One of the most interesting conversations I had at the HLTH conference in Boston this month was with Bevey Miner from Consensus. She has quite the history in healthcare and so she has a ton of experiences and perspective to draw on. Plus, she’s leading the charge for the newly branded Consensus suite of solutions which is a break off of J2Global and eFax that is just focused on healthcare.
While many government officials are calling for things like #AxtheFax, Miner gave me a number of perspectives on why the fax of today isn’t the same as your grandma’s fax. We’ve come a long way from thermal paper and physical fax machines.
This was best illustrated by a chart she showed me which illustrates how far a “fax” has come. At its most basic level, a home health nurse is sending a fax to a doctor. However, as you can see in the chart below, there’s a lot more happening behind the scenes of this digital “fax” to make it so much more useful.
When you see the details happening here, you can see how Consensus has taken faxing a document to the next level. Instead of it just being a document, they’re applying things like OCR and NLP on top of the document to create files like CCDA and FHIR that accompany the document so it can be added to something like an Epic EHR with the granular data. That’s much different than a piece of paper lying on a fax machine.
While I understand that many people don’t fax, I see innovations like this and realize that fax isn’t what it used to be. Should the physical fax machine die in favor of digital fax, absolutely! However, as I often tell people, why would you want to #AxtheFax when it’s the most interoperable part of helathcare?
Miner also offered a great perspective on why fax is likely to have a long life in healthcare. While most hospitals and ambulatory organizations have been able to implement an EHR, many in the post acute space haven’t done so. They didn’t receive any stimulus money to go electronic and many of them have extremely tight budgets.
Given this fact, how do you expect these paper based healthcare organizations to be interoperable? The reality is that if you can barely keep the lights on, you’re unlikely to implement an EHR in your organization. However, you can implement a digital fax solution. The point being that even if we’re able to achieve EHR interoperability for hospitals and medical practices (still far from a reality), they’re still going to have to have some sort of digital fax capability in order to communicate with many post acute care facilities. In many cases, that means sending a fax.
Needless to say, fax is going to be around healthcare for a long time to come.
There are a number of fundamental problems with faxing:
Patients provide health systems wrong information about there PCPs which generate routing errors which results in support desk calls and HIPPA issues.
Providers change practices all the time and do not update the area health systems with their new fax numbers.
Manual fax senders enter phone numbers as fax number FAR TOO often and thus try and send faxes to offices main phone numbers.
A fax failure rate (transmission errors) of 5% is acceptable to the telecom fax board manufacturers (Brooktrout) and the telecommunications. Not a big deal if your sending a couple hundred faxes a week. But when your an organization sending 40k+ to work even a 1% failure rate is a SIGNIFICANT failure rate.
I have seen fax destinations that had a 100% success rate for years go to almost zero overnight. Nothing changed on the sending side, nothing changed on the recipient side. After weeks of troubleshooting it is finally determined that some backbone telco made a routing change and that broke faxing. My organization comes across this multiple times per year and seems to accelerating over the past few years. Long story short the telecom industry doesn’t care about faxing because its utilization is declining every year.
The telecom industry is not support or maintaining faxing because basically only healthcare is still using faxing. 10 years ago the legal industry and real estate industry still relied on faxing. Today both industries have pretty much moved to DocuSign and similar products.
I have been fighting the faxing dragon for nearly a decade now and it is increasing and not decreasing because like your article implies it is easy to “just fax it” and too often that is the “solution” to exchanging health information as the lowest common denominator.