Overcoming Interoperability Challenges with Digital Fax and FHIR

Despite high rates of EHR adoption, challenges remain in the way of achieving meaningful and effective healthcare interoperability. While federal agencies continue to work on developing standards for document structure and transport to improve data exchange, they must take into consideration the care settings that depend on faxing for medical communication.  

While a modern data exchange platform — particularly one using the increasingly popular Fast Healthcare Interoperability Resources (FHIR) — is crucial to advancing structured data exchange by eliminating data entry, only certain care settings can conform to this standard, such as those with the most recent certified EHRs (e.g., larger hospitals, clinics). The same can’t be said of non-post-acute organizations: skilled nursing facilities, home health, assisted living, and clinics in underserved areas.  

Integrating digital fax into the health data exchange ecosystem is crucial to proper care coordination and delivery. To enable widespread data integration, technology is needed to bridge the gap between digital maturity levels and incorporate cloud faxing into the translation of data to the FHIR framework. 

Digital fax must be a part of interoperability conversations, particularly in areas where paper-based workflows are prevalent, such as prior authorizations, referrals, and attachments. The addition of fax to FHIR and FHIR to fax allows for transforming digital fax documents into FHIR messages and vice versa, satisfying technical requirements and facilitating information sharing between organizations.  

Digital fax solutions remove barriers to interoperability and continuity of care communications for organizations without sophisticated technology capabilities and resources. Moreover, when a digital fax can be converted to structured data, it serves as a method to reduce manual processes. 

In the final installment of this three-part series, the focus shifts to content and how existing and emerging technologies can allow unstructured data to enter the medical record seamlessly and eliminate communication gaps. 

Content matters 

The EHR Incentive Programs — or meaningful use — led to rapid digital transformation during the last decade. According to the Office of the National Coordinator for Health Information Technology (ONC), 78 percent of office-based physicians and 96 percent of non-federal acute care hospitals have adopted certified EHR technology. These were the providers that were given the incentives to implement an EHR. 

These providers are therefore using standards such as XML-based clinical document architecture for capturing and structuring clinical information into standardized document formats for clinical document exchange. The more recent consolidated CDA (CCDA) is a specific implementation of CDA that focuses on capturing and exchanging patient summaries and continuity-of-care documents. 

Those care settings that did not receive the funding to purchase EHRs are left with whatever communication tools they can use. Many today use the fax machine. This does not satisfy the objective of moving to structured data formats such as FHIR.  

Widespread adoption of C-CDA with EHR users still has challenges in aggregating data into a complete document. Proposed rules suggest the implementation of the USCDI V.3 data set, which is a subset of the C-CDA. For those underserved areas without a certified EHR, sending this required data set is nearly impossible without advanced technologies. A digital cloud fax may contain the demographic and clinical data necessary for a C-CDA or USCDI data set, but it is not structured. Using a technology solution that can apply NLP and AI to an unstructured document and extract the necessary data in a structured format can create more equitable technology solutions to cover all care settings in healthcare and not disrupt the continuity of care because one document is unstructured and the received end needs a structured document.  

A case in point 

During a recent HIMSS Interoperability Showcase demonstration titled “Document burden reduction fax on FHIR,” health data exchange experts showed how modern standards and technologies can directly impact patient care and outcomes. 

Introducing Walter. Walter visited his dentist, who noticed a suspicious area in his upper right jaw that could be early-stage cancer. Unable to reach the hospital by fax, the dentist could only tell Walter to go to the hospital without explicitly mentioning cancer. To convey the information, the dentist prints out documents, including x-rays, and marks the area of concern before giving them to Walter. The problem is that Walter and his wife don’t understand the situation, resulting in inaction. This causes challenges for Memorial Hospital, including increased costs and duplicated work when he finally presents in the ER. 

But Memorial Hospital had the foresight to do something different. The organization opted to implement eFax to send and receive faxes as well as technology that specializes in connecting healthcare applications and transforming data into a format compatible with receiving systems. In this case, faxed data becomes a JSON format. The latter takes the demographic and clinical data from the JSON structure and converts it into a FHIR message following USCDI best practices for patient matching consumable by the organization’s Epic EHR system without the need for data entry. 

Thanks to these capabilities, Walter’s dentist successfully connects with Memorial Hospital, and a specialist sees his patient. The cancer is appropriately identified and treated. All of a sudden, all the dentists in the area and other community members know that Memorial Hospital is different, treating them as a part of that care team. And providers at the hospital are witnessing an increase in referrals they never saw before and seeing their patients at the right point in their care. 

Why it matters 

A failure to close the reporting loop has severe implications for providers and patients. According to the Institute for Healthcare Improvement, as many as half of all referrals are never completed due to missing information, misdirected referrals, and faulty communication. Additionally, missed or delayed diagnoses come at a dangerous health cost to patients (12 million diagnostic errors) and a high financial price to the healthcare system ($631 million), according to recent data. 

Implementing eFax and data transformation capabilities enables healthcare providers to improve communication, reduce errors, and ensure timely and accurate diagnoses and treatments. Closing the reporting loop is crucial for patient safety and efficient healthcare delivery, as failures in communication can lead to missed or delayed diagnoses and incomplete referrals. 

The challenges to interoperability are numerous but can be overcome by addressing data exchange issues equally for all caregivers. By replacing paper-based faxing with digital fax technology as a starting point and leveraging advanced platforms like FHIR, the healthcare industry can move closer to achieving seamless and effective health data exchange at an attainable investment point. Such advancements level the playing field and ensure health equity while improving patient outcomes and experiences.

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See the other articles in this series:

⁠Why a Data Exchange Platform Is Vital to Healthcare Interoperability

⁠Enabling Healthcare Interoperability with Fax to FHIR Solution