Digital Fax 2019
What Is Possible with Digital Fax?

Measuring What Is Possible: Digital Fax Maturity Framework

Ideally, digital documentation solutions would be able to pull documents, images, and other discrete data from any source and integrate it directly into provider organizations’ workflows. If both ends of this process were digital, major data sharing and interoperability challenges could be eliminated. For example, a clinic could fax a patient record, image, or medication order from their EHR to the different EHR of a neighboring hospital, and that hospital could extract and incorporate the relevant discrete data. The technology to do this type of integration exists and is just starting to be used.

KLAS has created the following framework to help describe the current state of digital faxing, showing where vendors’ most advanced interviewed customers are on this spectrum. Most vendors have not been validated above Level 3; etherFAX, through a partnership with Vyne Medical, is the only vendor with a validated customer capable of Level 4.

Potential Benefits of Digital Fax

Cost Savings: 
Fax machines, toner, paper, machine maintenance—all of these come with costs that can add up to hundreds of thousands of dollars per year. One CIO KLAS spoke to said eliminating paper faxing would save their organization $5 million annually. Having a fully integrated digital-document strategy can also potentially create significant savings in the form of operational efficiencies. Sending, receiving, sorting, delivering, scanning, and filing paper fax documents is a people-heavy process, as are the IT efforts associated with servicing and maintaining analog technologies.

Improved Security:  
Paper faxes with protected health information (PHI) sitting on a fax machine are inherently not secure. Even records in physician inboxes, smart devices, or other queues are not necessarily protected. Automatically importing sensitive documents into patient or financial systems can eliminate some of these security concerns.

Data Sharing: 
With the right capabilities, digital fax solutions can potentially process inbound digital documents to extract discrete data (e.g., through natural language processing) and automatically insert that data into clinical or financial workflows. In such a case, information could be shared between different EMRs without point-to-point interfaces, APIs, or other interoperability methods, like Carequality or CommonWell.

Customer Experience Details

Vendor-Reported Digital Fax Capabilities

The following table shows the capabilities that vendors report to offer their customers. For detailed information on how these capabilities work, see final section below.

Looking Forward: How Will Digital Fax Evolve?

All interviewed organizations but one feel that digital fax will be a long-term part of their data-sharing strategy. Many of these note that digital fax is “unfortunately” necessary because faxing may never truly go away in the healthcare industry. To date, no vendor has been able to deliver on all of the expectations laid out in this report. What do customers expect moving forward?

What Does “Limited Data” Mean? 

Some products are used in only a small number of facilities, some vendors are resistant to providing client lists, and some respondents choose not to answer particular questions. Thus a vendor’s sample size for any one question may not reach KLAS’ required threshold of 6 unique respondents. When a vendor’s sample size for a particular question is less than 3, the score for that question is marked with an asterisk (*) or otherwise designated as Limited Data. If the sample size is less than 3, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

VENDOR-REPORTED INFORMATION 

Concord

Is this a cloud-based technology? Yes

What parts of your solution are in the cloud? 

Concord’s fax and document-handling platform is built entirely with cloud-native services. There are a small handful of ancillary utilities that must be deployed on-premises (e.g., a utility similar to a print driver), but these tools are for use cases we consider to be increasingly outside the mainstream of our healthcare enterprise customer base.

Is your solution secure and HIPAA-compliant for PHI exchange? Yes

Do you have inbound integration where documents can be routed to and attached to individual patient files with some mechanism or technology for document identification? Yes

How is this done?

Concord’s NEXSTEP suite of services delivers intelligent document-classification capabilities to help automate the manual work of sorting documents by customer-defined categories of documents.

NEXTSTEP uses different AI technologies, including machine learning, to determine the document class based on specific patterns or characteristics within the document. Machine learning begins by building a learning model to identify each document class. Once the model is built, NEXTSTEP determines the class of each document by comparing the documents with the classes in the model. As NEXTSTEP processes more documents, document classes can be retrained. Retraining rapidly increases NEXTSTEP’s ability in determining the correct class. In cases where a document is mis-classified, users can simply re-classify. By automating the classification and mapping document classes to specific workflow processes, NEXTSTEP significantly reduces the time and effort required to get documents to those who need to work with them.

Document-classification functionality automates the:

• Recognition and categorization of inbound document types delivered by fax and/or other document intake sources (e.g., scanned paper documents, PDF documents downloaded from an HIE to a designated network folder).
• Assignment of inbound documents to specific teams, departments, or work processes managing initial fax triage and document tracking within NEXTSTEP.

Following automated document categorization, documents can be assigned metadata based on intelligent automated data extraction or by manual indexing by appropriate staff.

Using API-based integration with the EMR, NEXTSTEP end-users are able select an option to perform a data look-up into the EMR.

Can your solution extract discrete data fields and insert that data into clinical, administrative, or financial workflows? Yes

How is this done?

NEXTSTEP utilizes multiple discrete OCR engines for processing inbound documents as a foundation for more advanced, AI-based methods of data identification and extraction. Each engine is optimized to execute specific conversion tasks. These engines are deployed independently but can be used in combination depending on customer conversion requirements. This approach enables NEXTSTEP to maximize processing velocity without sacrificing extraction accuracy, by selecting the best engine available for each task.

Intelligent data extraction is a process that automatically identifies and extracts key information and entities, also referred to as “relevant metadata,” from documents. Field-level patient information NEXTSTEP automatically extracts today includes:

• Patient name
• Date of birth (DOB)
• Date of encounter (DOE)
• Social Security Number (SSN)
• Medical Record Number (MRN)
• Patient-related identifiers, like patient ID, member ID, subscriber ID, account ID, etc.
• National Provider ID (NPI)

Several approaches can be used for data or information extraction. Natural language processing (NLP) along with linguistic rules play a key role when available data that machines can learn from is limited. The first iteration of NEXTSTEP, Intelligent Data Extraction, was primarily based on NLP, named entity recognition (NER), and linguistic rules. Within the past year, NEXTSTEP has embedded AI technologies, such as machine learning for internal classification, intelligent segmentation, and deep learning, to enhance extraction accuracy.

etherFAX

Is this a cloud-based technology?

etherFAX is a cloud-based platform that provides services to on-premises, cloud, or hybrid applications.

What parts of your solution are in the cloud?

All services that etherFAX provides are cloud based.

Is your solution secure and HIPAA-compliant for PHI exchange? Yes

etherFAX is a third-party validated PCI-DSS Service provider level 1 organization, and currently finalizing its HITRUST certification.

Do you have inbound integration where documents can be routed to and attached to individual patient files with some mechanism or technology for document identification? Yes

How is this done?

Through a rich variety of partner product integrations, such as Vyne Medical's Trace solution.

Can your solution extract discrete data fields and insert that data into clinical, administrative, or financial workflows? Yes

How is this done?

This is achieved through our partner integrations.

J2 Global

Is this a cloud-based technology? Yes

What parts of your solution are in the cloud?

eFax Corporate product is 100% cloud-based, which means that it does not require additional hardware, such as fax servers, or telco lines to operate

Is your solution secure and HIPAA-compliant for PHI exchange? Yes

eFax Corporate has been HIPAA compliant for many years. But most importantly, eFax Corporate has achieved HITRUST CSF certification, which is the gold standard for regulatory and security compliance in the most complex industry—healthcare. HITRUST CSF harmonizes key compliance frameworks—including HIPAA, NIST, and HITECH—with a repeatable and measurable framework, giving covered entities assurances that a product or organization is adhering to the most complex standards in healthcare.

Do you have inbound integration where documents can be routed to and attached to individual patient files with some mechanism or technology for document identification? Partially

How is this done?

eFax Router is a tool within eFax Corporate that allows configurable, inbound fax routing to folders and perform actions on that fax. However, eFax Corporate on its own does not actually attach documents to a patient file. This capability will be available in a separate product.

Can your solution extract discrete data fields and insert that data into clinical, administrative, or financial workflows? No

How is this done?

While eFax Corporate has OCR capability, the feature has not been extended to recognize forms, where data can be extracted and exported to another workflow. We expect to provide features in a future product.

OpenText

Is this a cloud-based technology? Yes

What parts of your solution are in the cloud?

OpenText is the only digital fax provider to offer on-premises, hybrid, full cloud services, managed services, and Direct messaging capabilities for healthcare. The cloud components include:

• Hybrid deployment: OpenText™ RightFax™ with OpenText™ RightFax™ Connect is a hybrid deployment that moves the telephony connections and transmission to the cloud with RightFax Connect. This is a popular healthcare deployment where the fax server remains on-premises and only the telephony moves to the cloud.
• 100% cloud-based deployment: OpenText™ Fax2Mail™. OpenText Fax2Mail includes additional HIPAA control settings for the privacy and protection of patient data.
• Fax managed services: OpenText™ RightFax™ Managed Services is a fully hosted and managed service, either in an OpenText data center or third-party cloud application, offloading the complexity of an on-premises deployment to a trusted provider to free up internal IT resources.
• Direct messaging capabilities: OpenText™ RightFax™ Healthcare Direct enables Direct-compliant electronic communications and discrete patient data transmissions between providers. Leveraging the RightFax infrastructure, RightFax Healthcare Direct provides cloud-based Direct messaging capabilities and fax-to-Direct message conversion for inbound and outbound exchanges.

RightFax also has two cloud-based optional modules:

• RightFax SMS Service
• RightFax Capture

Is your solution secure and HIPAA-compliant for PHI exchange? Yes

OpenText Fax2Mail has additional HIPAA control settings with a comprehensive HIPAA Compliance Program to meet HIPAA/HITECH requirements:

• Annual HIPAA risk assessment
• Annual HIPAA compliance audit
• Annual information security awareness training
• Annual HIPAA awareness training
• Breach-notification procedure

The following enhanced security features are also available in the cloud fax network to protect the security and privacy of protected health information (PHI):

• Immediate document deletion where the document is deleted on final disposition of message.
• Encrypted archiving where documents are archived with encryption enabled.
• No archive option for additional privacy protection.
• HIPAA viewer option that restricts unauthorized personnel from accessing and viewing customer data.

Do you have inbound integration where documents can be routed to and attached to individual patient files with some mechanism or technology for document identification? Yes

How is this done?

1. Integrated capture technology, available for both RightFax and Fax2Mail, will search for a barcode (unique to patient) or search for patient identification fields and relevant metadata, identify it, and match it to a patient record in an EMR system (via table look up) and upload the file.
2. RightFax Workflows is a new feature of RightFax that will match the patient ID on an inbound fax and metadata to a patient ID in the EMR system and upload the file to the appropriate patient record queue.

Can your solution extract discrete data fields and insert that data into clinical, administrative, or financial workflows? Yes

How is this done?

RightFax and Fax2Mail have integrated capture technology that will perform the search, extract the data and relevant metadata, and insert it into a workflow. RightFax Workflows is a new feature that can also take the extracted fields and create a workflow to perform the function based on rules customizable to the workflow.