessary measures based on the workflow of the organization as well as other needs.

Extraction of data from unencrypted stolen devices can amount to millions of dollars in losses.

  1. Adoption of Role-Based Access

Finally, establish role-based access to patient data. Numerous systems will usually allow healthcare organizations to uniquely configure their software subsequently limiting different system levels to different personnel. Each staff member has a login or key which restricts their access to only the section of the program they need as well as its limited related data.

For instance, in a health provider system that includes a practice management system, the organization’s receptionist might only need to utilize the scheduling application. In such a case, role-based access cannot allow the individuals to gain access to any financial or clinical data of the organization.

With this approach, the health provider can effectively boost privacy and subsequently prevent usage of PHI in committing fraud, for instance. What’s more, where a user misplaces their password or it is stolen, since he or she only has limited access to the system, it limits the total damage an intruder can cause.


While taking a sophisticated, multi-faceted security approach and measures may appear exhausting, where valuable and sensitive patient healthcare information is at risk, these additional security measures can guarantee protection.

To effectively keep up with the continually emerging security risks, it is crucial for healthcare providers to improve their data security and protection with these few approaches. This is in addition to the HIPAA rules as well as other regulatory-compliance initiatives which are also a solid starting point for establishing an effective data protection system and avoiding costly consequences.

Nonetheless, their efforts should go past just compliance to guarantee that sensitive and confidential patient data is well safeguarded against imminent threats today.

When a medical practice makes the decision to outsource their medical billing, the key priority is to choose a reputable company that they can trust 100% with their patient’s medical information. A physician needs to ensure that they engage a company that will be able to significantly reduce the headaches around billing issues, while at the same time protecting and securing their patient’s private data. A good choice of vendors will allow the physician to spend more time on his patient’s care and fewer hours on time-consuming billing rigmarole.

How do you go about evaluating medical billing services?

The right service should:

  • Be established with verifiable industry experience. It’s not about the number of years in business but rather about areas of specialty. They must have experience as a medical billing service that is able to bill both Medicaid and Medicare.
  • Have staff members on the team that are certified by the American Medical Billing Association (AMBA). This means they have in-depth knowledge of medical technology, ICD-10, CPT4, and HCPCS Coding as well as HIPAA and Office of the Inspector General Compliance – to name a few attributes.
  • Protect patient privacy by being 100% compliant with the Health Insurance Accountability and Portability Act (HIPAA)
  • Have a high level of service excellence. In the service level agreement make sure you are clear on whether the service will follow up on denied claims and unpaid bills.
  • Provide multiple support channels including email, phone, live messaging etc. along with in-person training or webinars to assist the providers’ staff on how to use their medical billing features and how to improve the practice’s revenue cycle.
  • Make use of the latest technology
  • Use a competitive pricing model
  • Not have too many clients on their books. They must have the capacity to execute the demands of your billing cycle timeously.
  • Share data on how to improve the practice. They will have reporting and analysis tools which could be exceptionally helpful to the medical provider. Be sure they are open to sharing their insights.

What functions do you need?

The functions you will need from an experienced medical billing service provider include

  • claim generation and submission
  • insurance carrier follow-up
  • payment adjudication, posting, and processing
  • patient invoicing
  • patient support
  • collection agency transfer services.

These are the core elements of an efficient medical billing services company. The provider should be super efficient in pursuing denied claims. Following up with insurance carriers should also be one of their fundamental strengths.

What other services can vendors provide?

Many medical billing service vendors offer a range of other features including appointment scheduling, insurance eligibility verification, credentialing and medical coding. The more services you chose, the higher the fees. The choice of items must be based on the cost as well as what the physician can realistically execute in-house and what definitely needs to be outsourced to ensure the practice can run seamlessly. There are three price structure possibilities:

  • percentage-based,
  • fee-based
  • hybrid (a combination of percentage and fee-based)

How to measure the performance of outsourced services

Once a provider chooses an outsourced medical billing service, the next step is to measure their performance. After about 4 months on the job, go back and do a charge capture audit on their work to date. Compare the log of your registered patients from all of your locations, and see if all procedures have been accounted for during this time. Doing a spot check is vital to reduce revenue leaking. No-one wants to be completing procedures that never make it into the billing system!

Evaluating accuracy

Another area to evaluate is the medical billing services coding accuracy. Is the company using an auto-coder and how often do they audit their coders? Are all of the physicians using the appropriate codes in the practice to ensure maximum reimbursement (under-coding can lead to noncompliance)? The billing company should be revealing a 95% and upwards accuracy rate (according to Health Management Technology).


It is important to know how your medical billing service monitors underpayment? To make sure a provider is being properly reimbursed, they need to be privy to the payer contracts that have been negotiated. The billing company should be delivering at least 80% of the expected collections every month. That figure is a good indication that their operational process is well oiled. It is essential to know how the vendor manages denials and what process they employ to report them to the provider. The reports the vendor submits should detail denial trends by the denial code. Once these denial reasons have been analyzed they should furnish an improvement plan on how to reduce them. This is the crux of evaluating the medical billing service’s performance.


The medical billing service does all of the heavy lifting of the billing process and can free up a huge amount of the physician’s time that could be better spent by seeing more patients in a day. To make it work, however, if you make the right medical billing vendor choice upfront.

Robin Healthcare’s co-founder, Noah Auerhahn, says the company is “problem obsessed.” This is what makes it different from other young healthcare companies that all too often start with a focus on technology first (e.g., “let’s do something cool with Alexa”). The problem the Robin team wants to solve is big and it’s important: the documentation burden that is contributing to inefficient and costly care as well as to the now pervasive issue of physician burnout.

The documentation problem

According to an article published on the website Physicians Practice, there is not much formal research linking EHR use and burnout, however it quotes the deputy chief health officer at IBM Watson Health, Paul DeChant MD, as stating that.

…there is data that shows for every hour physicians are directly with a patient, they are spending two hours doing administrative work. Many physicians are spending one to two hours at home working in the EHR — known as pajama time.”

He went on to say that the issue of burnout is

“eating away at the heart of [medical] practice.”

This is due, in part to the clunky nature of most EHR systems that require physicians to use a keyboard to enter data forcing them to turn their backs on patients while they try to capture all of the information the EHR requires. These systems were simply not designed to fit into a doctor’s practice, rather they were designed to meet the business needs of the healthcare organization (e.g., billing) no matter how disruptive they are to the physician-patient relationship.

How Robin is different

Instead of making physicians alter their workflow to accommodate the requirements of the Electronic Health Record (EHR), Robin fits seamlessly into the way doctors have been taking care of patients for ages. The device sits in the exam room unobtrusively recording audio and video of the patient encounter. Using artificial intelligence, the device can translate the doctor-patient conversation into a physician note. The note is reviewed by a medical scribe and then is ported into the doctors EHR where it becomes a part of the patient’s medical record. Unlike EHRs, it doesn’t require that the doctor spend most of the visit looking at a computer screen and unlike medical scribes, it doesn’t require the presence of someone else in the room.

Now, I have made it seem simple, but, of course, it is not. Conversations in medical exam rooms are often unstructured and can wander all over the place although most visits will consist of taking a patient history, doing a physical exam, and then formulating a treatment plan. Robin and its scribes must turn the recording into a highly structured note, using “doctor talk,” that can easily be read and understood by the examining doctor as well as other health professionals that have a medical need to access the record.

The Robin AI is not meant as a replacement for scribes any more than autopilot is a replacement for pilots. Rather, it is able to capture the entire conversation and create the first draft for a medical scribe to edit and a physician to review and sign before it becomes a part of the official record. Noah tells me that sometimes 80% of the note is generated by the machine with a 20% contribution by the scribe and other times only 20% is created by the machine with the scribes listening to the recording and doing most of the note creation. As with all systems that use AI, it is anticipated that it will get better and better as it learns from its experience (i.e., machine learning).

A conversation with Emilio

I was so intrigued by the promise of Robin that I invited Robin’s other co-founder, Emilio Galan to join me in a video interview. You can see the entire video, titled “Robin is Helping Doctors and Patients Eye to Eye” by clicking here. What follows is a condensed version edited for readability.

Pat: Emilio Galan is a serial entrepreneur. His latest venture that we’re going to talk about today is Robin Healthcare.  Emilio, I’ll just let you describe what it is, it’s really very cool.

Emilio: Robin is a device placed in the room with the physician and the patient. Instead of the physician typing and, every once in a while looking over his shoulder at the patient, he can maintain eye contact and actually just have a conversation.

Pat:  That’s the way we used to do it.

Emilio: Exactly and that’s what we are trying to create again – just place this device in the room and you get to forget about the documentation part of the encounter and focus on patient care.

Pat: You use artificial intelligence to capture the conversation but how does that turn into a note? What are the steps involved in going from me examining the patient to ending up with a note that gets ported into my patient’s electronic health record?

Emilio: For the physician, it’s kind of like this magical experience. You just get to focus on the patient and the note shows up in your EMR. On our end, you can imagine there’s a ton of work that goes into it. We are capturing audio and there is optional video so when a patient says “it hurts here” or “it hurts there” or if he comes in with a wheelchair, all that is captured.

The first thing the machine does is try to extract all of the clinical information from the conversation so if you’re talking about Game of Thrones or the weather or a recent trip to Hawaii, it is filtering all that out and it’s looking for the knee pain, the severity, tingling, medications. It identifies what is medical and extracts it out of the out of the conversation to place within the note.

One of the hard parts of the process is determining what is relevant and what is not. We also need to sort out confusing parts of the conversation (for example, previous aspirin use is different than current aspirin use which is different than I recommend aspirin use -Knowing exactly where to place that mention of aspirin is really important.

Macro shot of white asprin on white background with Robin text on top 650 x 432Pat: A lot of people are do think about AI as magic or probably the word I hear the most is it’s a black box. In fact, if you go into that black box it’s all about the people – people develop the algorithms. Who developed your algorithms? How do you tweak them? How do you keep them current? How do you do this thing they call machine learning which is, I think, really people teaching the machine.

Emilio: That’s an important point. Machines learn best from repetition, things that a human can do again and again and again – it picks up those patterns. We have a fantastic technical team that includes people from UC Berkeley and some former folks from Google who are helping build out those algorithms. The real key is having the data and breaking down clinical visits into something that’s repeatable, little chunks that we’ve seen again and again that the machine can learn from. For example, the first time I say “it’s your left knee that hurts, right?” the machine might say is it left or right? Or I’m depressed because my mother recently was diagnosed with cancer, who has the depression, who has cancer? It is difficult to tease these things out but when you see it again and again, the machine can learn that right is used differently here, they’re actually talking about the left knee and it can capture that and document it.

Pat: And how long has it taken you to build this out?

Emilio: We’ve been working on Robin for a year and a half.

Pat: Which is which is really a very short period of time.

Emilio: There’s been a lot of development in Natural Language Processing and Machine Learning. But the challenge is that unlike Alexa or Google home that may play the wrong song, documentation of a medication or a diagnosis needs to be correct. There is a very low tolerance for error in medicine, so an extra piece that we have to do with Robin is to ensure the accuracy of everything.

Pat: I understand that you use some human beings for that.

Emilio: Absolutely. There are humans in the loop as the machine learns more. Also, every note we create gets QA’d by a human. And then, the machine learns from any corrections the humans made on the algorithm.

Pat: Who are these humans and how does this relate to what a lot of doctors are doing right now by having an actual human, called a scribe, in the room. This person is capturing the information and creating the note.

Emilio: About 5% of the market now hires a human to follow them around and document as they talk with patients. There are challenges: (1) you have another human in this small room kind of invading that space and (2) it’s expensive to have a human follow you around all day to type (3) the human gets sick and even more so they’re doing the job to go off to medical school.

Pat: So you train one and then hopefully he gets into medical school and then you have to train another one.

Emilio: Yes, they typically leave after nine months – you train them which takes a few months and then they’re with you for another six months. The clinician’s experience with Robin is very similar except Robin never gets sick, never goes off to medical school and it’s much cheaper than having a human.

Pat: And, there isn’t another person in the room with you.

Emilio: Exactly, it’s like a sanctuary of patient and doctor. On our end, the humans we use to review recordings have very similar demographic to in-office medical scribes. The difference here is that our scribes are super-powered by the AI algorithms  – they are reviewing and guiding the algorithms.

Pat: So if I got it right, what you’re saying is that Robin does the first draft of the note, the scribe reviews it and does the next draft and then, I’m assuming, the physician does the final draft since he or she has the ultimate responsibility for the note.

Emilio: Exactly so no matter what solution physicians use now whether it be dictation with Dragon, an overseas transcription service or an in-person scribe, the physician always does the final review.

Pat: How much of an individual note does Robin generate versus how much is actually created by the scribe who listens to the recording?

Emilio: It depends on the complexity of the case, whether it’s a new patient or a follow-up. It also depends how many notes we’ve done for that physician and how much of their behaviors have been learned. The simple cases get automated much faster, the complex cases may always need some level of human review.

Pat: How much would you say it cost to produce a simple note?

Emilio: If you’re coming back after an operative visit, we most likely know you’re going to say. It’s very cheap to do those notes, it might just take 30 seconds for that note to be QA’d and sent to the EHR. A complex patient is another story. We’ve had physicians say Robin saved them 15 hours in a single week.

Pat: And, 15 hours of an orthopedist time is a lot of money!

Emilio: It is a lot of money. There are so many winners here: physicians are saving hours of time with Robin. They can see more patients and make more money if they want but more than that they get to go home on time see their family. One physician told me that he finally got to put his new son to bed for the first time after Robin. That’s the kind of story I love to hear. Patients, on the other hand, are saying, I love that the physician gets to look at me and maintain eye contact. This is instead of dictating in front of you or going in and out of the room to chart.

Pat: That’s fantastic because both doctors and patients say that a part of the joy of medicine is the physician-patient interaction.

Emilio: Every physician should have something like this, right? Whether it be Robin or any other service, physicians deserve to be able to just focus on medicine. Patients deserve physicians that are completely focused on them and the system at large deserves to have really great documentation. The other piece to Robin is having these great notes that are correct, that you can refer to and rely on – that’s what we’re working towards…I want to see this in every Doc’s office.

Pat: Well I want to thank you very much, not only for joining us and telling Robin’s story but for inventing this amazing device that could really be a game-changer – actually, it will be like going back to the kind of game that I experienced when I was first in training before we had electronic health records.

Emilio: We are trying to get back to the heart of medicine which is to focus on the patient. We are not just trying to throw some new technology at physicians, that’s not the point. The point is technology should get out of the way of practice and let Doc’s do medicine and let technology happen in the background.

Pat: We’ll let that be the last word. Thank you very much, Emilio.

The transcribed interview has been significantly condensed as well as edited for readability. We encourage you to learn more about Robin by viewing the entire interview here.

Emilio Galan screen shot from Galan-Salber interview 350 x 338

Emilio Galan, Co-Founder of Robin Healthcare.

Modern workforces are becoming increasingly connected to a world of digital information. With 77% of Americans now owning a smartphone, it’s never been easier to create, access, and share information online; from anywhere, at any time.

Given the widespread adoption of smartphones more generally, it should come as little surprise that the healthcare industry is becoming more and more reliant on mobile devices. One recent study revealed that four in five physicians (81%) use smartphones at work, while another study showed 88% of nurses are utilizing mobile to aid their daily tasks, including accessing clinical data and communicating with other staff at a medical facility.

 The increased adoption of mobile technology in healthcare is facilitating a shift in everyday workflows amongst healthcare professionals, and mobile messaging, in particular, is leading the charge in this transformation. A HIMSS Analytics survey of clinicians, clinical informaticists, and IT professionals found that secure messaging was the main driver in clinical communication selections. Users are seeking solutions that are not only HIPAA-secure but can also provide workflow and communication capabilities within a single, unified application.


Streamlining clinical workflows and patient care

Unlike pagers, which provide one-way communication, mobile messaging allows for two-way or group messaging, which helps accelerate workflows and enhance team collaboration. In turn, this improves efficiency, reduces wait times between requests, and significantly reduces the chances of a message not being seen by the intended recipient.

Consequently, patient health outcomes have been proven to improve through the use of mobile messaging. A study of two Pennsylvanian hospitals in 2016 found that care teams that communicated via secure mobile messaging were able to significantly reduce their patients’ length-of-stay, compared to those using pagers. Over the course of one year, researchers found that patients whose providers used secure mobile messaging were discharged 0.77 days sooner, equivalent to a 14% reduction in stay.

Mobile messaging also has the potential to improve communication between caregivers and their patients – enhancing patient care, reducing missed appointments, and improving relationships. However, even when communicating with existing patients, the HIPAA rules still exist, and therefore any sensitive data must be transmitted through secure channels. Plus, in order to meet HIPAA requirements, patients must first opt-in to any mobile messaging communications.


Minimizing errors

According to the Joint Commission, the not-for-profit organization responsible accrediting and certifying more than 21,000 healthcare organizations and programs in the United States, an estimated 80% of all medical mistakes are due to miscommunication between caregivers. Communication within healthcare organizations can be disjointed and complex, with archaic systems and inadequate hand-off procedures largely to blame; a seemingly quick exchange of information typically has to relay through several parties and at any of those points, a message can easily become distorted.

Real-time alerts and audit trails offered as part of secure mobile messaging solution help solve this problem, and ensure critical alerts don’t get missed.

Before getting started

The accessibility, scalability, and familiarity of mobile messaging as a service makes it a viable solution for care teams across the entire healthcare spectrum, inducing physician practices, hospitals, home health agencies, and everything in between. However, not all secure mobile messaging platforms are created equal, so finding a suitable solution is not always easy. By asking potential vendors a number of questions, organizations can make more informed decisions during the selection process. These questions should include:

  1. Is the solution truly HIPAA Compliant?

A HIPAA-secure mobile messaging provider will be able to provide assurances in the following key areas:

  • Administrative safeguards – A data termination procedure must exist, so PHI (Protected Health Information) can be quickly removed from the device. The application should also possess a remote wipe or shutdown functionality, to minimize data being exposed should a device be misplaced.
  • Physical safeguards – The application should be secured via PIN lock and strong multi-factor authentication.
  • Technical safeguards – PHI must be encrypted to the highest security standards throughout its entire lifecycle.
  • Redundancy – In order for an app to be HIPAA-secure, it must have data back-up procedures and a disaster recovery plan to protect PHI in the event of a device being lost or stolen.

The HIPAA rules also generally require that covered entities enter into Business Associate Agreements with their vendors (business associates) to ensure PHI is adequately safeguarded at all times. Failing to execute such a contract can be detrimental to both covered entities and their business associates, with OCR prepared to distribute serious penalties for noncompliance. If a vendor won’t sign a Business Associate Agreement, covered entities have every reason to question their security and privacy credentials.

  1. Can we integrate the secure messaging solution with existing applications?

In an effort to further streamline clinical workflows, organizations may look to integrate a secure mobile messaging application with existing tools and services, such as scheduling platforms, EHRs, and call centers. Integrating with a call answering service, for example, can help create a culture of more efficient patient care by providing instant connections to incoming calls, voicemail messages, and patient updates.

 Is there a desktop version available?

Mobile may be the dominant force in most modern healthcare environments, but providers still need services that communicate across both desktop and mobile platforms. Therefore, providers should seek a solution that offers applications for desktop, as well as iOS, and Android devices.


The bottom line

Secure mobile messaging in healthcare settings can be an effective way to improve care coordination and communication, but like any form of communication, it is not totally risk-free. Before rolling out secure mobile messaging throughout an organization, those responsible for managing its implementation must first establish workplace policies that clearly define best practices, potential risks, and user responsibilities. These policies should be reviewed regularly, and staff should be trained to reflect any changes in procedure. Most importantly, organizations need to ensure the solution they are considering is not just secure, but is HIPAA-secure – there’s a big difference, and failing to employ a service that has a proven track record in keeping PHI secure, could be a costly mistake.

A consensus committee defined diagnostic error as the failure to establish an accurate and timely explanation of a patient’s health problem and communicate the explanation to the patient. The impact of diagnostic error based on this definition is reflected in sobering observations.

  • Diagnostic errors contribute to 10 percent of deaths according to autopsy studies
  • They are twice as likely to have resulted in a patient’s death compared with other types of errors
  • Between 6 and 17% of adverse events in hospitalized patients are attributed to diagnostic errors.
  • Five percent of adults in the United States who seek outpatient care experience a diagnostic error.

The costs are no less troublesome: one report from the United States suggests diagnostic errors cost at least $17 billion annually. Adding to the costs is the observation that diagnostic errors are the leading cause of medical malpractice claims.

Diagnostic error is complex

Diagnostic error is complex. It results from a breakdown of the diagnostic process, in which the proper diagnosis and resulting actions evolve iteratively from interactions with a caregiver, patient, and the healthcare system. Examples include failure to recognize opioid intoxication in a patient with mental status changes, failure to consider pulmonary embolism in a patient with shortness of breath, incorrect diagnosis of iron deficiency anemia in a patient with a pre-malignant blood condition, an incomplete physical examination leading to a missed diagnosis of appendicitis, failure to communicate an abnormal chest x-ray finding leading to the delayed diagnosis of lung cancer.

Several recommendations have been endorsed broadly to reduce diagnostic errors. They emphasize efforts to do the following:

    • Facilitate effective teamwork in the diagnostic process
    • Enhance education and training
    • Encourage the use of health information technologies to support the diagnostic process
    • Achieve methods to learn from errors
    • Establish a culture that encourages better diagnostic performance,
    • Develop a reporting environment and liability system that facilitates learning from errors
    • Design a payment and care delivery environment that supports the diagnostic process, and
    • Provide funding for research on diagnostic errors.

Related content: Diagnostic errors are more common than you might think.

Barriers to reducing diagnostic errors

Unfortunately, due to several barriers that have impeded progress, these recommendations have not yet been adopted widely. Competing initiatives, particularly the implementation of health information technology systems and compliance with regulatory, billing, and reporting requirements, within healthcare systems have hindered progress. In addition, financial constraints among healthcare systems make it difficult to gain enterprise-wide commitment to these initiatives. And lack of requirement for public reporting of diagnostic errors means the scale of the problem isn’t always apparent within healthcare practices.

The economic impetus to tackle diagnostic errors remains largely rooted in the beneficence of healthcare providers, the fear of malpractice litigation, and, to a lesser extent, the recognition that diagnostic errors can be costly. On the last point, the costs of diagnostic errors, under a fee-for-service system, are not always born by those providing the care. As a result, there is limited incentive to prioritize efforts to reduce diagnostic errors compared to other initiatives more directly tied to reimbursement, regulations, or costs.

Related Content: The Why and How of Diagnostic Errors

Nevertheless, progress is being made

The considerations above translate into the lack of a strong business model that supports innovation in technological solutions to reduce diagnostic errors. Nevertheless, there has been measured progress. The adoption of electronic medical record systems permits some forms of diagnostic error to be more easily detected and prevented. For example, digital systems are in place that can ensure that abnormal laboratory or imaging results are communicated to the appropriate personnel. In addition, a number of software tools and other interventions have been developed that help clinicians improve clinical reasoning, thereby reducing cognitive errors that lead to a breakdown of the diagnostic process. Most of these have not been implemented widely, and some that have been adopted, such as tools to aid clinicians in achieving a list of possible diagnoses, have limited benefit. 

Clinical decision support (CDS) has also shown promise but data are still evolving. Defined broadly, CDS is a means to provide clinicians intelligently filtered information at the appropriate time to improve healthcare processes and outcomes.

Investigators at a Tokyo-based acute care hospital found that a popular decision support resource had an important impact on diagnostic error. The study compared rates of diagnostic errors made by clinicians equipped with the CDS system during 50 outpatient visits with 50 control patients cared for by clinicians without access to such a system. The authors observed significantly lower rates of diagnostic errors among clinicians who had access to the resource (2 versus 24 percent) even after considering factors such as the patient’s age, sex, primary diagnosis and case difficulty.

The answers to addressing diagnostic errors are not simple and they will require a holistic approach that healthcare systems are only starting to tackle. In the near term, today’s CDS capabilities already demonstrate the potential to substantially reduce diagnostic errors and improve patient outcomes.

Medicine is ripe for disruption. As David Lawrence, former Chairman and CEO of the Kaiser Foundation Health Plan, wrote in his 2005 book chapter Bridging the Quality Chasm:

“Between $.30 and $.40 of every dollar spent on healthcare is spent on the costs of poor quality. This extraordinary number represents slightly more than a half-trillion dollars a year. A vast amount of money is wasted on overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency.”

The costs that result from poor quality trickle down to consumers and patients, who shoulder much of the burden of ever-increasing healthcare costs. In order to improve healthcare accessibility, the utilization of medical resources must be made more accurate, more efficient, and more secure.

Two cutting-edge technologies, in particular, show significant potential for elevating the use of data and other resources in the medical industry. These technologies are blockchain and artificial intelligence. By utilizing the latest advancements in these technologies, the medical industry can improve quality, bring down cost, and democratize healthcare like never before.

Here are four key ways in which the healthcare field can leverage blockchain and AI technology.


Smart contracts

Originally developed for cryptocurrency in 2008, blockchain allows collaborating parties with competing interests to keep a tamper-proof, distributed, digital ledger.

As we have seen, the implications of this technology for finance are highly disruptive.  However, the implications of blockchain in medicine are more subtle and far-reaching because they involve medical ethics including consent, privacy, and accuracy of clinical measurements, as well as financial transactions.

Blockchain isn’t only for financial transactions. It holds value for any agreement between two parties that needs to be auditable. In the legal profession, this means revolutionizing property law, notary public functions, and chain-of-custody. But for pharmaceutical companies worried about the burgeoning costs of clinical trials blockchain has value in smart contracts.

Potentially protecting patient anonymity, and even enabling profit sharing, smart contracts can make research results available without the bias of human data collection and data analytics.

Related content: What Will Radiology Look Like in the Age of AI?

Reducing drug prices

Today’s most cutting-edge AI programs are capable of “contextual normalization,” which allows them to simultaneously generate and test new hypotheses by analyzing complex sets of biological data. AI holds significant promise for innovation within the healthcare industry, particularly in a pharmaceutical context.

AI is significantly increasing the variety and breadth of data that is analyzed during the course of drug research and development. Furthermore, AI accelerates the rate of analysis to speeds unattainable by human researchers. Today’s AI is also capable of generating and testing novel hypotheses with greater efficiency, which enables more accurate, efficient, and timely clinical trials.

Improved data analysis in pharmaceutical R&D means higher success rates, more innovation, and more affordable drugs for patients. Major companies such as Merck & Co. and Johnson & Johnson have already been investing in AI-driven innovation, and others are sure to follow.


Secure data transmission/warehousing

There is increasing divergence between the convenience of consumer software such as mobile phones and the achingly inefficient and out-of-date software that is sold to hospital systems at an enterprise level. A panel of UK experts commissioned to examine this discrepancy for the National Health Service in 2015 concluded that the “digital revolution has largely bypassed the NHS“. The report concluded:

“Many records are insecure, paper-based systems which are unwieldy and difficult to use. Seeing the difference that technology makes in their own lives, clinicians are already manufacturing their own technical fixes.

They may use Snapchat to send scans from one clinician to another or camera apps to record particular details of patient information in a convenient format.

It is difficult to criticise these individuals, given that this makes their job possible. However, this is clearly an insecure, risky, and non-auditable way of operating, and cannot continue.”

This report was born out by other findings that the behavior of clinicians in-hospital is quite different from their stated concerns. Fifty-five percent of physicians say they are worried about cyber attacks and 87% physicians say that their practice is compliant with HIPAA security rules, while only 66% are confident they know what those rules are.

Clinical working groups frequently text patient details and clinical photos to each other to facilitate care interactions. In a private 2012 online survey of hospital workers at the UC Davis medical center (a well-respected US hospital), 88% of surgery residents and 71% of attending surgeons routinely texted about patient-related care. A UK NHS data was comparable, 63% of doctors admitted texting patient information, and 46% sent photos or x-rays to colleagues.

Because 83% of physicians use mobile phones, and the most common security breaches are with stolen mobile phones, clinical texting behavior is a non-trivial issue in clinical data security. Given that this behavior is not likely to cease, we need to facilitate it in more functional ways. Blockchain has the ability to make this data-transfer secure and tamper-proof, and even obtain patient consent for photo-sharing with smart contracts.

Related Content: Artificial Intelligence: Can It Improve Results of Cancer Screening Programs?

Increasing interoperability

While its true that blockchain is not widely used yet, it’s being implemented rapidly compared to many other disruptive technologies. For instance, in 2017, blockchain was designed for use in three applications in healthcare: identifying and tracking selected prescription drugs, audit trails for provider networks, and value-based care (payment based on outcomes, not procedure). Many more uses-cases have been posited, such as EMR record access by providers, supply chain integrity to prevent losses from pharmaceutical counterfeiting, reduction in Medicare fraud, clinical trials, and data security in the new Internet of Medical Things (IoMT).

A 2017 IBM survey of 200 healthcare executives in 16 countries found that 16% expected to have a commercial blockchain solution at scale in 2017, while 9 out of 10 institutions planned to invest in pilots by 2018. Executives were primarily interested in blockchain in three primary areas; clinical trial records, regulatory compliance, and medical and health records.

Blockchain has many upsides and few downsides for the savvy entrepreneur. Perhaps when blockchain is implemented, we will finally see better software in medicine. We could replace the siloed, out-of-date, and overpriced enterprise systems clinicians currently use with true EMR interoperability, smartphone/wearable patient apps, and secure interoperable back-end data-sharing.