The Perfect Option for Healthcare Interoperability

I’ve come up with the perfect option to take care of healthcare interoperability. I realize that this is a major problem and solving that problem would improve care, lower costs, and make healthcare great again (sorry, I couldn’t help it).

This approach is unique because every healthcare organization out there already supports it. In fact, I don’t know any healthcare organization that would need to spend more money to implement this solution. In fact, the standard this option would use is already out there and everyone has already adopted the standard.

Furthermore, every provider and hospital already have a unique credential and their identity is shared with most of the people that need to share information with them in healthcare. In most cases the information to make the health data sharing between offices and hospitals is already on their website. Plus, this option is something that is easily learned by everyone involved. Most people in healthcare already know how to use it well.

The healthcare interoperability solution I’m describing is: The Fax.

Yeah. It’s shocking I know. That long list of benefits that I describe already exist in the fax. In fact, healthcare data sharing has been happening with faxes for a long time. Why then isn’t fax enough to make healthcare interoperability a reality?

While Fax has plenty of upside (there’s a reason it’s stuck around so long in healthcare), faxes also have a lot of downsides. First is that faxes still have to be sorted and assigned to a patient. This doesn’t happen automatically. It’s still a manual process. Second, faxes are often low quality and readability can really be a problem. Certainly, they’ve gotten better as we’ve started faxing printed reports, but faxes can still be very hard to read.

If you’ve ever worked in medical records, you know how hard it can be to make sure you’re attaching a fax to the right patient. It can be a real challenge. Plus, it’s not surprising that faxes often get attached to the wrong patient.

Another problem with faxes is that they can use up a lot of paper. There are definitely fax servers and other forms of secure electronic fax out there, but it’s shocking how many practices still print regular faxes and then scan and attach them into their EMR. Plus, is the fax really that secure? They can be, but in many cases they’re not. No one is tracking who looks at the faxes that are received. There aren’t restricted permissions on who can and can’t look at the faxes. It’s just an open stack of faxes that anyone can look at and read.

Another big problem with faxes is that they don’t provide any granular data. This is why it’s often hard to identify the correct patient for the fax. However, it’s also a problem as we start wanting to do more predictive analytics and population health efforts that require granular health data on a patient. Sure, you could use OCR (Optical Character Recognition) and NLP (Natural Language Processing) to pull out the details from these unstructured faxes, but that’s not as good as granular data that’s more precise.

Of course, we all love the way the fax produces a Blarrrrrring NOISE!!

While this post is somewhat tongue in cheek, I think it’s important to look back at these “legacy” technologies that have been so popular. Understanding why they have been so popular and in many ways still are so popular can help us understand what the solutions of the future need as a baseline to be a successful replacement. Healthcare Interoperability efforts can certainly learn a lot from the success of faxes in healthcare.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Fax is the workhorse of document exchange in US healthcare for two reasons: (1) it was here first; and (2) it does the job. OpenText owns RightFax, the fax software system with one of the largest install base in US healthcare. We have introduced RightFax Healthcare Direct, which converts faxes to Direct Messages and which can serve as a transition technology from the world of fax to the world of Direct messaging without any workflow changes. We have also introduced Fax2Mail for Healthcare to the market, the first fax solution built specifically for healthcare, with a portal to receive, manage, and triage documents, and then move them to an EMR or a DM system.

  • John,

    At best, fax should be a method of nearly last resort, voice calls being the only thing that is worse (highly prone to miscommunication). Sure, there are solutions such as Brian noted, and I’m not suggesting that it go away because it does help to make the best of a poor method of communication. It’s just that in real life fax’s are often partially or completely unreadable, can’t get through, don’t reach the right person or entity, or even something as stupid as someone forgetting to press SEND or OK. Of course, if the fax came from an EHR, quality would likely be fine – but typically, someone fills in something on a photocopied form – perhaps legibly, and then that sheet is put into a fax machine and maybe even gets both sent and received.

    Real life scenario; doctor sends a patient to the ER for an emergency transfusion, to be followed up by related infusions (which were going to be done on an outpatient basis the next day until the situation worsened). The doctor writes up the orders to have someone fax to the ER, but along the way, something unknown happens and the ER never gets the fax. Patient arrives, ER has no clue what to due, figuring the orders will eventually arrive. One nurse figures that the problem is with the pharmacy. The patient’s family pushes hard and finally – 6 hours later, discovers that no orders have arrived; doctor is phoned, and 10 minutes later the ER has the instructions.

    What should have happened? In very plain terms, the doctor should have logged into the EHR (albeit a different system than the hospital uses), put in orders, and those orders should have gone straight to the ER’s EHR (I gather via Direct Messaging) so that when the patient arrived the ER would know what to do. OR – the doctor should have logged into the hospital’s EHR remotely and entered the orders. But that’s not what happened, and the patient waited many hours for badly needed blood, and a valuable ER bed was occupied for those same hours with no treatment being done.

    Fax does have its uses – but IMO they should be limited to situations where there is no other choice, not be ‘how we do things’.

    BTW, the scenario above actually happened. Oh, and the ER in question is now being expanded, an expansion that might not be needed if 1. it had decent communications with doctors feeding it patients, 2. it’s EHR was fully connected to that used by the rest of the hospital, 3. It had a viable and efficient work flow revolving around the EHR. Instead, patients are stacked up in the hallways and waiting room waiting for treatment, for techs to come, for orders to hopefully show up. The hospital is spending 10’s of millions to expand but not addressing the root causes of their problems, the biggest of which is poor communication based primarily on phones and fax machines.


  • Brian,
    I’m interested to know how this direct implementation is going for you. It makes sense to opt for direct over fax when it’s available. The question really is about how quickly it will get adopted.

    Tragic story and great example. I think I’ll have to turn it into its own blog post.

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