How Cloud Fax Enables Healthcare Interoperability

May 20, 2019 - In 2015, the Office of the National Coordinator for Health Information Technology (ONC) published a roadmap for achieving nationwide interoperability over a ten-year period. The division of the Department of Health & Human Services tasked with managing health IT certification at the federal level emphasized the crucial role of interoperability in realizing a learning health system wherein information sharing is seamless and efficient.

Nearly five years later, agencies within HHS — namely the Centers for Medicare & Medicaid Services (CMS) — made clear their plans to advance healthcare interoperability by reducing and eliminating the use of fax machines to share sensitive health data securely. Proponents of the so-called “axe the fax” movement view the technology as a legacy holdover with little value going forward.

As it turns out, the fax isn’t going anywhere. Healthcare relies heavily on the technology to complete critical daily activities tied to patient care and reimbursement. What’s more, payers increasingly require prior authorization to determine the appropriateness of clinical decisions, a process that typically uses fax to be completed. What’s more, fax has evolved as a technology, leveraging both security and reliability of the cloud to make data exchange more efficient and less dependent on local and potentially vulnerable hardware.

Enabling rather than hindering digital transformation

Today, 78% of doctors and 96% of hospitals use certified health IT. But despite the best efforts of innovators like many of the individuals in this room, health care providers are in a 1990s time warp where doctors are faxing patient records, medical staff are manually entering results into EHRs, and hospitals are handing out data on a CD-ROM while the rest of the economy is functioning on fully digitized, integrated data that informs decision-making instantaneously.

—Seema Verma at the ONC Interoperability Forum on August 6, 2018

The fax machine has become a symbol of healthcare’s resistance to change, but it should read more as a sign that interoperability is still widely lacking. The technology criticized for being antiquated continues to thrive because of its ability to move information quickly and securely.  Those calling for the complete elimination of faxing are blaming the messenger for a much larger problem.

In 2018, Sarah Kliff of Vox detailed the struggles of the healthcare industry to move beyond the fax machine and attributed the inability to do so as a failure on the part of federal officials to make information sharing a core element of health IT adoption as part of the now-defunct EHR Incentive Programs (i.e., Meaningful Use). According to estimates, the article noted that 75 percent of all medical communication occurred via the fax.

And the integral role of the fax isn’t limited to provider-to-provider communication. Likewise, it serves as the means for payers to manage prior authorizations, the practice of gaining approval for services before their provisioning. Findings from a recent survey conducted by the American Medical Association found that a majority of physicians use the phone and fax as the primary method for completing prior authorizations. A meager 21 percent said their EHR systems support electronic prior authorizations for prescription drugs.

Rather than an obstacle to interoperability, the fax is the tie that binds. Semantic interoperability remains on the horizon. In the meantime, the fax is doing yeoman’s work. That said, there remain ample opportunities to improve faxing to support patient care and secure health data privacy.

Evolution of faxing technology in healthcare

Faxing has evolved thanks to the growth of cloud computing and the availability of cloud-based products and services. The impetus for change? Vulnerabilities in the traditional fax machine.

Security researchers and privacy advocates have good reasons to remain critical of legacy fax technology. Sending personal information to the wrong recipient can lead to a data breach. Legacy fax machines and multifunction printers prove vulnerable to hackers capable of exploiting software flaws and injecting malware over “dumb” telephone lines.  

Additionally, providers upgrading their faxing infrastructure run the risk of forgetting to remove sensitive data from equipment at the end of its life cycle. As security firms have come to recognize, many fax machines are branded office supplies and are not managed by IT despite their potential to hold 20k-40k pages on their local hard drives.

The security risks and workflow inefficiencies of traditional paper-based fax equipment have led to the growth of cloud-based faxing solutions. Secure cloud fax services operate without fax machines or phone lines and instead rely on encrypted communication channels to protect data in motion. Cost savings come from eliminating hardware (e.g., fax machines, servers), physical resources needed to run them (e.g., paper, toner, power), and dedicated lines.

The challenge for providers moving from traditional to cloud-based faxing is integrating shared data into the workflows of clinicians. Information must be made actionable in the hands of providers, so healthcare CIOs and IT leaders need to develop a strategy for ensuring that imported information finds its way into clinical systems and in turn inform the provisioning of appropriate care.

Value-based care and alternative payment models are ratcheting up the need for information sharing that is unprecedented in the world of healthcare. Until industry-led efforts such as the Argonaut and DaVinci projects powered by Fast Healthcare Interoperability Resources (FHIR) take hold, organizations must work with available technologies and resources to move critical sensitive data.

Cloud-based faxing eliminates endpoint vulnerabilities, scales to the performance and storage needs of individual organizations, and most importantly keeps protected health information out of the hands of unauthorized viewers and bad actors but conveniently accessible to providers and care teams.

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About J2 Global:

eFax Corporate® recently became the first major Cloud Fax provider to achieve HITRUST CSF® Certification. With eFax Corporate, faxes can be securely sent and received by email, from any desktop, tablet, smartphone or from within EHRs via APIs – helping organizations boost productivity, enhance regulatory compliance and eliminate on-site fax hardware.