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Digital Fax 2019 Digital Fax 2019
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Digital Fax 2019
What Is Possible with Digital Fax?

author - Doug Tolley
Author
Doug Tolley
author - Sam Eaquinto
Author
Sam Eaquinto
 
January 14, 2020 | Read Time: 14  minutes

Current Time Inside Cache Tag Helper: 6/25/2022 2:47:29 PM and Model.reportId = 1596

While healthcare industry buzz tends to focus on flashy technologies and new approaches to care, many provider organizations are still combating a highly analog problem: eliminating paper faxing.  While exact estimates vary, most medical communication still relies on faxing, even with nearly ubiquitous EHR adoption. This report provides a unique look at digital fax solutions, which aim to support a fully digital documentation strategy. Vendors offering these solutions tout their ability to reduce costs, address the security concerns of paper faxing, and even solve interoperability challenges. How well do they deliver? KLAS interviewed organizations identified by vendors as their most advanced users in an attempt to understand what is possible with digital fax solutions.

“The fax of life: Why American medicine still runs on fax machines,” Vox
“90% Healthcare Providers Still Rely on Fax Machines, Posing Privacy Risk,” Health IT Security

HtmlReportContent Current Time Inside Cache Tag Helper: 6/25/2022 2:47:29 PM and Model.reportId= 1596 and Model.HtmlReportContent_LastWriteTimeUtcInTicks=637534323006982789

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.

digital fax maturity framework

Potential Benefits of Digital Fax

icon1

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.

icon2

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.

icon3

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.

No Validated Deployments Using All Promised Capabilities 

See charts below for details on vendor-reported capabilities.

concord

All five customers KLAS spoke with are using Concord’s cloud-based solution. Organizations are able to use system metrics to monitor the product’s usage and performance. They have also established EMR integration so that they can send digital faxes out within the EMR workflow, and for Allscripts users, faxes can be pulled into the EMR and, upon user verification, added to the patient record. Allscripts users are also able to automatically route inbound notes to defined folders based on document title; if the title is not in the exact specified location, the fax must be reviewed manually.

etherfax

etherFAX shared a very short list of advanced customers, so validation of their technology is based on insights from only two interviewed customers. The most advanced client reports that while they have the technological capabilities for bidirectional, discrete data integration with the EMR, they have opted not to take this route due to internal HIM and security concerns. This organization, who is early in their use of etherFAX, plans to refine their workflows in the future to take advantage of those capabilities.

j2 global

KLAS spoke to two healthcare provider organizations using J2’s digital fax solution (many of the advanced customers J2 shared are not primary caregivers). From these interviews, KLAS has validated that J2 customers can integrate their solution with the EMR to send out faxes. Respondents also say the vendor has shared a road map for incorporating OCR technology to route incoming faxes to patient records and extract discrete data into patient charts. While this functionality is not yet live for either responding organization, they don’t anticipate needing a third-party solution to get these capabilities.

opentext

Interviewed OpenText customers are reaching the highest levels in the Digital Fax Maturity Framework, but these customers use third-party applications to achieve these capabilities. Through these outside solutions, the organizations use OCR to route faxed charts to the correct patients and pull discrete data elements into the EMR. Human oversight is used as an added quality measure to ensure all documents are handled correctly, though no manual work is required for documents to be routed or data to be extracted. Customers not using third-party applications have not been able to achieve inbound or discrete integration. These organizations can send faxes from clinical or financial applications (e.g., through EMR integration).

Highest Validated Level of Digital Fax Integration: etherFAX and Cerner 

highest maturity level validated by emr in use

In order to reach the highest levels of KLAS’ Digital Fax Maturity Framework, data from a fax document must be integrated with clinical, financial, and other core workflows. KLAS asked respondents specifically about their level of clinical workflow integration. Only one technology combination—etherFAX and the Cerner EMR—was validated as enabling a bidirectional flow of data (incoming and outgoing faxes) as well as discrete integration of clinical data into the clinical workflow. With other combinations of fax solutions and EMR vendor environments, respondents are able to send out faxes; however, no other vendors have demonstrated the ability to ingest, parse, and utilize digital document data. Multiple vendors have shown some outbound faxing capabilities with Allscripts, Cerner, Epic, and NextGen Healthcare EMRs.

Across the Market, Products Generally Strong; Improvement Needed in Customer Support

Across vendors, a few metrics stand out as strengths: overall product quality, product works as promoted, and quality of implementation. Few organizations have had problems getting their solution up and running. The most advanced users are especially likely to report their solution works as expected. Additionally, nearly all organizations say their fax solution is secure, though few have actually tested the security.

quote1

Areas for improvement for most vendors tend to be service-oriented metrics, like quality of phone/web support, quality of training, and executive involvement. Customers report inconsistency in their experience with this type of vendor support as they try to work through issues. The exception is Concord, whose customers report helpful resources and good service.

quote2

For most organizations, digital fax is a basic technology that they simply set up and leave alone, but a few see potential for it to do more. There is a lot of room for vendors to communicate about and deliver advanced capabilities to get their customers above Level 2 (Outbound Fax Integration) in the Digital Fax Maturity Framework; only a couple of the most advanced customers KLAS spoke with had any idea that they could expect their digital fax solution to get them so far.

Customer Experience Details

compliance with security expectations & help executing strategy - all vendors combined
customer-reported levels in maturity framework
vendor helpfulness in executing strategy
overall satisfaction distribution
helpfulness in executing strategy vs. average respondent maturity level

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.

vendor-reported digital fax capabilities

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?

future outlook of interviewed organizations

Plenty of work remains for digital fax to become a more strategic solution, beyond solely acting as a replacement for analog faxes. However, this early research has found that there is potential for the transition from analog to digital faxing to help provider organizations solve the problems of data sharing and interoperability. While the use of digital fax technologies to deliver more advanced levels of interoperability shows promise, vendors are still in the very early stages of bringing their intelligent automation capabilities to market.

About This Report

The data in this report was collected over the last 12 months; the number of unique responding organizations is given in the chart to the right. Interviewed provider organizations shared both what types of digital faxing technology they have and performance ratings for their vendor solutions regarding product, service, and other types of metrics. With a couple of exceptions, organizations interviewed by KLAS for this research are those identified by vendors as their most advanced users.

standard evaluations

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.

organization size
respondent job level

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.

author - Amanda Wind Smith
Writer
Amanda Wind Smith
author - Jess Wallace-Simpson
Designer
Jess Wallace-Simpson
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2022 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.