Enabling Healthcare Interoperability with Fax to FHIR Solution

Part of operationalizing TEFCA, as a section of the 21st Century Cures Act, includes the adoption of Fast Interoperability Healthcare Resources (FHIR) by qualified health information networks (QHINs) to facilitate health data exchange among healthcare organizations (e.g., providers, payers, public health agencies).

As noted in the first installment of this three-part series, FHIR has become a growing health IT standard and application programming interface (API) among regulators and developers, but the use of FHIR alone will not enable widespread health data exchange across the continuum of care. That’s because fax remains a dominant mode of health data exchange, accounting for 75 percent of all medical communication.

For FHIR to help healthcare organizations — from networks enabling information sharing to end users having access to actionable information — it must include a mechanism for enabling health data exchange with differing levels of digital maturity.

“The impetus to mandate healthcare communications through FHIR must answer an important question: How does fax fit into that framework?” Matthew Baker, Associate Director of Product Management at Consensus Cloud Solutions, says. “On the surface, it doesn’t. But the technology now exists to transform digital fax documents into FHIR messages and vice versa that satisfies many technical requirements for QHINs and the technological capabilities of the various organizations sharing sensitive information.”

This is the rationale behind developing fax to FHIR as a data sharing solution that can ensure more messages can be consumed by the receiving party and acted upon.

“Fax is largely ignored in the industry, especially in the integration space, but it needs to be considered. Helping people communicate is interoperability,” Baker maintains.

“We’re seeing with TEFCA that FHIR is going to be pushed on both ends,” he continues. “The focus is going to be on health systems and how they are going to be able to meet regulatory requirements with the use of a certified EHR. What’s forgotten with meaningful use and likely to be ignored into the future are those smaller organizations — such as home health organizations, skilled nursing, long-term care facilities, and post-acute care settings — that did not receive those incentives and haven’t upgraded their technology.”

Power of the lowest common denominator

The health data exchange ecosystem gets to the heart of interoperability, and digital fax should be a part of that solution, as it enables care coordination and delivery based on timely information. Fax to FHIR and FHIR to fax allows both the sender and receiver to benefit.

The power of fax to FHIR is becoming apparent in areas where paper-based workflows are prevalent (e.g., prior authorizations, referrals, and attachments). Federal officials have signaled their intent to digitize these processes moving forward.

“In the case of prior authorizations and referrals, we’re now able to capture content — paper, PDFs, or scanned files — and fit those into current processes automatically by first digitizing and then extracting the content using AI and then transform that information into data elements that can be consumed into an EHR or health IT workflow,” Baker explains. “A fax can flow as structured data into the patient chart the same way an HL7 message would. From the hospital's standpoint, they see information within their systems without knowing that the originating content was a fax or PDF. We are able to additionally send the original document with the structured data so the original source can be reviewed if desired.”

Those healthcare organizations relying on digital fax encounter fewer barriers to entry to participate in effective health data exchange.

“The healthcare industry must focus on meeting people at the lowest level of technology they are comfortable with,” stresses Baker. “Faxing makes the barrier of entry very low. Whereas a new EHR requires training, the fax is known for its ease of use. If you give somebody a piece of paper to fax,  it’s highly likely it can be done without training , and a digital fax is just as easy to use.”

Furthermore, a digital fax remains a reliable backup method, proving the importance of considering the technology as integral to interoperability.

“We’ve got these great digital workflows and pathways where data can go, but the second that something fails, it always falls back to scanned documents or even to paper,” adds Baker. “How can we get that fallback plan to be digital as well and get the error to flow back into the normal flow after it falls out? This is where digital fax shows its strength, especially when combined with FHIR to reduce the amount of paper and manual processes.”

An essential part of integrating digital fax into the health data exchange ecosystem centers on educating the market. According to Baker, healthcare organizations tend to treat their interface engines and fax servers (local or cloud) as separate operations serviced by different teams. Bringing the two under one roof gives these organizations a more robust platform for sharing and utilizing information to improve patient care and outcomes.

Stay tuned for the third and final installment of this three-part series to learn how emerging forms of technology can be brought to bear on digital faxing and medical communications.

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See the other articles in this series:

Why a Data Exchange Platform Is Vital to Healthcare Interoperability

Overcoming Interoperability Challenges with Digital Fax and FHIR