Case Study Background


QTbreasthealth Works With FormAssembly Implementation Services to Enrich their Patient-Centric Healthcare Experience

Jim Bollinger,

CEO, Integrity Healthcare Advisors; Consultant

Case Study Snapshot

Breast imaging company QTbreasthealth worked with consultants at Integrity Healthcare Advisors and FormAssembly’s Implementation Services team to build a medical history form that enables the transfer of information to Salesforce, which in turn sends it to their Electronic Health Record (EHR) system. The FormAssembly form contributes to the easy digital patient experience QTbreasthealth wants to provide for women in search of adjunct breast cancer screening options.

About QTbreasthealth

We have an innovative product that was developed that’s really advanced, and it is our personal belief that it will change the way breast screening is completed, discussed and imagined in the future,” Bollinger said.

  • QT Ultrasound is the technology company behind the QTscan™, a revolutionary method of using both reflective and transmission ultrasound to scan for breast cancer.
  • QTscan™ provides a more comfortable, safer, more reliable method of breast cancer screening, especially for women with dense breasts and women in their 20s and 30s.
  • The QTscan™ is currently approved by the FDA as an adjunct to mammography.
  • Founded with the goal of “empowering women to have access to better more accurate information concerning their breast health,” according to Bollinger.
  • Held a grand opening of their first QTbreasthealth clinic and launched FormAssembly medical history form in August 2018.

About Integrity Healthcare Advisors

  • Consulting company with over 100 combined years of healthcare experience.
  • QTbreasthealth enlisted the consultant group to help to bring the QTscan™ product to market.

The numbers

5 min.

approximate time to fill out a medical history form

July 2018

started working with Implementation Services


forms built with FormAssembly

The Need

Need for Compliant, User-Friendly Way to Gather Patient Information

We want to make the entire experience not frustrating but comforting and reassuring. If that form doesn’t work well, then the perception that the woman has that’s filling out that form is ‘Well, if they can’t make the form right, how does the technology work that’s putting all these 1.5 trillion data points together to make my image work?’ “

Leading up to the launch of their first QTbreasthealth clinic in Novato, Calif., in August, QTbreasthealth needed a way to collect medical information from patients who had scheduled an appointment for the QTscan™. Data needed to be integrated with Salesforce and, in turn, their EHR system CareCloud. In addition to fulfilling their workflow needs and being HIPAA compliant, the form solution they used had to be user-friendly and further their overall goal of providing an excellent and easy patient experience.

The Solution

Implementation Services Assistance & HIPAA Compliant Forms

For our practice, the HIPAA compliance is the most important feature. Because we are a healthcare organization—everything that we do—we need to make sure that we’re going to be HIPAA compliant,” Bollinger said.

With the help of FormAssembly and the Implementation Services offering, they created a Salesforce-connected, HIPAA compliant, user-friendly patient information form in FormAssembly. A link to the form is emailed to a patient after their initial contact.

HIPAA Compliance

FormAssembly’s HIPAA compliance was a must for QTbreasthealth, and allows them to remain compliant as they gather medical data and personal details collected through the medical history form.

A User-Friendly Experience

QTbreasthealth’s medical history form, in addition to being HIPAA compliant and integrated with Salesforce, is also user-friendly. The form takes minutes to complete and offers the option to pay in advance for a discount. Bollinger said FormAssembly’s Chargent integration was used to enable this functionality.

Implementation Services Assistance

Bollinger said they also benefited from the form assistance provided by Implementation Services, included in their onboarding implementation package.

“I love the product and the implementation services,” Bollinger said. “I’m very happy that we went with that.”

While Bollinger said FormAssembly offers great self service support options and the product is fairly intuitive, he noted it can be time consuming to ensure that the Salesforce connector, flow of the form, and other aspects are set up in an optimized way.

“Having somebody help you with that pays for itself in the amount of time you will spend looking for that piece of information,” Bollinger said. “Tutorials are great, but most of us have a lot of stuff that we’re trying to do, so to sit down and go through five to six hours of tutorials is sometimes harder than it should be.”

Use Cases

Use case

Patient Information Form

QTbreasthealth’s main use case is a medical information form. The form is emailed to patients after they reach out to QTbreasthealth in a number of ways. On Implementation Services’ suggestion, the form also includes FormAssembly’s Chargent connector to offer easy payment straight from the patient portal.


What’s Next?

At first, QTbreasthealth will have the ability to scan eight women a day in their clinic. That number will increase to 50 women a day by end of the year, Bollinger said. The number of clinics will also grow to five at the end of this year, with much more growth likely in the future.

“We believe that if you turn the clock ahead a couple years there will be hundreds of these clinics,” Bollinger said. “This technology is set to change the face of breast imaging, and in turn, breast health.”

With the high level of growth expected, FormAssembly’s scalability and flexibility was an attractive feature for QTbreasthealth.

“I can’t tell you today whether I’m going to have 300 people a month fill out a form or 3,000,” Bollinger said. “So to have a solution that did not have a limitation to how many potential responses you could receive was advantageous.”

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