CDM Management has never been Easier with Clinical Data Automation

 Erika Regulsky RCM, RPA
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Clinical data management using RPA assisted Health systems

Clinical Data in Healthcare Systems

According to a report, the average cost of data breaches in healthcare in the country is estimated at $15 million. More and more PHI falls into the wrong hands and they misuse it to get ransom or even sabotage the entire health system. Punishments towards HIPAA infringement are very serious, be it the medical organization’s issue or not. For instance, the punishment for abusing HIPAA by sending PHI to some unacceptable contact or patient is a fine of $50,000.

PHI comprises past, present, and upcoming wellness examination data about the ailments (both physical and psychological well-being) of a patient. This clinical data can be conveyed in three structures: electronic records, dictations on patient prognosis, and physical paper records.The PHI likewise incorporates historical patient data (patient history), medical records, medical expense bills, lab test results, and segment data like patients’ names, telephone numbers, addresses, financial data, Social Security number, photographs of the face, surgical records, etc.

The normal tone of health systems and hospitals isn’t quiet and of wonderful perspectives, hence, omissions and errors regarded as record related issues aren’t unrealistic. The procedures and steps expected to fill and enter PHI sensitive data endorsed by patients are typically lengthy and include pursuing individuals down to get approvals. Every one of these generally leads to avoiding a few procedures and making the simplest of errors.

Implementation of RPA

Robotic Process Automation

However, by executing RPA and automating healthcare services work processes, patients’ information is naturally moved and processed. This diminishes the gamble of abusing HIPAA guidelines while additionally eradicating the requirement for executives to perform repetitive and complex tasks. Around 80% of healthcare professionals guarantee that automation and electronic medication prescription have essentially diminished the degree of human interaction and time taken to settle the final paperwork. 

Robotic Process Automation keeps up with compliance by securing clinical information and guaranteeing all processes are in accordance with HIPAA and other regulatory authorities. Technology officers of various healthcare organizations are looking to automate their data management and compliance with RPA involving custom reports and point by point audit logs can also be maintained securely.

It is a well known fact that most healthcare organizations still use manual charts and medical records data extraction methods such as creating a physical paper super bill scanning it and then uploading it to the respective EHR or EMR. This process costs a lot and is very time consuming.

Medical services professionals and CTOs might utilize various applications to store and access patient information. Securing such a tremendous measure of data can be challenging and complicated. With RPA, HIPAA compliance becomes simpler to manage. Audit controls can be easily executed utilizing process automation. Definite audit histories can be set up automatically and any time there’s an external or internal audit, auditors can undoubtedly access this data easily.

Automating data management processes setting down deep roots in the current healthcare situation. RPA is adaptable to automate any system and is fundamentally to assist with clearing the messiness of data breaches consequently smoothing out the whole process. With RPA around, finding the needle in the largest haystack is simplified to the full extent.

How does RPA manage clinical data?

As healthcare professionals we know that charts, progress notes and surgical documents are of utmost importance when it comes to providing accurate care and getting reimbursed for it. In the past 5 years these documents are barely maintained and were taken for granted which has resulted in lots of unwanted audits by insurance companies stating the services are not medically necessary for the patient. To avoid this Chief Technology officers of various specialties conducted a study on how to improve CDI and precise documentation when it comes to incentive programs and audits. The end result of this study was RPA. 

Medical records department has lacked this technology over the years and once implemented it created a whole new perspective of auditing the charts and medical records before submission of any clinical data to the patient or the insurance companies. This not only created a positive response from external auditors and insurance companies, but also the medical examiners in each of these audits were overwhelmed by the quality of charts and records presented. RPA can be set with CDI, NCCI and ICD10 protocols so whenever a medical records department creates a patient medical record it easily allows them to rectify the errors they made. 

These RPA bots and the technology have given medical records departments of health systems new methods of clinical chart extraction, including Consolidated Clinical Document Architecture (CCDA), APIs directly linked to their respective EHR/EMR and HL7 or FHIR used in more advanced integrated RPA systems. Each can be an effective way to transfer clinical data between EHRS/EMRs used by various healthcare professionals. 

We understand the next question which is raised in your mind  “if the records are accessible by RPA bots, are they HIPAA compliant?”

The answer to your question is yes, RPA is completely HIPAA compliant. Unlike EHRs, EMRs and PMS follow HIPAA regulations, RPA are customized to follow HIPAA guidelines as they are just protocols which can be enabled in any automation system. For example if there is an automation system for reading charts and suggesting ICD10 codes, the bots will cross verify with the HIPAA protocols and not release any sensitive data apart from the clinical and RCM professional. If it identifies a breach in HIPAA compliance it can directly provide an alert to your designated supervisor which keeps in close communication with the compliance violator management. 

Implementing RPA significantly reduces Data Breaches

Guaranteeing the protection and security of sensitive patient information is one of the top worries for healthcare systems. Utilizing RPA guarantees that PHI must be provided to the proper staff. This role based accessibility limits information breaks or ill-advised utilization of information.

RPA permits healthcare services professionals to control information access and guarantee that the important staff can get to PHI when required. This control is of utmost importance since specialists, IT staff, and the cases offices need shifting degrees of accessibility to protected patient information.

Other reasons why HIPAA compliant automation must be utilized

HIPAA compliant automation

High risk patients with infectious diseases prefer automating processes and frequently visiting hospitals may risk everyone including the healthcare professionals. They prefer RPA to be a boon because of timely documentation and patient statements in a secure and user friendly manner. 

Since the outbreak of COVID-19 most doctors prefer using telemedicine for outpatient E&M services, therapists also favor telemedicine as they need not meet the patients in person. This has allowed the branching of a whole new technology which can link both HIPAA compliant RCM and securely sharing PHI to their billing staff or to the patients themselves. Integrated clinical data management RPA with telemedicine application will ease the tension of these healthcare professionals to lean towards automation for creating error free clinical documentation and keep audit logs in the system for future references. This will not only reduce significant time saving and also cost. 

Electronic edits check in CDM is automated using RPA for faster and error free eCRFs. This applies to patients with conditions which require 2 or more specialist physicians working together to identify the underlying cause of illness. 

Source data verification (SDV). SDV is a process of evaluating eCRF entries against original clinical records and data from devices. If the health system uses devices which are enabled to RPM (remote patient monitoring) , data can be directly captured from the RPM application and directly cross verified with the original clinical record using RPA solutions. 

Data anonymization can be performed by using RPA, before submission of data to any third part, clinical data must be de-identified to ensure that it complies with the HIPAA. This means deleting all information of protected health information (PHI) that can link the document to a particular person this way the patient’s clinical data is protected and the third party doesn’t know their sensitive illness or disease to be exposed. Lab partners who are outside of the health systems and need additional clinical data from these types of patients, RPA data anonymization is used. 

If a health system has multiple locations in the same state and if they are looking for one centralized hub to exchange clinical data without the risk of data breach and compliance violations RPA is the best option. The reason is RPA bots and systems can be coded in such a way that it interacts with other locations EHR/EMR even though they all follow different process workflows. So at the time of an external audit from CMS or other federal government agencies CTOs are able to provide the audit data with less hassle. 


It is known that various companies are good at coding bots to do repetitive tasks, but the loophole here is that they might not be experienced in the inner workings of health systems and the technologies used by their CTOs. It is important to identify the skill set of a company which has already been in the RCM and healthcare IT solutions for over 15+ years. We have created various HIPAA compliant automation systems which are currently used by health systems and RCM companies to make their processes secure and streamlined. 

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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