Faxing is still most providers’ preferred method of sharing medical information, accounting for 75% of all such communications [1]. This is hard to believe considering the fax machine was invented in 1846 [2]. That’s right—173 years ago. In light of the substantial liability that comes with exposing PHI or patient financial information, we have to ask ourselves why we’re holding on to such outdated, error-prone, risky technology.

Provider offices should already be considering a transition from fax to other, more secure methods of communication. Those that aren’t may be setting themselves up for a big challenge in the not-too-distant future. During the 2018 ONC Interoperability Forum, CMS Administrator Seema Verma talked about the issues of faxing patient information and challenged attendees to eradicate the fax machine from all physician offices by 2020 [3]. While no mandate has been set, it’s just a matter of time. In the very least, providers should begin a plan of action and assign a date to get started.

A great place to begin the transition is with referrals, the majority of which are done via fax and phone. The referral process is one rife with inefficiencies, and those inefficiencies are a real problem. Today, 46% of referrals go unscheduled. Some get lost. Some are faxed to the wrong place. And some just take so long that the patient becomes frustrated and decides to forgo the appointment altogether. With increasing pressure from value-based care to improve outcomes and patient satisfaction, the successful completion of referrals can have a significant impact on a provider’s reputation and bottom line.

Consider the current workflow with its frustrating office-to-office and office-to-patient phone and fax tag. Once a connection is made, the average call can last seven minutes. By some estimates, it takes 1.5 hours per day per staff member to manage calling and faxing of referrals. Finding the best specialist for the patient’s diagnosis and insurance plan is challenging and prone to error. And the specialists’ reports are often overlooked or lost, sometimes leaving the patient to hunt it down themselves. In some smaller practices, it’s the nurse who must manage referrals, which takes away from direct patient care.

It is also important to understand the significant risk of faxing patient information, especially now that patients are putting more of their healthcare costs on credit. Adding financial risk to the risk of exposing PHI, and it’s a danger that could put practices out of business. One slip of the finger on the fax machine could send sensitive patient information to your local TV station as was the case in a multi-provider office in Texas. Fortunately, the media outlet recognized the issue, destroyed the information, and contacted the provider practice to let them know of the error [4]. Breaches such as these can result in millions in penalties, not to mention the harm to the practice’s reputation and the long-term damage to a patient’s personal life and finances [5].

Besides the potential for human error, fax machines have become an increasingly desirable target for cyber criminals. All they have to do is get the fax number from the provider’s website and send a specially coded image to the fax machine. The fax machine then decodes the image upon which malware is sent to the machine’s memory. At that point, the malware infiltrates any network connected to that fax machine, giving hackers access to hundreds or thousands of patient records. Why do criminals care about patient records? Because they can be worth many time more on the black market than social security numbers or credit card numbers. Patient health records contain that information plus information on relatives, health conditions, work history—any and all information collected over the lifetime of the patient-provider relationship.

By simply switching to an online referral solution, providers can eliminate these risks while, at the same time, reducing the time it takes to request a referral from days to just 90 seconds. Customized forms can automatically verify the patient’s insurance information and suggest the best specialists based on the patient’s unique needs. Because online referrals connect to the provider’s PMS and EHR systems, the specialist’s reports go directly into the patient record. The entire process is simplified and drastically shortened. And this can reduce incomplete referrals to less than 5%. Staff is more productive and less stressed. There’s more time to spend on patients. Patients get the care they need faster, which improves outcomes and increases patient satisfaction—all while reducing costs and administrative burdens for the provider.

With results like these, why would anyone want to stick with 173-year-old technology? Online referrals are a great opportunity to take that first step.

[1] https://www.vox.com/health-care/2017/10/30/16228054/american-medical-system-fax-machines-why [2] https://faxauthority.com/fax-history/ [3] https://www.cms.gov/newsroom/press-releases/speech-remarks-administrator-seema-verma-onc-interoperability-forum-washington-dc [4] https://www.hipaajournal.com/faxing-error-sees-phi-sent-to-local-media-outlet-8693/ [5] https://compliancy-group.com/hipaa/hipaa-violations-penalties/

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