Dropping the F-Word at HIMSS22

Fax is not a vulgarity in the English language, but in healthcare, it is close to being one. The word conjures up images of medical charts printed on curled thermal paper. It is a horrible way to deliver information to patients. However, it is a viable technology that is still one of the most ubiquitous forms of interoperability. The key is unlocking the value for the unstructured data contained in a fax.

F-word on Stage

“We’re going to talk about the f-word right now…fax!” was the opening line from Frank Toscano, Head of Product Management for Consensus Cloud Solutions who moderated a panel discussion during HIMSS22. The panel topic was Digital Freedom From Unstructured Documents and featured:

• Nick Knowlton, Vice President Strategic Initiatives at ResMed
• Jim McKinnon, President at Summit Healthcare Services (recently acquired by Consensus Cloud Solutions)
• Shane McNamee MD, Chief Medical Information Officer at SmileCDR

Following his semi-salacious opening, Toscano set the tone for the panel by pointing out an overlooked fact about how healthcare handles unstructured data:

How we deal with unstructured information hasn’t changed much – still manually and cognitively intensive. @ConsensusCS #HIMSS22 pic.twitter.com/3FRX2m97dp

— Colin Hung (@Colin_Hung) March 15, 2022

In other words, it’s not fax technology itself that is the problem, it’s that we are using a 1970’s approach to handling that form of information exchange.

Why is Fax Still Around?

Toscano posed this question to the panel and got a colorful set of responses.

Knowlton: It works. It gets information from one party of the health ecosystem to another in a reliable manner.

McNamee: Because healthcare is not a technology. We come to events like HIMSS and we pray at these altars of information technology, but that’s not fundamentally what healthcare is all about. We deliver care and we use the tools in front of us to do that. Fax is one of those tools that meets the needs of where healthcare is now.

McKinnon: It is a trusted source of information in healthcare so we keep using it.

There was general agreement amongst the panelists that work should continue to build applications and technology platforms that eliminate the need for faxing, but while we wait, there are ways in which we can modernize the way we handle faxes to make it more useful and less burdensome to clinical staff.

Making Fax Useful

“The question is not how to improve faxing,” said Toscano. “The question is how to improve workflows. It may turn out that faxing is one of the best options to achieve a smooth and optimal process for patients and clinicians.”

To do that, according to McNamee, we need to eliminate the manual parts of the worklow related to faxing – the manual data entry of the information on the fax into an electronic system (like the EHR).

“Technology in healthcare needs to be efficient. That means we can’t have a human being clicking or doing data entry as one of the steps”. @shanemcnamee_md @smilecdr here on @ConsensusCS panel #HIMSS22 pic.twitter.com/6PofcBzKKm

— Colin Hung (@Colin_Hung) March 15, 2022

By using natural language processing (NLP), it is possible to transform the unstructured data held on a faxed document into rich, useful information that can be fed directly into applications that need it. This bypasses the step where a person needs to read the fax and figure out where it goes.

In other words, NLP unlocks the value of faxing.

Overcoming legacy bias

Later in the panel, McKinnon challenged the audience to examine their own biases against legacy technologies like faxing.

“Enabling technology that helps patients, clinicians and deliver better care should be implemented even if it based on an “older” tech. We need the relief now.” Nick Knowlton @ResMed on the @ConsensusCS panel #HIMSS22 pic.twitter.com/G2zUdJX6Ke

— Colin Hung (@Colin_Hung) March 15, 2022

McNamee added to that comment by saying “We shouldn’t be looking at the specific technologies but rather at what that technology enables us to do. If it’s FHIR great! If it’s fax, equally great!”

Bottom line, we need to overcome our biases against “older technologies” simply because they are older. If the technology is working, we should instead be looking at ways to improve how we work with that technology first, rather than immediately hunt for a new technology and end up right back where we are today.

Where Opportunities Exist

Knowlton brought up an excellent point during the panel. He pointed out that post-acute care accounts for 3% of the country’s overall healthcare spend, but they have over 30% of the industry’s fax volume. “When those post acute facilities need a piece of information from the patient’s original medical chart, they get a 200 page fax where the 1 bit of information they need is buried on page 77.”

Knowlton went on to say that: “there is no financial incentive or disincentive for healthcare providers to use a different modality to deliver this information. Because of that, they default to what has worked well in the past – faxing”

The panel agreed with Knowlton that what healthcare needs is tools that can help sort through the mountain of faxed information an extract the one or two bits of information they need I order to deliver better care to patients.

An example solution: use NLP to process inbound faxes. Hand the data interpreted from that fax to an application that reconstitutes it into a Direct Message CDA and deliver it to the EHR where it can become part of the patient’s permanent record (like Epic). This is a solution that is available today.

With 80% or more of the data in healthcare still being unstructured, it is important that we look to quickly adopt solutions that can unlock the valuable information held within faxes, and other unstructured documents. If that solution happens to run on an older technology, so be it. The goal is not to implement technology, but to make the delivery of care better for patients and clinicians.