Viewpoint

Get the Fax Straight

High quality, accurate documentation has long been a cornerstone of both patient care and the business side of modern medicine. And nowhere is this more true than in a hospital setting like the Medical University of South Carolina Medical Center, where collaboration and information sharing between referring physicians, residents, specialists, hospital staff, the business office, insurance providers, and others is an absolute. Treatment of a single patient often requires passing that person's medical history, insurance card information, referrals, verification documents, and other notes on to several parties. Multiply that by thousands of patients and it becomes a huge volume of information going in and out of the hospital on a daily basis. 

Because of the requirements for security and privacy in the Health Insurance Portability and Accountability Act (HIPAA), the bulk of this information must be transmitted via fax. According to current law, other document sharing tools (particularly e-mail) are too vulnerable to being intercepted without having a costly and complex secure messaging system in place, thereby putting patient privacy at risk. Faxes are considered more secure since they cannot be pulled out of cyberspace. In addition, doctors are often reluctant to give their personal e-mail addresses to hospitals, insurance companies, and others for fear of having their inboxes inundated.

Still, sending information via fax machines is not without risk. Misdialing a fax number can cause a patient's records to be sent to a car dealer instead of a consulting physician's office. Inbound paper faxes can be lost, misfiled, or delivered to the wrong person (e.g., cases where there are two Dr. Browns on staff). And the sheer volume of paper required to print all those faxes is also costly, going against mandates both for fiscal and environmental responsibility.

We've experienced all these concerns at the Medical University of South Carolina Medical Center, at scale. Describing the number of faxes we send and receive as "high volume" is like saying a jet engine at full power is "loud." It doesn't begin to explain the enormity of the number of faxes being processed each month. The Medical Center receives roughly 50,000 and sends another 10,000 faxed pages each month, with the number of outbound pages scaling up. That's a lot of paperwork to manage, if we were to do all this in hard copy. Just keeping fax machines loaded with paper and toner could be extremely labor intensive. And the priority of getting the faxes to the right people in the right departments is no small matter.

The concerns don't end even when a fax is properly delivered. Medical issues tend to have a long shelf life. Information that was contained in a fax, especially background data such as a copy of the patient's insurance card, might be needed six months or more later. It could be extremely time consuming to track down the right fax within all the paper files spread all over a large medical center. With no way to search electronically, you'd have to go into the file room, start digging, and hope that with luck you'll find the paper fax quickly.

While it was clear to us for years that we needed to move to electronic faxes, we didn't want to get into managing fax servers. We wanted an outsourced service, where we could get some help with development, and once it was running all of the technical management would be handled for us. We found such a service and made our move a little more than three years ago.

Because of the size of the project and the pressing need for searchability, we decided to start with inbound faxes. Our MyFax solution went live after six months of planning and development time, and it has now been in service for three years. The outbound fax service component was launched at the end of 2007. MUSC Medical Center currently has 40 fax numbers feeding 76 fax queues; its old fax numbers are forwarded to the new MyFax numbers, eliminating the need for people outside the Medical Center to change their old habits.

When faxes come in they are tagged with medical record numbers. If required, critical patient information is pulled in from the medical records system. The faxes are then routed automatically to the right department by software that scans the cover sheets and determines where they should go, regardless of the fax number it was sent to originally. This capability not only helps improve efficiency; it also helps reduce potential HIPAA violations.

Once a fax gets into the queue it is monitored on a regular basis, and the appropriate action (such as attaching it to a patient's chart) is taken. When the fax has been properly delivered it is marked complete, taken out of the queue, and stored electronically.  Assigning medical record numbers also helps MUSC Medical Center locate faxes weeks, months, or years later.  Because they are electronic files the faxes can now be searched by number, patient last name, or other criteria, taking a process that used to require hours or even days down to one minute or less.

The move to electronic faxes has had a big impact on outbound faxes as well as inbound--particularly in helping reduce potential HIPAA violations. Making sure we had the right fax numbers for all the physicians we work with was a huge issue in the past. Physicians move their offices and/or change their fax numbers for other reasons all the time. We now have a central database called Doctor Manage that we use to keep numbers up todate. It's tied into MyFax in a way that lets users type in the first few letters of the doctor's last name, or the first few digits of the phone number, and then the right fax number fills in automatically.

We've also reduced paper consumption by a total of almost 60,000 sheets per month--that's nearly three quarters of a million sheets of paper per year. And we're saving the energy needed to power all those separate fax machines plus many other associated costs of operating and maintaining them.

Staff who use the service get hooked on it. And the support we've received from MyFax has been beyond excellent. I wish all enterprise-level tools worked this smoothly and were supported this well.


About the Author

Sujit Kar is the IT manager for business development and marketing services at the Medical University of South Carolina Medical Center.

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