health care management certification

What to Delegate First When Your Practice Is Growing

Posted on by Joseph Gerard

A young doctor is sitting in the clinic and talking on telephone and doing paperwork that should be done by an an admin assistantWritten by Ashleigh Atuahene,

Before I, Ashleigh, co-founded Ataraxis, I spent years working inside the kind of practices I now help other people staff. I started on the administrative side, spending a few years in a physician’s office doing patient intake, scheduling, insurance verification, and prior authorization. Later I took a role providing one-on-one ABA therapy under a licensed therapist, and once that clinic realized I already had an admin and insurance background, the same kind of work found its way on my desk there too. Over time I handled intake, scheduling, chart QA, prior auths, and insurance verification across pediatric, internal medicine, and behavioral health. So when I talk about what to delegate first, I am not repeating something I read in an operations handbook. I watched practices get this right, and I watched practices get it wrong, sometimes from inside the same building.

Here is the question I hear most often from growing practices: what should I hand off first? Most owners assume the answer is “someone to answer the phones.” Sometimes it is. But the real answer depends on one thing, and that is how your practice gets paid.

Start With How You Get Paid

If you accept insurance, delegate billing and coding first. Not the phones, not the calendar. Billing. This is the part owners resist, because the phone is loud and the billing is quiet. The phone interrupts you all day, so it feels like an emergency. Billing sits in a queue and does not shout, so it feels like it can wait. It cannot. Every claim that goes out late, coded wrong, or missing a prior authorization is money you earned and may never collect. In behavioral health especially, where claims are denied more often than in general medicine, the person who owns your billing is the person who owns your cash flow. Hand that off to someone who does it well, and do it early.

If your practice is out-of-pocket or cash-pay, the situation flips. When there are no claims to chase, your bottleneck is not billing, it is access. In that case, delegate everything that touches the patient but does not generate a billable hour: new patient intake, new patient questions, taking messages, routing questions meant for the provider, screening the sales reps who want “just five minutes” with the office, and, yes, the scheduling everyone expects. The clinical hour is the product. Anything that pulls the provider out of that hour without adding revenue should be delegated, and a good virtual medical receptionist can absorb most of it.

Reducing Friction

When a practice grows, the growth is not invisible to your patients. They feel it. Scheduling gets harder to manage. Reaching the provider takes longer. Those small frictions are the first thing a patient notices, and they are the first thing that makes a patient wonder whether they should look elsewhere.

The goal of your first hire is to keep the patient from feeling the growth at all. Ideally, a practice at forty patients should feel as easy to work with as it did at ten. That does not happen by accident. It happens because someone whose whole job is responsiveness is standing between your expanding schedule and the person trying to book into it. 

The Cost of a Missed Moment

The larger a practice gets, the more opportunities start to fall through the cracks. Imagine a solo provider with a handful of patients. It is simple to manage the schedule, move an appointment, stay on top of notes, and answer a quick question between sessions. Now picture that same provider booked back to back all day. The moment their calendar fills up, they lose the ability to manage those small functions effectively.

Here is a real-life example I saw over and over. Your one o’clock is running late and calls to reschedule. If you have a light day, you see the message and move them in two minutes. If you are in back-to-back sessions with no admin, you will not even see that message until it is already one o’clock. That patient could have been rescheduled and the slot backfilled. Instead you have an empty hour, a frustrated patient, and a note you still have to write. Multiply that by a full calendar and you can see how a growing practice starts leaving money and goodwill on the table, not because demand dropped, but because no one was available to catch the moment.

Money Is to the Business What Gas Is to the Car

No one understands the value of the clinical hour better than the provider delivering it. You are paid on billable hours. Accumulate them and the practice runs. Let them drop and you cannot cover overhead, and you certainly cannot pay yourself without dipping into reserves. Money is to the business what gas is to the car. The good news about growth is that it brings more billable hours. The hard news is that it also brings a flood of administrative work, and that work does not bill.

In a landmark time-and-motion study, physicians spent close to two hours on documentation and desk work for every single hour of direct patient care (Sinsky et al., 2016). Behavioral health is often heavier still: a fifty-minute session usually generates another twenty-plus minutes of notes, before you consider billing, intake, or authorizations. And prior authorization deserves its own line. The American Medical Association found that physicians and their staff spend an average of thirteen hours per week, per physician, completing prior authorizations, working through roughly thirty-nine requests each week (American Medical Association, 2025). That is more than a full workday, every week, spent on paperwork where the rules keep changing.

So the math is simple, even if the decision feels hard. Your time is finite, and growth makes that scarcity impossible to ignore. Every hour you spend on a task someone else could do is an hour you are not billing. Why waste billable hours when you can pay someone twelve dollars an hour overseas, or thirty dollars an hour locally before benefits, to do well, when that same hour of your time is worth hundreds? Hiring is not the cost. Doing your own admin is the cost. It just does not show up on an invoice.

When You Get the Order Wrong

Delegating well is not only about what you hand off. It is about the order you do it in, and about being honest with yourself when something is not working. The practices I have been part of taught me this in different ways.

Hiring Too Late

At a small ABA practice, there was one admin who handled the phones, the schedule, and parent questions. She was capable, but she had little experience with insurance verification or prior auths and no time to learn them. I came in as an ABA therapist, and once they learned about my earlier admin experience, insurance work for three providers got delegated to me, the family therapist, the speech-language pathologist, and the ABA side. By the time I took it over, the practice was already swimming in denials and patching broken workflows. We got it back on track, but you cannot fully recover the time and income lost to mistakes made months earlier. Billing delegated late is more expensive than billing delegated early, because the denials compound while you wait.

Too Slow to Change

I also worked with a solo speech-language pathologist who did one thing right and one thing wrong. She hired an admin first, then brought on a billing specialist through an agency later, which is a reasonable order. Her mistake was not listening. When the billing specialist told her the claims were not collectible as submitted and the system was fighting them, she kept pushing to make it work instead of finding someone more adept. Even if a stronger specialist had cost more, she would have come out ahead. Delegation only works if you trust the person you delegated to, or replace them, rather than overriding the expertise you hired.

Getting the First Hire Right

More recently, I watched these same principles play out from the other side of the table as my team worked closely to help staff a small group therapy practice in San Jose with three clinicians. They were making their very first hire. The founder was not in crisis mode, which is exactly the point. She was still seeing her own clients while personally carrying the billing, the session submissions, and the scheduling, and what wore her down was the constant switching between being a clinician and being an administrator. In her words, she needed another brain.

What made this one go right came down to two decisions. First, she hired before the wheels came off, while she still had the bandwidth to onboard someone properly instead of handing over a mess. Second, she was honest about what mattered most. Her practice is bilingual, and an assistant who also spoke Mandarin would have been a nice bonus, but when it came down to it she chose deep behavioral health experience and a strong command of HIPAA and her EHR over the language skill. 

The person she brought on had a psychology background and already knew the systems her practice ran on, and she took over the session submissions, the billing, the out-of-network claims, and the scheduling at about twenty hours a week. That was enough to hand the founder her clinical focus back. The last thing she did right is the piece most first-time hirers skip: she wrote down her processes before the start date, so her new assistant was working from clear documentation instead of guessing. Get the right person and the right instructions in place, and the handoff is usually simple.

Where to Start This Week

If you take one thing from my experience, let it be this. Decide how you get paid, and delegate that pressure point first: billing if you bill insurance, patient-facing overhead if you are cash-pay. Delegate early rather than at the point of pain, because the mistakes made while you wait are the expensive ones. Trust the specialists you bring in, or move on quickly if they do not perform, but do not spend your own high-value hours overriding them. Growth is a good problem. It only becomes a bad one when the administrative load grows faster than your willingness to hand it off.

 

Ashleigh headshotAuthor’s Bio:

Ashleigh Atuahene is co-founder of Ataraxis. Before building the company, she provided one-on-one ABA therapy under a licensed therapist and spent years in healthcare administration, handling patient intake, scheduling, prior authorization, insurance, and documentation across pediatric, internal medicine, and behavioral health practices.

 

References

American Medical Association. (2025). 2024 AMA prior authorization physician survey. American Medical Association.

Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., Westbrook, J., Tutty, M., & Blike, G. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753–760.

 

 

 

Please also review AIHCP’s Managed Health Care Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

What Is Role Based Access in Healthcare IT

Posted on by Joseph Gerard

a stethoscope is on the keyboard of a computer. allocation and organization of doctors.Written by Veronica Turner,

A nurse does not need the same system access as a pharmacist, and a billing specialist should not be able to browse a patient’s full clinical record simply because both work for the same hospital. Role based access control, or RBAC, turns that basic idea into a practical security framework.

In healthcare IT, RBAC gives people access according to their jobs and responsibilities rather than handing every authorized user the same permissions. Done well, it protects sensitive information without putting unnecessary barriers between clinicians and the data they need to care for patients.

What Is Role Based Access in Healthcare IT

Role based access control assigns system permissions to defined roles and then assigns users to those roles. Instead of configuring every employee individually, an organization might create access profiles for emergency physicians, registered nurses, pharmacists, billing staff, residents, and IT administrators.

That distinction matters in a hospital where thousands of people may interact with dozens of applications. According to HHS, the HIPAA Security Rule requires regulated organizations to authorize access to electronic protected health information when that access is appropriate for the user’s role.

RBAC gives healthcare organizations a manageable way to put that principle into everyday practice. Someone’s badge may get them through the hospital door, but their digital role determines which electronic doors open after they sign in.

Roles Should Reflect Actual Clinical Work

The difficult part is defining roles closely enough to match real workflows. Giving every physician identical permissions sounds simple, but an attending physician, radiologist, resident, and locum tenens physician may have different responsibilities.

Effective RBAC therefore starts with understanding how people actually work. Healthcare IT, security, compliance, and clinical leaders may need to collaborate so permissions support patient care rather than merely reflecting job titles on an organizational chart.

RBAC And Least Privilege Work Together

RBAC determines which permissions belong to a role, while least privilege guides how broad those permissions should be. Under least privilege, users receive the minimum access reasonably necessary to perform their responsibilities.

Consider a scheduler who needs demographic and appointment information but does not need unrestricted access to clinical notes. RBAC can create the scheduler role, while least privilege keeps unnecessary clinical permissions out of it.

A practical access design commonly considers several questions:

  • What information does this role genuinely need
  • Which systems should the role access
  • How long should those permissions remain active

Those questions become especially valuable when roles change. A nurse moving into management, for example, should not automatically retain every permission from a previous clinical assignment simply because nobody removed it.

RBAC And ABAC Solve Different Problems

Role based access is effective when permissions map cleanly to predictable jobs. Attribute based access control, or ABAC, goes further by evaluating characteristics surrounding a particular access request.

Those attributes might include department, location, device, time, patient relationship, or assignment status. A physician could have the correct professional role yet still face restrictions because the patient is outside the physician’s current care relationship.

ABAC can therefore handle context that a broad role may miss. Healthcare organizations can also combine approaches, using RBAC for baseline permissions and additional contextual controls where clinical circumstances require finer decisions.

On Call Work Creates An Important Test

Healthcare does not operate on a predictable nine-to-five schedule. An on-call physician may suddenly need records that would normally fall outside a routine assignment, while covering clinicians may temporarily assume responsibilities belonging to another team.

Access policies need a controlled method for accommodating those situations without permanently expanding someone’s permissions. Time-limited access, documented approvals, contextual rules, and audit logging can help organizations distinguish legitimate exceptions from excessive standing access.

Break Glass Controls Handle Genuine Exceptions

Sometimes normal permissions cannot anticipate an urgent clinical need. Break-glass functionality can provide exceptional access when delaying care to obtain routine authorization would be inappropriate.

The important word is exceptional. A break-glass mechanism should not become a convenient shortcut around ordinary access rules, and organizations can require users to provide a reason while recording the event for later review.

The American Medical Association has also highlighted an important nuance: HIPAA does not specifically require healthcare organizations to apply universal restrictive break-glass functionality to employee patient records. Organizations need to balance privacy controls with the possibility that unnecessarily restrictive workflows could interfere with legitimate treatment.

Audit Trails Make Exceptions Accountable

Emergency access becomes safer when it leaves a meaningful record. Security teams should be able to determine who accessed information, when access occurred, what was accessed, and whether an exception mechanism was invoked.

Review matters just as much as collection. An untouched access log offers little protection, while monitored records can help security and privacy teams identify unusual patterns and investigate questionable activity before it becomes an accepted habit.

Credential Lifecycles Matter As Much As Roles

Access control does not end when an account is created. Healthcare workforces constantly change as employees transfer departments, clinicians gain privileges, residents rotate through services, contractors finish projects, and temporary physicians complete assignments.

HHS’s Healthcare And Public Health Cybersecurity Performance Goals identify unique credentials and credential revocation among essential cybersecurity goals. For healthcare teams, that means knowing who owns each account and promptly changing access when the person’s relationship with the organization changes.

A well-managed credential lifecycle covers provisioning, modification, review, and removal. Connecting those stages to human resources, medical staff, residency, and contractor processes can reduce the chance that forgotten permissions remain available after their legitimate purpose disappears.

Password Handling Still Deserves Attention

RBAC controls what an authenticated account can reach, but it cannot compensate for careless credential handling. Shared passwords and reused credentials make individual accountability harder and can weaken otherwise thoughtful access controls.

When staff legitimately manage multiple credentials, secure storage provides a more sensible alternative to recycling memorable passwords. Bitdefender frequently appears in expert roundups of the best password manager solutions, offering an example of how unique login credentials can be securely stored and organized rather than reused.

Healthcare organizations should still follow their own approved technology, credential, and device policies. Password management supports RBAC when each account remains attributable to a specific authorized person instead of becoming an informal shared doorway into protected systems.

Rotating Residents And Locum Tenens Need Special Attention

Temporary clinical assignments expose one of RBAC’s biggest operational challenges. A locum tenens physician may require substantial privileges immediately but need them removed just as quickly when an assignment ends.

Residents create similar movement as they rotate between services and facilities. Their clinical responsibilities can change several times during training, so an access profile that was appropriate last month may be excessive during the next rotation.

Automation can help tie account changes to authoritative workforce and scheduling information, but organizations still need clear ownership. Someone must be responsible for confirming when temporary access begins, when it changes, and when it expires.

Cross Organizational Access Adds Complexity

Clinicians increasingly encounter information that crosses organizational boundaries. A 2025 scoping review of healthcare professionals’ EHR access found that cross-organizational access involves considerations including information quality, training, and trust among healthcare providers.

For the people managing access, this means a valid clinical identity alone may not answer every authorization question. The organization also needs to understand the person’s current relationship to the patient, facility, and specific care activity.

Periodic Reviews Keep Role Based Access Accurate

Even a carefully designed RBAC program becomes outdated. Departments reorganize, applications gain new features, responsibilities evolve, and users accumulate permissions as they move between positions.

Periodic access reviews give managers, system owners, security teams, and compliance staff an opportunity to ask whether current permissions still make sense. High-risk systems and privileged accounts may justify more frequent attention than low-risk tools.

Reviews should also examine the roles themselves, not only the people assigned to them. If almost everyone repeatedly needs exceptions, the underlying role may be poorly designed; if a role contains permissions nobody uses, it may be broader than necessary.

Evidence from those reviews can also support compliance and accreditation efforts. Documented approvals, removals, exception records, and review histories show that access management is an ongoing governance process rather than a policy sitting untouched in a binder.

Stronger Role Based Access Supports Safer Healthcare

Role based access works best when healthcare organizations treat it as a living system. Roles establish sensible starting permissions, least privilege limits unnecessary access, contextual controls address unusual situations, and break-glass processes provide an accountable route through genuine emergencies.

Credential lifecycle practices and periodic reviews complete the picture by keeping permissions aligned as people move through the organization. This approach makes role based access practical for complex workforces that include permanent clinicians, residents, temporary staff, contractors, and on-call teams.

For healthcare leaders reviewing their own security practices, a useful next move is to compare current permissions with the work people actually perform. AIHCP readers can explore relevant professional education and healthcare resources on the site’s service pages, then consider where their own organizations could tighten access without creating new obstacles to patient care.

Small access improvements today can prevent much larger problems tomorrow. 

Author Bio: Veronica Turner is a health and lifestyle writer with over 10 years of experience. She creates compelling content on nutrition, fitness, mental health, and overall wellness.

 

Please also review AIHCP’s Managed Health Care Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Personalized Healthcare: Why One-Size-Fits-All Treatment Approaches May Fall Short

Posted on by Joseph Gerard

Cartoon laptop with medical symbols from varying fields of medicine on it.

Written by Amanda Collins,

For most of modern medical history, treatment has been built around the average patient. Clinical trials enroll a defined population, researchers measure how that population responds to a drug or intervention, and the results become the basis for guidelines that are then applied broadly. This approach has produced enormous public health gains, but it has an inherent limitation: no single patient is actually “average.” As healthcare professionals increasingly recognize, the gap between population-level evidence and individual patient response is where a great deal of ineffective, and sometimes harmful, care originates. Personalized, or precision, medicine is the growing effort to close that gap.

The Problem with Standardized Treatment

Clinical guidelines are, by design, statistical summaries. A dosing recommendation or first-line therapy is typically the option that performed best on average across a trial population. But “best on average” can obscure enormous variation underneath. A medication that produces strong benefit in the majority of trial participants may be ineffective, or even harmful, in a meaningful minority. Genetics, metabolism, body composition, comorbid conditions, and lifestyle factors all influence how an individual actually responds to a given intervention, yet standardized protocols often cannot account for all of these variables at the point of care.

Guidelines still serve an essential purpose: they give clinicians a defensible, evidence-based starting point, and quality-of-care frameworks like those taught in health care quality management certification programs exist precisely to help systems balance consistency with outcomes. But a starting point is not a finish line, and treating it as one is where standardization tends to fail patients.

This is part of why interest in individualized health optimization has grown well beyond the prescription pad. Patients are increasingly proactive about supporting their own physiology based on their personal biomarkers and goals, whether that means requesting more detailed lab panels or exploring targeted nutritional support such as premium NMN supplements, which some patients pursue as part of a broader, individualized approach to cellular energy metabolism and healthy aging. The larger point clinicians should take from this trend is not about any one product category. It’s that patients themselves are already thinking about their care in more personalized terms than the standard treatment model typically offers.

The consequences of ignoring this variability are not trivial. In the case of pharmaceuticals, adverse drug reactions are estimated to be the fourth leading cause of death in the United States, contributing to roughly 128,000 deaths and $136 billion in costs annually, a burden larger than the total cost of cardiovascular or diabetes care.

A meaningful share of that burden traces back to treatment decisions made for the “average” patient rather than the one actually sitting in the exam room.

Why People Respond Differently

The biological basis for variable treatment response is well established. Pharmacogenomics, the study of how genetic variation affects drug metabolism, has shown that genetic factors alone can account for anywhere from 20% to 95% of the variability seen in drug response, depending on the medication and condition involved.

 Variants in genes encoding cytochrome P450 enzymes, for example, determine whether a patient metabolizes a given drug quickly, slowly, or not at all, directly affecting both efficacy and the risk of toxicity.

Genetics is only one piece of the puzzle. Body composition and age change how drugs distribute and clear from the body. Pre-existing conditions can alter organ function in ways that affect dosing safety margins. And a newer area of research, sometimes called pharmacomicrobiomics, has demonstrated that differences in gut microbiome composition can meaningfully influence drug absorption and metabolism, adding yet another layer of individual variability that standard protocols rarely capture.

Taken together, these factors explain why two patients with the same diagnosis, given the same medication at the same dose, can have entirely different outcomes.

Where This Shows Up in Practice

These effects are not theoretical: they show up across common areas of clinical care:

Antidepressant prescribing is a frequently cited example of trial-and-error medicine. In the landmark STAR*D trial, only about a third of patients achieved remission on their first antidepressant, with response rates dropping further at each subsequent treatment step.

Much of this variability is now understood to relate to genetic differences in how patients metabolize SSRIs and other psychiatric medications, which is why pharmacogenomic testing prior to prescribing is gaining traction in psychiatric practice.

Statin response varies considerably as well. Some patients achieve significant LDL reduction on a standard dose, while others see minimal benefit or experience side effects such as myopathy, often tied to genetic differences in drug transport and metabolism.

Cancer treatment has arguably moved furthest toward personalization. Tumor genomic profiling now routinely informs chemotherapy selection, allowing oncologists to match specific targeted therapies to the molecular characteristics of a patient’s tumor rather than relying solely on cancer type and stage. A related example is clopidogrel therapy in cardiovascular medicine, where genetic variation in the CYP2C19 gene means up to 30% of patients treated for acute coronary syndrome show a poor response to the standard regimen, with heritability accounting for the majority of that variability.<sup>6</sup>

Diabetes management protocols illustrate a different kind of mismatch, not pharmacogenomic, but behavioral. Standardized dietary and medication regimens frequently fail to account for a patient’s work schedule, food access, cultural food practices, or comorbid conditions, all of which affect whether a plan is actually sustainable.

What Personalized Care Looks Like Instead

Precision medicine does not mean discarding evidence-based guidelines; it means using them as a starting point rather than a final answer, then adjusting based on the individual in front of the clinician. In practice, this looks like several concrete shifts in care delivery:

  • Genetic testing before prescribing, particularly for drug classes with well-documented pharmacogenomic variability, such as certain antidepressants, antiplatelet agents, and chemotherapy drugs.
  • Biomarker-driven treatment planning, using more thorough bloodwork and diagnostic panels to guide decisions rather than defaulting to standard dosing based on age and weight alone.
  • Lifestyle-integrated care plans that account for a patient’s actual daily routine, occupation, and support system, rather than assuming a uniform capacity to follow a rigid protocol.
  • Clinician-led assessment over protocol-driven defaults, restoring the physician’s judgment as the final filter through which population-level guidelines are applied to a specific patient. This is also where case management plays an underappreciated role: professionals trained through programs like AIHCP’s case management certification are often the ones coordinating across specialists, translating biomarker-driven plans into something a patient can actually follow day to day.

This shift is also visible in the growth of specialized, condition-focused clinics that build their entire care model around individualized assessment rather than generic primary care visits. Men’s health has become a particularly active area for this kind of specialization, with dedicated practices offering in-depth hormone panels, metabolic testing, and tailored treatment plans that a standard 15-minute appointment often cannot accommodate. A patient in the Midwest, for instance, might seek out a men’s health clinic in St. Louis specifically because it offers more comprehensive, individualized diagnostic workups for concerns like low testosterone, fatigue, or metabolic changes than a general practice visit typically allows. This trend reflects a broader consumer expectation: patients want their care to be built around their specific physiology, not a generic template.

The Role of Technology

Much of what makes personalized care more feasible today than it was a decade ago comes down to technology. Direct-to-consumer and clinician-ordered genetic testing has become dramatically more affordable, making pharmacogenomic screening realistic for routine use rather than a specialty-only tool. Telehealth platforms have expanded access to specialists who can interpret complex biomarker data, particularly for patients outside major metropolitan areas. Wearable devices and continuous monitoring tools now generate real-time physiological data (glucose trends, heart rate variability, sleep architecture) that can inform treatment adjustments far more responsively than periodic office visits alone.

Electronic health records with integrated clinical decision support are also beginning to flag gene-drug interactions automatically, reducing the burden on clinicians to remember every relevant pharmacogenomic interaction. Collectively, these tools are lowering the cost and complexity of individualized assessment, moving precision medicine from a resource reserved for academic medical centers toward something achievable in routine practice.

Takeaway

Personalized medicine is not about adding complexity for its own sake, nor is it a rejection of the clinical trial evidence that underlies modern medical guidelines. It is about recognizing that guidelines describe an average patient who does not exist in any single exam room. The genetic makeup, metabolism, lifestyle, and health history of the actual person receiving care all shape how that care should be delivered. As genetic testing, biomarker panels, and digital health tools become more accessible, healthcare professionals have a growing set of tools to close the gap between population averages and individual outcomes, and an increasing responsibility to use them. The National Institutes of Health has framed this shift plainly: medicine has long relied on an expected “average” response, and precision medicine exists to correct for the patients that approach leaves behind. For healthcare professionals looking to build these principles into their own practice, resources like AIHCP’s continuing education and certification programs offer a practical next step toward more individualized, patient-centered care.

References

  1. Medical Laboratory Observer. (n.d.). The role of pharmacogenomics in precision medicine.
  2. PMC. (2024). The role of pharmacogenomics studies for precision medicine among Ethiopian patients and their clinical implications: A scoping review.
  3. IntechOpen. (2023). Pharmacogenomics – A prospective journey towards precision medicine.
  4. PMC. (2023). Drug-microbiota interactions: An emerging priority for precision medicine.
  5. Psychiatric Times / Carlat Publishing. (2024–2026). STAR*D reanalysis and antidepressant remission rate coverage.
  6. PMC. (2018). Pharmacogenomic impact of CYP2C19 variation on clopidogrel therapy in precision cardiovascular medicine.

 

About the Author

Amanda Collins is a healthcare writer and patient advocacy specialist with over a decade of experience covering clinical practice, care coordination, and health system design. Her work focuses on translating complex health policy and research into rigorous, evidence-informed content for clinical professionals. Amanda has contributed to a range of professional health publications and holds a particular interest in neurodevelopmental intervention, chronic disease management, and the structural determinants of healthcare quality.

 

 

Please also review AIHCP’s Managed Health Care Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

How Extreme Heat Is Changing Patient Care for Older Adults

Posted on by Joseph Gerard

Meeting the needs of all populations.

Written by Lucy Peters

Every summer breaks new temperature records. The periods of extreme heat that used to occur only rarely have become normal and are increasingly long and frequent. For the healthcare system, the unusual environmental phenomenon has long since become a serious clinical issue in dealing with older people. Heat-related illness is becoming a common clinical issue as the climate continues to heat up. However, heat does not just cause dehydration. In fact, it can worsen existing disease, interact with medicines and even cause transient cognitive impairment or alter mental status in otherwise stable patients.

Why Heat Has Become a Growing Healthcare Concern

Global average temperature is still rising and abnormal weather such as longer lasting and stronger heat waves keeps occurring all over the world. In addition, the temperature in cities is getting higher. This is because city surfaces, roads and buildings made of concrete and asphalt retain heat throughout the day, and create what researchers describe as the urban heat island effect.

Extremes of heat are becoming a predictable seasonal challenge for health care systems. Besides placing increased pressures on hospital and emergency department services and other health care services and programs in the community, a very large proportion of younger and middle aged people are admitted due to the effects of heat. However, older adults account for a disproportionate number of heat-related admissions, and the reasons extend far beyond spending too much time outdoors. The reality is that aging changes how the body responds to heat in ways that many people never consider.

Ageing Changes the Body’s Response to Heat

Keeping your internal temperature at a constant level is very important. Your body has a natural defense in the form of the cardiovascular system, kidneys, nervous system and your skin. As we age, the protective functions are weakened. Less sweat is produced by your sweat glands, which means that evaporation cannot take place to cool down your body. Blood vessels respond more slowly, which limits the body’s ability to move heat from its core to the skin where it can dissipate. Cardiac reserve also declines with age, reducing how effectively the heart can increase circulation during periods of thermal stress.

A reduced sense of thirst can also affect older people. Consequently, they can become seriously dehydrated before feeling thirsty and experiencing its effects. These natural changes of aging and the uncomfortable conditions of extreme weather can quickly create problems for older people such as dehydration, and imbalanced supply of electrolytes. So what causes mild discomfort for a fit, young person could cause a problem like heat exhaustion for someone over 75 years of age.

Chronic Illnesses Multiply the Risks

Most older adults are managing at least one long-term health condition, while many live with several. During periods of extreme heat, these conditions can become considerably harder to control. Heart failure provides a clear example. As temperature rises, blood vessels dilate to release excess heat. This normal cooling response causes blood pressure to drop. The heart of failing patients therefore, tries to compensate for decreased blood pressure by increasing work to attempt to maintain circulation. Since the failing heart is already working suboptimally, an increase in its work can lead to a decline in clinical status and even to hospitalization.

People with kidney disease also need consideration. Their kidneys rely on a constant supply of blood to be able to clear waste products from the body. In the dehydrated patient with kidney disease, the blood supply to the kidneys can rapidly drop, which can lead to a sudden decline in kidney function and may result in a patient developing acute kidney injury even after relatively modest fluid loss.

People with diabetes have additional issues to contend with in heatwaves. The higher temperature can cause the insulin in a diabetic patient to be absorbed more quickly into the body, leading to a risk of a hypoglycemic attack. In addition, they are at risk of fluctuations in blood glucose levels due to dehydration. Therefore, diabetes management becomes far more complex during a prolonged heatwave.

The problems of respiratory disease can also increase in extreme heat. The hot stagnant air can be very loaded with pollutants and with ozone which can irritate the inflamed airways of people suffering from respiratory disease such as asthma or chronic obstructive pulmonary disease. Combined, they explain why extreme heat can destabilize patients whose health had previously been well managed.

Medications Can Increase Heat Vulnerability

As we’ve discussed, the conditions themselves are causing enough issues, but many of the typical medications for older adults also affect the body’s ability to regulate in the heat. Diuretics for example cause increased fluid loss thus increasing the chance of dehydration in hot, long periods of time. Other blood pressure medications (e.g. ACE and angiotensin receptor blockers) may contribute to declining kidney function when dehydration develops. Beta blockers reduce the heart’s ability to increase its rate in response to heat stress, limiting one of the body’s natural cooling mechanisms.

Certain types of antidepressants and antipsychotics have anticholinergic effects, and can cause people to stop sweating with severe consequences in hot weather. Because older people are often on medications for long-term health conditions, the risk of severe heat-related illness becomes even higher. But the good news here is that medication reviews help patients before the warm months and also during the warm months. These reviews become even more valuable when the weather gets hotter, and this is especially true for patients who manage several chronic illnesses.

Practical Steps Healthcare Professionals Can Take

Prevention of heat related illness starts well before temperatures reach dangerous levels. Use of routine medical appointments to discuss patients’ hydration and to review their medications for potential effects of heat is important. By asking questions such as whether the patient lives alone, whether they have air conditioning and can easily leave their home during a heatwave may reveal risks that would otherwise remain hidden.

Strategies to cool down the body are important to reduce the body load. Air conditioning is especially effective, as it not only cools down but also reduces the humidity. This way the body can lose heat by evaporation, which is the most beneficial and effective for people of any age. It’s also important to mention that even spending a few hours each day in a cool environment can significantly reduce the risk of heat-related illness for vulnerable older adults.

In addition to early warning signs of severe heat illness, such as dizziness, unusual fatigue, muscle cramps, confusion, headaches and reduced urine output, patients should be encouraged to monitor for these early signs of heat illness. Patients during periods of extreme heat can also benefit from cooling centers, from welfare checks and home support services during prolonged periods of extreme heat. Home safety should also be part of these conversations. Portable air conditioners, ceiling fans and other cooling devices can only be effective if the home’s electrical system can safely support them. This means a property could have old wiring or too many appliances on for too long a time, potentially resulting in an electrical fault. Where upgrades or repairs are needed, families can use local trusted directories to search for qualified electricians to complete the work. Also, family caregivers need education as well. Many people think that offering a drink now and then is enough, but older adults often need frequent reminders to drink water before they feel thirsty.

Heat Will Continue to Shape Future Patient Care

Heat is becoming a regular feature of clinical practice, affecting people with cardiovascular disease, kidney disease, diabetes, respiratory illness and cognitive decline. To address heat, healthcare needs to think differently about it, because dehydration is no longer considered a seasonal health problem but a clinical risk factor that affects health in every dimension for older people. Early education, proactive medication reviews, environmental assessments and coordinated community support can all prevent serious illness and its consequences before they occur.

Author bio

Lucy is a freelance writer who enjoys contributing to a range of publications, both in print and online. She spent almost a decade working in the care sector with vulnerable people before taking a step back to start a family and now focuses on her first love of writing.

 

 

Please also review AIHCP’s Health Care leadership Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Healthcare Standards for Managing Severe Transit Injuries

Posted on by Joseph Gerard

Scene of a car accidentWritten by Sarah Mitchell,

Real standards for treating severe transit trauma aren’t tested in textbooks. They’re tested in the first ninety seconds after a patient rolls through the trauma bay doors, vitals crashing, and someone has to make a call. This piece walks through what actual protocol adherence looks like at the bedside — where it saves a life, and where a shortcut quietly costs one.

The First Ten Minutes After Impact

Multi-vehicle collisions rarely produce a single, obvious injury. A patient arrives tachycardic, mildly confused, complaining about rib pain and the temptation is to chase the loudest symptom first. That’s exactly where a rigid primary survey protocol earns its keep.

Take a real-world pattern seen in Level II trauma centers across the Southwest: a 34-year-old rideshare passenger, GCS 14, ambulatory at the scene, insists she’s “just bruised.” Standard ATLS sequencing — airway, breathing, circulation, disability, exposure — catches a slowly expanding subdural hematoma that her normal-sounding speech was masking. Meanwhile, a FAST exam picks up free fluid suggesting a splenic laceration nobody would’ve guessed from her calm demeanor. Without the standardized secondary survey and mandatory repeat neuro checks at fifteen-minute intervals, that combination gets missed until she’s crashing in radiology. That’s the whole argument for protocol over instinct: instinct reads calm patients as stable patients, and sometimes it’s dead wrong.

There’s also a financial reality tangled up in all this clinical decision-making, and it’s worth naming plainly. CT panels, serial imaging, extended observation beds — none of it is cheap, and insurance disputes over “medical necessity” for multi-system trauma workups are common. When accident victims in California have a Palm Springs bus accident lawyer sorting out liability coverage and claims early, hospitals face fewer reimbursement fights down the line, which means clinicians aren’t quietly pressured to trim the workup to what a payer will pre-approve. That breathing room matters more than most administrators admit out loud.

What the Primary Survey Actually Catches

  • Tension pneumothorax masked by adrenaline-driven normal-seeming vitals
  • Pelvic fractures with retroperitoneal bleeding that don’t show external bruising for hours
  • Cervical spine instability in patients who are talking, walking, and insisting they’re “fine”
  • Compartment syndrome developing silently under a splint applied too early in the workflow

Where Standards Meet the Real Floor

Here’s the thing about protocols — they’re written for the chart, but they live or die in how two departments talk to each other at 3 a.m.

Surgery and Neuro Aren’t Always on the Same Page

Picture a 52-year-old motorcyclist with a femur fracture requiring fixation and a small subdural bleed that neurosurgery wants to observe rather than evacuate. Ortho wants him in the OR within six hours per fracture-fixation timing standards. Neuro wants forty-eight hours of stable imaging before clearing him for anesthesia. Without a documented, jointly-signed care plan — not just a verbal hallway agreement — one team ends up operating on outdated information. Best practice at high-functioning trauma centers is a shared progress note, updated by both services, with explicit sign-off thresholds written in: “Cleared for OR if repeat CT at 0600 shows no bleed progression.” That single line in the EHR prevents a scheduling conflict from becoming a malpractice exposure.

The Paperwork Problem Nobody Wants to Talk About

A missed repeat neuro check doesn’t just risk a bad outcome clinically — it creates a documentation gap that insurers exploit ruthlessly. Consider a patient discharged after a rear-end collision with a diagnosis of “mild TBI, resolved.” Three weeks later she’s back with post-concussive symptoms and cognitive deficits. If the chart shows only one neuro exam at admission and nothing at the mandated four-hour and eight-hour marks, the payer can — and often will — argue the deterioration is unrelated to the original accident. That’s not a hypothetical. It’s a recurring reason for denied coverage on delayed-complication claims. The fix isn’t complicated: nursing staff need a hard-stop alert in the EHR that won’t let a shift close out until reassessment vitals are logged. Boring? Sure. But it’s the difference between a covered claim and a six-month appeal process.

Pain Control, Rehab, and the Handoff Nobody Likes

Standardized pain protocols get criticized for being too rigid, but the good ones build in room for judgment.

Case in point — an elderly pedestrian struck by a vehicle, multiple rib fractures, on a standard opioid-sparing multimodal regimen. Her pain scores stay high because standing orders don’t account for her mild renal impairment limiting NSAID dosing. A pharmacist-led med reconciliation catches it on day two, swaps in a regional nerve block instead. Pain drops, she’s out of bed and doing incentive spirometry within hours, which matters enormously for rib-fracture patients since immobility is what kills them via pneumonia, not the fractures themselves.

Rehab Starts Before Most People Think It Should

  • Bedside range-of-motion exercises begin within 24-48 hours for stable patients, even those still on monitors
  • Occupational therapy evaluates ADLs before discharge planning even starts, not after
  • Home-care coordination happens in parallel with acute treatment, not as an afterthought tacked on at discharge
  • Family training on wound care and mobility aids is scheduled as its own appointment, not squeezed into a five-minute hallway conversation

The Handoff Gap

Transferring a patient from trauma surgery to rehab medicine is where continuity often quietly breaks. A patient stabilized after a severe pelvic fracture gets handed to a rehab team that receives a summary note but not the granular pain-response history that guided dosing decisions for two weeks. Result? The rehab team restarts trial-and-error pain management, the patient regresses, and family members lose confidence in the process. Structured handoff templates — not free-text notes, but standardized fields covering pain response, mobility status, and psychosocial flags — close that gap. Makes sense, right? The information already exists; it just needs a format that survives the transfer.

What This Means for Frontline Teams

None of this is about adding more paperwork for its own sake. It’s about making sure the protocol that exists on paper actually shapes what happens in the room — because the patients who do best after severe transit trauma aren’t the ones treated by the most brilliant individual clinician. They’re the ones treated by a team that followed the same standard, consistently, from the ambulance bay through the last outpatient rehab appointment.

 

Author Bio: Sarah Mitchell is a seasoned law copywriter with 10 years of experience in personal injury law and healthcare-related legal content. She specializes in transforming complex legal and medical concepts into clear, practical guidance that helps readers understand their rights, navigate the claims process, and make informed decisions after an injury. 

 

 

Please also review AIHCP’s Managed Health Care Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

How Small Clinics Streamline Vendor Payments

Posted on by Joseph Gerard

Please also review AIHCP's Healthcare Case Management Certification and see if it meets your academic and professional goals

Written by Sarah Jenkins,

In the intensity of small clinic operations, it’s typical to see focus placed on providing the best outcome for service users, which inevitably means making compromises in other areas due to a lack of adequate people power. Such a strategy might make sense from moment to moment, but the big-picture perspective provides clear evidence that if important pieces of admin are sidelined, the knock-on effects can be catastrophic. Imperfect vendor payment management is a prime example, as missteps here can leave dents in your medical supplies and even have a deleterious impact on facility upkeep.

All of this sounds daunting. But the reality is that making the most of modern tools and tactics can iron out all manner of issues with paying vendors promptly.

If you’re still on the fence about whether it’s actually necessary to take action, consider the fact that processing an automated invoice takes 3.3 days, compared to 2 weeks for manual systems, according to the CAQH Index Report. Such a dramatic reduction in time, as well as the shift away from manual processes which would otherwise monopolize the working day of at least one team member, allows office managers to focus on patient coordination rather than tracking down lost paper trails or managing disgruntled contractors waiting on late payments.

Building The Foundation Of A Reliable Intake System

The efficiency of a vendor payment workflow is like medical billing, in that it’s determined early on, long before a check is cut or an ACH transfer is initiated. It begins during the vendor onboarding phase, where legal and financial expectations are set. Many clinics fail because they treat onboarding as an afterthought, leading to frantic requests for W-9 forms during tax season or payment delays when insurance certificates expire.

Standardizing the intake process ensures that every service provider, whether they are a recurring medical waste disposal company or a one-time flooring contractor, meets the clinic’s compliance standards. Collecting a Form W-9 before the first invoice is processed is a non-negotiable step that prevents backup withholding penalties from the IRS. Without this document, the clinic remains at risk for significant fines during an audit.

For specialized facility repairs, such as HVAC or plumbing, the documentation becomes even more granular. Administrators need to verify that contractors carry the appropriate liability insurance and workers’ compensation coverage to protect the practice from litigation. A centralized digital repository for these documents ensures that payments are never issued to non-compliant vendors, creating a natural gatekeeper for the clinic’s funds.

Small clinics often find success by adopting digital tools that mimic the transparency found in professional service industries. When a clinic works with tradespeople, they often encounter a contractor estimate app like Joist which provides clear, professional breakdowns of labor and materials. This level of detail helps administrators understand exactly what they are paying for, allowing for faster internal approvals and reducing the back-and-forth communication that typically slows down the accounts payable cycle.

Establishing clear communication regarding payment terms is the final piece of the intake puzzle. Most vendors default to Net 30 terms, but clinics can often negotiate better rates or prioritized service by offering shorter windows, such as Net 15, in exchange for a small early payment discount.

Streamlining Approval Tiers And Purchase Orders

Once a vendor is onboarded, daily invoice management requires a structured hierarchy to prevent unauthorized spending and ensure accuracy. The use of Purchase Orders (POs) is a gold standard in healthcare because it creates a pre-approved spending limit for specific services. When an invoice arrives, it is matched against the PO and the packing slip, a process known as three-way matching.

Approval tiers add a necessary layer of security, especially in clinics with multiple departments or locations. For example, a department head might have the authority to approve medical supply orders up to $500, while any facility repair exceeding $2,000 might require the signature of the practice manager or the physician-owner. This prevents “maverick spending” and ensures that the clinic stays within its monthly operational budget.

To maintain a smooth workflow, clinics should follow these specific steps:

  • Digital capture of all incoming invoices through a dedicated email address
  • Automatic routing to the designated department head for initial verification
  • Final authorization by the practice manager before the payment is queued

Moving away from physical sign-offs is essential for clinics that want to remain agile. Paper-based approvals are notorious for getting buried under patient charts or lost in inter-office mail. A digital approval workflow provides a time-stamped audit trail that shows exactly who approved a payment and when, which is invaluable during year-end financial reviews.

Emergency repairs often bypass the standard PO process, leading to chaos in the general ledger. To mitigate this, clinics should establish “emergency spending caps” for trusted vendors. If an HVAC unit fails during a summer heatwave, the facility manager should have pre-authorized approval to approve the repair up to a certain dollar amount without waiting for a board meeting.

Transitioning To Secure Digital Payment Methods

The final stage of the workflow is the actual disbursement of funds. While paper checks were once the backbone of small business commerce, they are increasingly viewed as a liability in 2026. Data shows that paper checks remain the primary target for fraud, accounting for 63% of payment security breaches.

ACH transfers and virtual cards have emerged as the superior alternatives for small clinics. ACH is cost-effective and integrates directly with most accounting platforms, reducing the manual labor required for reconciliation.

Virtual cards go a step further by offering “single-use” credit card numbers for specific transactions. This is particularly useful for one-time vendors or emergency contractors, as it allows the clinic to set a strict limit on the card that expires immediately after use.

Virtual cards also provide automated reconciliation. Because each card is tied to a specific vendor or project, the accounting software can automatically categorize the expense, saving the bookkeeper hours of manual data entry. This level of precision ensures that the clinic’s financial statements are always up to date and accurate.

Managing change orders in construction or facility maintenance is another area where digital payments shine. When a roofing contractor discovers unforeseen damage during a repair, the budget can shift instantly. Having a digital system that allows immediate adjustment of a virtual card limit or rapid approval of a revised estimate prevents project delays and keeps the vendor-client relationship healthy.

Ensuring Audit Ready Records And Compliance

The ultimate goal of a streamlined vendor payment process is to produce records that can withstand the scrutiny of an audit. Whether it is a routine tax audit or a more rigorous healthcare compliance review, the clinic must be able to prove that every dollar spent was authorized, documented, and paid to a legitimate entity.

A centralized document management system links the original estimate, the approved PO, the final invoice, and the payment confirmation. This “golden thread” of information prevents double payments or fraudulent invoices from slipping through the cracks. In a high-stakes environment like healthcare, this transparency is the best defense against financial mismanagement.

Standardizing these processes also simplifies the transition in the event of turnover among administrative staff. When the workflow is documented and digital, a new office manager can quickly understand the status of every pending invoice without having to dig through filing cabinets. It creates institutional knowledge that protects the clinic’s operational continuity.

For more insights on optimizing the administrative side of your healthcare practice, we recommend exploring our internal blog resources on medical billing efficiency and practice management strategies.

Integrating Service Professionals For Smooth Facility Management

Facility maintenance often presents the most volatile variable in a clinic’s budget due to the unpredictable nature of structural repairs. The majority of plumbing calls qualify as emergency dispatches, meaning a clinic’s payment workflow must be agile enough to handle immediate billing without compromising oversight. When a pipe bursts or the HVAC fails, the administrative team cannot afford to spend three days debating internal approvals while the lobby floods.

Modern medical administrators are increasingly looking toward the service industry for cues on how to handle these rapid-fire transactions. Many elite tradespeople provide transparent, line-item quotes that can be approved via a smartphone in seconds. By demanding this level of professional digital documentation from your HVAC or electrical partners, you eliminate the guesswork from facility overhead.

The goal is to create a symbiotic relationship in which the vendor is paid instantly for their expertise, and the clinic retains a clean, audit-ready record of the work performed. This prevents the common trap of verbal agreements that lead to billing disputes six months later during a financial review. A structured payment path for these external pros ensures the physical environment remains as healthy as the patients being treated inside it.

Modernizing The Clinical Back Office

Implementing these changes requires an initial investment of time and a shift in mindset, but the long-term rewards are undeniable. By moving toward a digital-first approach to vendor payments, small clinics can reduce their overhead costs, strengthen their relationships with essential service providers, and protect themselves from the growing threat of financial fraud.

The transition from manual chaos to automated precision allows the clinic’s leadership to focus on what matters most: providing exceptional patient care. When the lights stay on, the supplies are stocked, and the contractors are paid on time, the entire ecosystem functions at its highest potential.

Author Biography

Sarah Jenkins, MHA

Sarah is a veteran practice management consultant with over 15 years of experience helping small and mid-sized healthcare facilities optimize their operational workflows. She holds a Master of Health Administration and is a certified Healthcare Financial Professional. Sarah specializes in the intersection of clinical excellence and administrative efficiency, focusing on how digital transformation can reduce burnout in the medical office.

 

References

Internal Revenue Service. (2025). About Form W-9, Request for Taxpayer Identification Number and Certification. https://www.irs.gov/forms-pubs/about-form-w-9

AFP. (2025). 2025 AFP Payments Fraud and Control Survey. https://www.financialprofessionals.org/training-resources/resources/articles/Details/companies-stick-with-check-payments-despite-fraud-risk

CAQH. (2025). The 2025 CAQH Index 

https://www.caqh.org/insights/index-report

 

 

 

Please also review AIHCP’s Health Care Leadership Certification program and CE courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Hospital Consumables and Clinical Outcomes: What Procurement Choices Mean at the Bedside

Posted on by Joseph Gerard

Doctors wearing gloves giving a thumbs upWritten by Kelton Lewis & editorial team at MAP Medical,

Gloves, IV bags, and administration sets sit in every supply room, but their specifications shape infection rates, medication errors, and nurse workload in ways that purchase orders rarely reflect. Barrier failures, incompatible tubing, and inconsistent sizing show up first at the bedside, not in procurement dashboards. Facilities that source wholesale hospital supplies from distributors with documented quality controls give clinical teams something most contracting conversations overlook: consistency from one lot to the next.

Supply variation is not neutral. When a unit’s glove brand changes mid-week, nurses relearn tactile feedback, donning friction shifts, and occupational allergen profiles can move. When IV sets change manufacturers, Y-site port spacing, roller-clamp resistance, and drop factors may differ in ways that raise the cognitive load of high-acuity care. These small mismatches accumulate, which is precisely why value analysis committees staffed by clinicians, rather than contracting staff alone, should drive catalog decisions.

Gloves are the highest-volume consumable in any healthcare facility and a useful case study for these decisions. When a nurse or infection preventionist evaluates medical supplies gloves for formulary inclusion, four characteristics matter more than unit price: barrier integrity under use conditions, allergen profile, chemical resistance for expected tasks, and donning ergonomics. The regulatory baseline for these products is also specific enough to shape contract language.

The regulatory floor for medical gloves

Medical gloves function as primary barriers under OSHA’s Bloodborne Pathogens Standard, 29 CFR 1910.1030, which requires employers to provide appropriate PPE wherever occupational exposure to blood or other potentially infectious materials is reasonably anticipated (Occupational Safety and Health Administration, 1991). Every medical glove sold in the United States is a Class I reserved medical device that requires 510(k) premarket notification. Under 21 CFR 800.20, the Food and Drug Administration applies a minimum acceptable quality level (AQL) of 1.5 to surgical gloves and 2.5 to patient examination gloves, using the ISO 2859 sampling plan and a water-leak test method (U.S. Food and Drug Administration, 2024). A 2.5 AQL means that, statistically, up to 2.5 percent of gloves in a batch may contain pinhole defects and still pass inspection. Many health systems now specify 1.5 or lower for all exam gloves, particularly in oncology, emergency, and critical care units, where barrier reliability is non-negotiable.

Since January 18, 2017, powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon’s glove have been banned under the FDA’s final rule published at 81 FR 91722. The agency found these products to present an unreasonable and substantial risk of severe airway inflammation, hypersensitivity, and peritoneal adhesions, and determined that labeling changes could not mitigate these risks (U.S. Food and Drug Administration, 2016). Procurement specifications should still explicitly require powder-free product, because the ban does not apply to powdered radiographic protection gloves, and cross-border sourcing of non-compliant stock remains a risk.

Material selection in practice

Nitrile

Nitrile has become the clinical default for non-surgical use across most U.S. health systems. It is latex-free, has strong puncture resistance, and performs reliably against common disinfectants. For oncology and pharmacy personnel handling antineoplastic agents, United States Pharmacopeia General Chapter 800 requires gloves tested under ASTM D6978 for chemotherapy drug permeation, along with double-gloving during compounding and administration (United States Pharmacopeial Convention, 2019). Facilities should stock these chemotherapy-rated gloves as a separate line item from standard exam inventory, and pair them with compliant gowns and engineering controls.

Latex

Natural rubber latex still offers the most refined tactile feedback, which is why many surgeons continue to prefer it for procedures that require fine motor control. Its drawback is well documented: occupational IgE-mediated sensitization in healthcare workers, with reported worldwide prevalence averaging around 9.7 percent and rising higher in populations with intense latex exposure prior to the shift toward powder-free and synthetic alternatives (Wu et al., 2016). Facilities that stock latex for surgery should maintain synthetic alternatives for latex-sensitive staff and patients, and a latex-safe protocol for known allergies.

Vinyl

Vinyl gloves are suitable for brief, low-risk tasks such as environmental services, food handling, and certain non-sterile support functions. They are a poor choice for sustained patient contact, venipuncture, or any scenario where barrier integrity must hold under stretch.

IV administration sets and medication safety

Infusion-related errors remain among the most frequent preventable harms in acute care. The 2024 INS Infusion Therapy Standards of Practice, now in its ninth edition and published as a supplement to the Journal of Infusion Nursing, establishes evidence-based expectations for device selection, care, and evaluation across the infusion pathway (Nickel et al., 2024). Several design elements deserve specific attention during procurement.

Free-flow protection

An administration set without integrated anti-free-flow protection can deliver an uncontrolled gravity bolus when tubing is removed from a pump. Free-flow protection should be a baseline specification for any set used with electronic infusion devices, and the clinical team should confirm that the mechanism engages automatically, rather than requiring a separate step by staff.

DEHP-plasticized tubing

Di(2-ethylhexyl) phthalate is a plasticizer historically used in PVC tubing. It can leach from tubing into infusates, with leaching rates highest in lipid-containing solutions. In its 2002 public health notification, the FDA identified male neonates, pregnant women carrying male fetuses, and peripubertal males as populations of concern, particularly during total parenteral nutrition, ECMO, and multi-device procedures in the NICU (U.S. Food and Drug Administration, 2002). DEHP-free tubing is now standard in NICU, PICU, and oncology settings in most U.S. health systems, and should be specified explicitly in purchase contracts for those units.

Drop-factor standardization

Macro-drip sets (typically 10, 15, or 20 gtt/mL) and micro-drip sets (60 gtt/mL) serve different clinical purposes. Mixing drop factors on a single unit invites calculation errors when staff revert to manual rate verification during pump downtime. Facility-wide standardization, supported by written policy and clear labeling, reduces this risk.

Supply chain resilience after 2020

The COVID-19 pandemic exposed the fragility of single-source consumable procurement. Glove shortages, IV fluid allocations, and PPE rationing forced many U.S. hospitals to rebuild sourcing strategies. Dual-source agreements, real-time PAR-level dashboards, and formal substitutability testing for backup SKUs have become the new baseline. Nurses, who see empty bins before they appear in a report, are the most reliable early signal in this process and should be invited into sourcing reviews rather than informed of their outcomes.

The clinical voice in value analysis

Clinical staff surface evidence that contract bids cannot: tear rates on 12-hour shifts, skin reactions that emerge over weeks, tubing kinks in crowded corridors, pump alarms that correlate with a specific set design. Formalizing nurse participation on value analysis committees consistently produces better formulary decisions and stronger staff engagement with supply protocols. The financial case is also direct: a product that reduces one medication error or one catheter-related bloodstream infection pays for significant price differences many times over.

Choosing a wholesale partner

A supplier’s role is not limited to fulfillment. Clinical teams benefit from partners that can produce FDA 510(k) documentation, ASTM test reports, and lot-level quality data on request. MAP Medical is a distributor of medical products for clinics, hospitals, and surgical centers, carrying gloves, IV bags, IV sets, and other daily consumables supplied under the quality standards outlined here.

About the authors

This article was prepared by the editorial team at MAP Medical, a U.S. distributor of medical consumables to clinics, hospitals, and surgical centers, together with Kelton Lewis, Managing Manager. The team draws on direct experience supporting procurement, infection prevention, and nursing leadership across acute-care facilities.

References

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., Ong, J., Clare, S., & Hagle, M. E. (2024). Infusion therapy standards of practice (9th ed.). Journal of Infusion Nursing, 47(1S Suppl. 1), S1-S285.

Occupational Safety and Health Administration. (1991). Bloodborne pathogens standard, 29 CFR 1910.1030. U.S. Department of Labor.

United States Pharmacopeial Convention. (2019). USP general chapter <800>: Hazardous drugs-handling in healthcare settings. USP Compounding Compendium.

U.S. Food and Drug Administration. (2002). Public health notification: PVC devices containing the plasticizer DEHP. Center for Devices and Radiological Health.

U.S. Food and Drug Administration. (2016). Banned devices: powdered surgeon’s gloves, powdered patient examination gloves, and absorbable powder for lubricating a surgeon’s glove. Federal Register, 81(243), 91722-91731.

U.S. Food and Drug Administration. (2024). Patient examination gloves and surgeons’ gloves; sample plans and test method for leakage defects; adulteration, 21 CFR 800.20. Code of Federal Regulations.

Wu, M., McIntosh, J., & Liu, J. (2016). Current prevalence rate of latex allergy: Why it remains a problem? Journal of Occupational Health, 58(2), 138-144.

 

Please also review AIHCP’s Health Care Management Certification program and CE Courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

The Importance of Pre-Authorization in Preventing Denials

Posted on by Joseph Gerard

Medical Coding Bill And Billing Codes SpreadsheetsWritten by James Eric

Healthcare revenue is not only dependent on the quality of care delivered to the patients. It also relies on how well your billing process supports that care. One weak link in the medical billing process can disrupt the entire cycle. One of those critical links within the medical billing workflow is the prior authorization, a step that providers manage internally or with the support of a medical billing company to ensure accuracy, compliance and timely approvals. While many providers still treat it as a routine task, in reality, it plays a strategic role in denial prevention. When handled well, you can spot the importance of pre-authorization becoming fruitful for your revenue outcomes. It protects your revenue and builds payer trust. When ignored, it leads to denials and revenue delays, losses that could have been easily avoided.

Let’s break down the real role of pre-authorization and how it shapes a stronger billing workflow.

Prior Authorization in the Medical Billing Process

The prior authorization in medical billing is executed before the healthcare service is delivered. It is the step that makes sure that the insurance provider agrees to the coverage in the patient’s plan. This approval is the key that aligns all the stakeholders: the patient, the practice, and the insurance company, on the medical coverage.

The Right Prior Authorization Workflow

The prior authorization process is the step conducted between patient scheduling and service delivery. It acts as a checkpoint before costs are incurred. A typical workflow for the execution of the pre-authorization includes:

  • Eligibility verification
    The team checks if the patient’s insurance is active and valid.
  • Clinical documentation submission
    Providers send medical records, diagnosis codes, and treatment given.
  • Payer review and approval
    The insurance company evaluates medical necessity.
  • Authorization tracking
    Staff track approval status and ensure validity dates align with service delivery.
  • Final confirmation before service
    The provider proceeds only after approval.

Each step demands accuracy and timing. Even a small gap can lead to denial.

Why It Matters Early

Pre-authorization sets the tone for the entire revenue cycle. It reduces uncertainty before care begins, ensuring that the medical necessity of the services is recognized by the payer. Without the timely pre-authorization, the practice will transition into a reactive approach. The time and resources wasted on the denial handling hit back at your revenue.

Medical Billing and The Importance of Pre-Authorization

The importance of pre-authorization becomes clear when you look at denial patterns. A large portion of denials comes from missing or incorrect authorizations.

Direct Impact on Claim Approval

Insurance payers expect strict compliance with authorization rules. If a service requires approval and the provider skips it, the claim faces high denial risk. It is a mandatory step, and the absence of it could directly lead to the claim denial. Due to the unverified medical necessity, the payer is unable to approve the payment.

Streamlined Cash Flow

Denied claims delay the rightful payments for a practice while also increasing the need for rework by the billing teams. Pre-authorization reduces this friction. With a strong prior authorization management system, providers:

  • Improve first-pass claim acceptance
  • Reduce accounts receivable days
  • Lower administrative overhead

This way, the practices can target improved revenue outcomes and a faster payment release.

Billing Transparency and Patient Satisfaction

The common belief among the patients is that their insurance will cover their healthcare. When authorization fails, they receive unexpected bills. Pre-authorization helps avoid these situations. It gives patients clarity about coverage before treatment. This builds trust and reduces disputes.

Regulatory Risks and Compliance

Payers conduct audits to check for compliance. In the case of a lack of authorization, it can lead to an audit or a penalty. A prior authorization workflow has several advantages, including the assurance that there is adequate documentation to protect revenue as well as reputation.

Results of Inefficient Pre-Authorization Management

When a healthcare reorganization lacks the proper management of the prior authorization requirements, it drastically affects its revenue. It decreases the staff’s efficiency, the billing workload increases, and the patient satisfaction goes down the drain.

Higher Denial Rates

The most immediate effect of inefficient prior authorization in medical billing will be a rise in denial rates. This will be due to a lack of approval, authorizations that have expired, and incorrect codes being used. Your billing team will be required to rework a claim from denial to an accurate one and then send it out for submission. It slows down the entire revenue cycle.

A Draining Revenue Cycle

Not all denied claims are eligible to be recovered. Some will be lost in the system due to a lack of time or resources. This will lead to a leakage in revenue. This leakage adds up to a huge revenue loss when calculated annually.

Administrative Workload

Manual processes are often inefficient. They require a lot of time to monitor approvals, make phone calls to payers, and correct mistakes. This leads to low productivity and high employee burnout. Manual processes also increase operational costs.

Delayed Patient Care

If authorizations are not obtained in a timely fashion, this will lead to delays in patient care. This delay affects patient satisfaction, and with the rescheduling required, it drains their trust in your practice.

Poor Data Tracking

However, without a proper prior authorization processing in place, it becomes challenging to track and monitor this process. It becomes harder to check into the approved, pending, and denied claims, optimize the revenue, and identify trends.

Target Improvements with Prior Authorization Best Practices

Improving pre-authorization does not have to be a transition for the whole process to have a significant impact. Best practices for a well-implemented prior authorization workflow include accuracy, speed, and accountability.

1. Standardize the Process

Practicing the process as a prerequisite develops consistency. Standardize the processing protocols for each step of the prior authorization workflow.

  • Define the required documents for each service
  • Use checklists to avoid missing details
  • Align coding with payer requirements

Standardization ensures every request meets payer expectations.

2. Integrate Technology for Automation

Manual operations delay the billing execution, while automated processing improves speed and accuracy. Use tools that:

  • Verify eligibility in real time
  • Auto-populate patient and provider data
  • Track authorization status

Utilizing advanced technology ensures prior authorization improvement while reducing errors and speeding up execution.

3. Staff Training for Compliance Standards

Each payer has different requirements. Staff must understand these variations.

Regular training helps teams:

  • Submit accurate requests
  • Avoid common denial triggers
  • Handle complex cases with confidence

Knowledge-driven teams perform better and reduce rework.

4. Improve Inter-Departmental Communication

The prior authorization execution involves different parties, including the front desk staff, the physicians, and the billing team. A minor error from one of these and the claim becomes erroneous. Create a connected workflow where:

  • Scheduling teams flag authorization needs early
  • Clinicians provide complete documentation
  • Billing teams verify approvals before claim submission

This alignment improves the entire prior authorization in revenue cycle management for your practice.

5. Monitor Key Performance Metrics

Tracking performance helps identify gaps. Focus on metrics such as:

  • Authorization turnaround time
  • Approval rates
  • Denials linked to authorization issues

Regular monitoring supports continuous improvement.

6. Authorize Ahead of the Patient’s Appointment

Waiting till the last moment to get the pre-authorization is not a wise idea. Make sure that you attain the authorization as soon as the patient sets the appointment. A proactive timing helps through:

  • Reduced delays
  • Improved approval rates
  • Ensured smoother patient flow

This approach reflects strong prior authorization best practices.

7. Highest Documentation Accuracy

Inaccurate or incomplete documentation has the highest ratio of causing claim denials. To combat this, ensure that your clinical documentation is practiced with the greatest accuracy levels. Clear documentation increases your first-pass claims rate. Verify the accuracy standards by checking for certain details in the documentation:

  • Accurate Diagnosis codes
  • The treatment plan
  • Physician’s notes

8. Dedicated Prior Authorization Team

A specialized team plays a key role in improving billing efficiency. A focused team handles authorization tasks with greater accuracy with the help of their regulatory understanding and expertise. An improved pre-authorization reduces delays in the payment and improves the billing outcomes.

9. Real-Time Claim Status Tracking

Not knowing the claim status may cause delayed reactions from your billing team. With the help of timely tracking and follow-up for the submitted claims helps:

  • Identify pending requests
  • Follow up with payers
  • Avoid expired approvals

An optimized medical billing process delivers a progressive revenue cycle to your practice.

10. Regular Audits for Targeted Improvement

A healthcare billing system can never be consistent. To keep it on track and streamlined, regular revenue cycle audits help quite a lot. They help review:

  • Denial patterns
  • Process delays
  • Processing Loopholes
  • Recurring Errors
  • Staff performance

Use insights to refine your prior authorization management strategy.

Conclusion

Pre-authorization is not just a compliance step. It is a strategic tool for denial prevention and revenue protection. The importance of pre-authorization becomes clear when you connect it to financial outcomes and patient experience. A strong prior authorization in the medical billing framework ensures that services align with payer expectations before they are delivered. This minimizes the risks, increases claim acceptance, and facilitates smooth cash flow. On the other hand, poor management of prior authorization processes causes unnecessary claim denials, delays, and lost revenues. It also increases the workload and compromises patient trust.

The way ahead is quite clear. You should focus on structured workflows, documentation, and the effective use of technology. You should implement tried and tested prior authorization best practices. If done well, the pre-authorization process transforms your revenue cycle from reactive to proactive. It provides your healthcare business with control, clarity, and confidence in all your claims.

 

 

Author Bio:

James Eric is a seasoned healthcare professional with over 10 years of experience in medical billing, coding, and compliance. Throughout his career, he has helped practices optimize revenue cycles, ensure regulatory compliance, and streamline documentation processes. His in-depth knowledge of payer guidelines and coding standards makes him a trusted resource in the industry. Currently, James is bringing his expertise to Physicians Revenue Group, where he contributes to delivering high-quality, efficient billing solutions tailored to healthcare providers’ needs.

 

 

Three Barriers in Rehabilitation That Require Timely Intervention 

Posted on by Joseph Gerard

Planning is key in healthcare management

Written by Deepika,

In times past, the term rehabilitation had a rather simplistic meaning. You hurt, you rest, and you feel better. That sounds easy, right? Well, the same cannot be said today, as the idea of rehabilitation has evolved from basic recovery to a dynamic process. 

It is still about healing the body, but also includes care tailored to patients’ unique goals and challenges. Metropolitan areas like Denver, with a 713,000+ population, comprise a mix of patients recovering from joint replacement or healing from work-related injuries. 

Physical rehab in Denver must go beyond cookie-cutter methods to ensure meaningful patient progress. Now, growth often brings with it certain barriers. Likewise, healthcare is still striving to identify the different hurdles to patient progress for timely intervention. 

Are you aware of such barriers, particularly the most common ones? This article will focus on three main roadblocks to rehabilitation. Care teams can use the insights shared to keep the patient at the center of every step. 

 

One-Size-Fits-All Treatment Plans 

Across industrial verticals, what has helped bring about the revolution of adding value to customers? The simpler answer is personalization. Healthcare, being a largely people-oriented industry, cannot afford to neglect personalization either. 

This is crucial in light of how the definition of rehabilitation covers a holistic approach. In other words, healthcare providers must move from a disease-centered approach to a wellness-focused one. Care that is not tailored to a patient’s needs can thwart recovery and frustrate patients. 

A 2025 review of patients in exercise rehabilitation found that 27 items of evidence were identified in the form of expert recommendations and randomized controlled trials. Shockingly, none of the evidence was implemented in clinical practice. This was especially true of areas like prescription and personalized assessment tools. 

The authors of the study concluded that this lack of tailored assessment led to suboptimal patient outcomes. It only shows that the definition of rehabilitation has evolved, but only in paper, not in practice. Individualized care is a must, which may include adjusting the intensity of therapy or setting realistic recovery goals. 

In many urban areas, the needs of patients coming for rehabilitation are wide and varied. Rehabs in such settings would have to go beyond standard protocols and offer reconditioning therapy. It is an approach aimed at restoring the strength and mobility required after deconditioning. 

Total Physical Therapy shares that deconditioning happens when your body loses function in certain areas due to inactivity. What does diversity of needs have to do with this? Patients who arrive after periods of illness, hospitalization, or inactivity will not respond to generic therapy. 

So, how do healthcare professionals make treatment plans fit the individual in question? It may be done in the following ways:

  • Conducting in-depth patient assessments, including their health and lifestyle 
  • Adjusting the timing or frequency of an exercise based on patient feedback 
  • Reviewing and updating treatment plans periodically to match the patient’s progress 

 

A Lack of Patient Cooperation 

It doesn’t take long for someone in the healthcare field to understand how real the conflict between a patient and their specialist can be. Traditionally, the medical profession has worn a badge of honor that almost deifies those involved in it. 

However, discords are not uncommon, and they may range from minor disagreements to downright cases of violence. From the perspective of rehabilitation, a lack of patient cooperation acts as a major hurdle. It can not only delay the recovery process but also increase the risk of complications. 

Now, how does non-cooperation arise in the first place? It could take various forms, depending on factors mentioned below:

  • Fear of pain if a patient’s therapy involves inadequate pain management 
  • Cracks in knowledge, which can go as far as patients skipping exercise sessions because they feel no immediate relief 
  • Worry regarding the recurrence of injuries, which contributes to patient hesitancy.
  • Busy schedules, comprising work or caregiving, that lead to missing sessions or inconsistencies in treatment 
  • Psychological distress, including anxiety or depression, that lowers a patient’s motivation to participate in their recovery

We have some real-world examples to support this. As per a 2025 qualitative study, physiotherapists testified to a major lack of patient adherence. From the healthcare provider’s viewpoint, the main reasons were a lack of motivation and communication gaps. As for patients, many reported psychological factors, physical limitations, and second thoughts about rehabilitation. 

This makes for a dual approach wherein we understand how cooperation issues may emerge from both patient experience and provider interaction. So, what can be done about this? Healthcare professionals should conduct frequent reviews to detect this barrier. 

Moreover, simple and thorough instructions should be provided to patients. Just ensure the dialogue is supportive, leaning more toward patient concerns. 

 

Breakdowns in Team Communication 

Communication, be it with patients or fellow team members, is the cornerstone of high-quality care. This is not something new, but an important part of care that has been known since the time of Florence Nightingale. 

You may wonder how communication just breaks down, especially since healthcare teams are so closely knit these days. Well, the process is more of a slide than a leap. In other words, it happens so subtly and gradually that discrepancies may see the light of day only when things go haywire. 

Let’s say a patient needs to be handed over by a hospital to an outpatient rehab team. During the transition, important patient information, such as recent progress or new complications, is not conveyed. Since the new team will be clueless as to the latest health stats, their treatment may not work, or worse, negate the progress already made. 

A similar scenario occurs when different healthcare providers give instructions that contradict each other. An example would be a physical therapist who wants the patient on advanced exercises, whereas the nurse instructs them to rest due to swelling. One can only imagine how disastrous the consequences of such miscommunication can be. 

Since we are at it, let’s walk through some other communication gaps that usually take place:

  • Delays in reporting complications can prevent timely interventions. 
  • Unclear discharge plans often lead to incomplete therapy or missed appointments. 
  • A lack of distinct roles may cause each healthcare professional to (falsely) assume that someone else is handling a particular task, which raises the risk of incompletion. 

Research suggests that over 70% of adverse events in healthcare originate from communication failures. When do most of these failures happen? Not so surprisingly, at the time of handovers or transfer from one unit to another. This means nobody can say that they didn’t see an adverse event coming, at least in the majority of cases. 

Now, nurses usually act as the central link in the care team. This means they are in a solid position to remove this particular barrier. For instance, nurses can ensure that the transitioning team receives complete and accurate patient information. 

They can also clarify unclear or conflicting instructions before they affect patient care. Only when gaps are addressed at the earliest can patients experience faster recovery. 

 

Based on what was just discussed, how immune would you consider your facility to be? Indeed, immunity against poor rehabilitation care is a matter of constant vigilance. If you observe that communication between care teams is falling apart or audit a care plan only to find that patient progress is stalled, take action. 

The future of rehab is dependent on turning every possible obstacle into an opportunity for growth. Your patients are looking for meaningful recovery, something which takes time and intention. 

The journey counts, which means every small victory is important. So, which barriers could be hiding in plain sight, and how can your team pull them down for better outcomes?

Author’s Bio:

Deepika is a budding content creator who enjoys exploring various niches, be it lifestyle or healthcare. With a knack for breaking down complex topics, she strives to make information relatable and accessible to everyone. During her leisure, Deepika enjoys reading novels and practicing fine arts to keep her creativity alive. 

Please also review AIHCP’s Nursing Management Certification program and Nurse Manager Courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification

Cybersecurity in Healthcare: The Complex and Troubling Intricacies of Social Engineering Threats

Posted on by Joseph Gerard

Cybersecurity on a laptop.

By Lucy Peters

The healthcare industry has long been a favored target for cybercriminals. In 2024, the industry faced more cyberthreats “than any other critical infrastructure industry,” an American Hospital Association News article highlights the findings of the Federal Bureau of Investigation’s Internet Crime Report for that year. Ransomware is just one major threat, though these aren’t the only cyber-risks that the healthcare industry faces. While many may recognize common cybersecurity terms like ransomware and malware, social engineering threats can feel less familiar despite their potential for massive security disruption. Typically cloaked in a clever disguise, these cyberattacks largely depend on a victim’s human nature to attack and obtain access to valuable data, underlining an extra sinister side of cybersecurity that all professionals must be aware of.

 

The unsettling nature of social engineering

Many may conjure up an image of a lone hacker behind a cyberattack, furiously typing away as they unlock sacred information. Armed with elite skill and high-level know-how, bad actors are often depicted as “evil geniuses.” While this may be how some breaches occur, attacks that stem from social engineering utilize a much more unsettling approach. Rather than fall back on computer science know-how and hardcore skill, bad actors often use tactics that play on a victim’s human nature in order to achieve their goal.

There are a number of different ways that social engineering can drive a cyberattack through to success. Phishing is a majorly popular way that social engineering is put to work to extract valuable information from victims, often making use of specific wording that helps play into human psychology by appealing to a person’s emotions. An email from an illegitimate source that states an account is in danger and that action “must be taken now” is just one example in which a phishing scam may involve malicious social engineering. Business email compromise, or BEC, is another common type of social engineering strategy, in which hackers often trick victims by pretending to be a valuable figure within the company itself, from vendor to manager or even the CEO. BEC threats often use stolen yet legit credentials in order to pass through security measures, ultimately making these types of scams sophisticated and financially damaging in nature.

An IBM Think article titled “What is social engineering?” further explores the many faces in which such threats may take form, and why it often works out for cybercriminals. Aside from phishing, social engineering may take the form of ‘scareware,’ the article describing it as a sort of malware that induces fear into the victim, ultimately persuading them to share sensitive information or take an equally dangerous action. Another form highlighted by the article is ‘pretexting,’ in which a cybercriminal may tailor a scenario that caters to the victim and points to a sort of resolution via something that may look like “click here to resolve.” The IBM article goes on to point out that nearly every social engineering attack utilizes some sort of pretexting, making it necessary for professionals to understand how to identify in real-world application. Cybercriminals tend to find success in social engineering methods due to their simple yet manipulative nature. IBM explains this concisely: “They manipulate victims’ emotions and instincts in ways proven to drive people to take actions that are not in their best interests,” the article states.

 

The ramifications — a closer look

The healthcare industry is exceptionally connected, from sensitive patient records to financial information. While this makes it a “perfect” target for cybercriminals, it also illustrates the striking amount of damage that any attack can have. One 2025 TechTarget article by Jill Hughes highlights a number of some of the largest healthcare data breaches that were reported that year, all of which listed involved “hacking or IT incidents.” First listed is the Yale New Haven Health System, or YNHHS breach, which happened to impact 5,556,702 individuals and involved a “multimillion-record” breach. According to the article, an investigation by YNHHS brought to light that an “unauthorized third party had gained access to its network.” It’s important to note that while the breach did not involve any electronic medical records, vast amounts of personally identifying information were involved, underlining a significant concern for patients across the board.

Outside of the most commonly known risks associated with sensitive data and financial consequences, healthcare organizations and their patients can be affected in ways that may be less obvious upon first thought. Operational disruption or a strained infrastructure within a facility, for example, can heavily impact the patient experience. In addition to schedule disruption and long wait times, patients may fail to receive the care they may need at the moment, causing them to go elsewhere. Reputational damage is another major point of concern, as patients are likely to lose trust in a facility that falls victim to an attack — especially if it was preventable from the get-go.

While operational disruption wreaks havoc on the facility, professionals themselves may discover a variety of shortfalls in the meantime. Short-staffed and often made to rely on manual practices throughout an attack, healthcare workers can become overly stressed and overwhelmed, which can make one more prone to human error while on the job. A lack of preparedness on the facility’s part can lead to even more chaos, especially should employees feel unprepared or downright lost during a cyberattack. On the flip side, those that fall victim to a social engineering attack may face additional fallout. Based on the situation, an employee may require retraining, face investigation, and even disciplinary action. In some cases, an accidental incident may cause a facility to rethink their training altogether, instead opting to retrain the staff in an improved way.

 

Preparation will always set the tone 

Social engineering threats are intimidating, however, every healthcare professional plays a critical part in their prevention. Training is a major part of this, as education is crucial for employees to understand the risks and how to identify them straight on. However, in conjunction with the importance of upholding such knowledge and best practices, the healthcare industry plays a critical and powerful component in cybersecurity as a whole.

Preparation in the form of foundational security measures is an essential for any healthcare entity — while employees can be properly trained, threats can be complex and can continue to evolve. As such, developing an industry-wide mindset that accepts that human error or a high-tech threat may one day become a reality can be a great way to approach security framework measures. With this mindset, the industry can be more proactive with a vigorous security system that thinks ahead, rather than lags behind. A 2025 MSSP Alert article by Faisal Misle highlights several beneficial recommendations for healthcare organizations. Among the suggestions include the implementation of multi-factor authorization, the strengthening of email systems, and even the enlistment of an AI-driven threat detection system. Other suggestions include a comprehensive response plan, as well as routine training to maintain consistency. When coupled with other measures like routine security audits, healthcare organizations can take charge and adapt as necessary.

The unsettling nature of social engineering threats can make for a challenging security environment in healthcare. Through impactful training and foundational security measures, the healthcare industry can buckle down and proactively prevent threats.

 

Author bio

 

Lucy is a freelance writer who enjoys contributing to a range of publications, both in print and online. She spent almost a decade working in the care sector with vulnerable people before taking a step back to start a family and now focuses on her first love of writing.

 

 

Please also review AIHCP’s Health Care Management Certification program and CE Courses see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification