Greater KC Insight

    Faxing: Is It Still Relevant in Today’s Modern Healthcare IT Picture?

    Doctors Depend on this Old-School Technology

    By Chris Lanaman


    In today’s need for fast data transfers through the Internet, Wi-Fi or 4G methods, many people feel that faxing is “so old school.” I don’t even think today’s eighth-graders can tell you what a fax is. Throughout the medical community, however, faxing is still an instrumental form of passing patient information. I also believe that healthcare organizations value faxing for its strategic importance in driving business to their facilities over their competitors. Over the next three blogs, I will explain why doctors’ offices consider faxes their lifeline to business, how faxes help healthcare providers maintain their relationships with doctors and how to ensure your information gets where it needs to go when it needs to get there.

    Let me set the proper context. Cerner calls its module for faxing Remote Report Distribution or RRD. It is one of the members of the system group called Clinical Reporting. I contend that management should require at least one full-time employee (analyst) to support faxing. Even if the faxing system is configured exactly as designed, RRD faxing can still create large problems for healthcare organizations

    Many doctors’ offices do not have the equipment needed to perform complex clinical tests, so patients are referred to places that have the equipment, which is often the nearby hospital. Both doctors and patients want to get the results as quickly as possible, and hospitals look to their EMR system to be able to provide the timely results through faxes. In addition to faxing radiology findings and lab results, hospitals also use faxing to report on consults, send patient summaries of hospital visits, distribute notification letters to doctors and even send patient appointment reminders. Doctors’ offices rely on these faxes on a daily basis.

    I have talked with many doctors’ offices on how faxes affect their processes for seeing patients. Here’s a typical scenario: When a fax containing a patient’s test results comes in, the office staff is responsible for delivering the information to the doctor for his or her review and for setting up a follow-up appointment for the patient to hear the results and begin necessary treatment. From a business perspective, these faxes are helping doctors generate new office visits. Some of the offices I have spoken to say this process accounts for up to 40 percent of their office visits. Without the faxes being sent to these doctors’ offices, physicians would be relying on results being mailed to them or the patients themselves calling for follow-up visits once they received the results from the hospital — neither of which would be acceptable to the referring physician.

    So how do organizations leverage faxing to doctors’ offices? Some have contracts with doctors’ offices that include time frames for how soon results will be sent out, such as within 24 to 48 hours of the completion of the test. Additionally, organizations will offer to schedule the faxes to arrive during the nighttime hours or at a time the office deems appropriate. The office just needs to make sure its fax machine is on. All of these commitments can be configured usually through the RRD system. Some of the hospitals I have worked for have processed anywhere from 400 to 3,500 faxes within a 24-hour period. If each fax represents just a $10 co-payment, this could be a lot of money to doctors. Because doctors rely on faxes to deliver quality patient care and drive more business, you can be sure that they won’t want to work with facilities that can’t deliver faxes in a timely and reliable way.

    Prognosis: Hospitals can leverage a dependable faxing service to become the provider of choice for referring physicians.

    Next: Why faxing is the gateway for healthcare organizations to strengthen relationships with primary care physicians and ultimately promote their vision for practicing healthcare.

    Keeping relationships strong with Primary Care Physicians (PCP)

    As stated earlier, I showed why doctors’ offices have a strong reliance on receiving test results and patient information through faxes — which are sent through Millennium’s Remote Report Distribution (RRD) servers — and why it’s important for hospitals to make sure their faxes go out on schedule. Today we’ll look at another strategic importance of faxing, one that will help your healthcare organization distinguish itself from others.

    In his novel 1984, George Orwell wrote the following ominous statement related to information control: “Who controls the past controls the future. Who controls the present controls the past.” I want to present a more practical paraphrase of the quote: “Whoever controls the old technology (like faxes) will be able to drive the introduction of the new technology (like interfaces).” What do I mean? The more relationships that your organization has established and is actively sending faxes to gives you the power to drive conversations about joint ventures in connecting electronic medical record (EMR) systems through interfaces.

    Although many doctors’ offices do not have any form of EMR system, the number of “office size” EMRs has grown in the last five years and will continue to grow. As part of this conversion, I have found that larger doctors’ offices are happy to say good-bye to the piles of faxes that can often be difficult to manage. They still want notifications but are ready to move to a “paperless” environment.

    When these offices start asking you how their number of faxes can be reduced, they are giving you the opportunity to strengthen your alliance with their office. If you can successfully interface your system with theirs, you stand a good chance of merging your organization with theirs to increase your share of the healthcare pie. In any case, the result is the same: Faxes go digital.

    You might be thinking, “Great, no more RRD problems.” Au contraire, I suggest you keep your RRD servers well-tuned because faxes will be around for quite some time. Not all the information that offices request can be sent digitally. Plus, not all primary care physicians (PCPs) have embraced the paperless mindset. As long as a patient’s PCP wants to keep a paper patient record in the office, you will need to keep your RRD servers spitting out faxes. The volume of faxes that your organization spits out every day is a barometer for how much work it has in front of it to encourage doctors to move to an EMR system. The tighter your relationships, the more likely your fellow healthcare providers will listen to your vision for moving forward and working together into the digital future.

    Prognosis: “Who controls the past controls the future.” If your organization has complete control of its RRD servers and the faxes they send, you will maintain and grow your partnerships with doctors’ offices well into the future.

    Next: How to maximize your RRD investment so you have complete control over how faxing is conducted at your healthcare organization.

    Troubleshooting your RRD application

    Previously, we have looked at the important role faxes play in relaying critical information from the hospital to doctors’ offices and how a reliable fax service can improve relationships and business with these offices. Today we turn our attention to making sure Remote Report Distribution (RRD) servers, which send the faxes, are operating at peak performance.

    It’s not always an easy task — which is why when I first addressed this subject I recommended that management dedicate at least one full-time analyst to support faxing. Gone are the days that you walk over to the fax machine, set your forms on the paper feeder, type in the phone number, hit a button and away it goes. Now many processes typically occur before a document reaches the RRD queue and is ready to be made into the fax and sent on to the primary care physician.

    When training new analysts over the past few years, I often taught them the Cerner RRD application first, before graduating them to the Clinical Reporting applications. This method might seem backward, but I found it to be the most effective. With most things in the IT world, the best way to learn how to fix things is to start at the outcome and then work your way backward. If your end-users are saying they didn’t get the fax, you check the RRD server.

    RRD technology has not changed much in recent years. Because of this, RRD servers can quickly become overwhelmed when a hefty number of faxes are pushed through them. If you’re experience faxing delays or failures, I recommend you check the following:

    • Operating system. Imagine sitting at your computer all day and faxing a Word document over and over, all day and night, through the computer’s modem. At some point, you would become exhausted and would need a break to regroup and refresh. Similarly, the RRD application needs to be refreshed. Small things like clearing the memory (cache) and straightening (defragging) the files are often forgotten but can help speed up the process.

    • Fax volume. It’s important to know the number of faxes you are sending each day. If you’re sending more than your RRD servers can deliver in a timely manner, you might need to beef up your RRD servers. Remember, as I stated in an earlier blog, delays in fax deliveries can be very damaging to your organization’s relationships with referring physicians.

    • RRD services. Make sure the RRD services are running on your RRD servers. Without these running, you simply have a desktop computer not doing anything.

    • Phone lines. Another area that often gets overlooked is whether the phone lines are still active. Troubleshooting might be as simple as making sure you have a dial tone on the lines going into your RRD servers.

    • Modems. Check to see if your modem is hung and not releasing your transmissions. If you use Softek Panther, make sure the RRD: Stalled sensor is set and then check for any Error messages. These messages might indicate a problem with your modem, not your RRD system.

    • Obsolescence. Sometimes customers have fax machines that are so old that the Smithsonian is looking to add them to its collection. Ask your customers for the make and model of their fax machine, and then check to see if your current RRD application level supports that model. Keep in mind that if you are not using internal modems on the RRD server, and instead have serial modems attached to the RRD server, those serial modems might be the issue as well. Sometimes a simple reboot fixes the problem.

    As you can see, any RRD application around faxing can get hung up in a lot of areas. That’s one reason why tracking faxes for a healthcare organization is a full-time job. The next time someone tells you, “It’s just a fax,” remember you have your organization’s reputation – as well as a lot of money - riding on the fax getting where it needs to go.

    Prognosis: Faxing, although an older technology, still has in important role in today’s healthcare IT picture. Assigning a full-time member of the IT team to own the maintenance and support of these important faxing services are still key to success in discrimination of patient information.