First, Eradicate Polio, Then The Fax
By Mike Hurley, healthcare industry manager at Hyland
Polio, A Case Study For Mobilization
According to the Gates Foundation, polio paralyzed over 350,000 every year, mostly young children, through 1988. Since then, the Global Polio Eradication Initiative (GPEI) mobilized and launched an immunization campaign that has immunized nearly 3 billion children. Because of that, polio is down 99 percent since 1988. It has been eliminated in India and currently exists in only three countries: Afghanistan, Pakistan and Nigeria. It took awareness, careful examination of the facts and tireless, sustained action by the GPEI, the World Health Assembly and organizations like the Gates Foundation. Last year, there were fewer than 40 cases reported worldwide.
While polio hasn’t yet been completely eradicated, it’s hard to argue with this success. How did we beat down this terrible disease?
Here is one theory: polio is an obvious villain. Eradicating polio reduces human suffering. It is a global, bi-partisan, humanitarian, fiscally conservative, socially progressive and environmentally sustainable cause. It requires no grand bargain between feuding political factions, no sub-committees, no repealing and no replacing. It requires focus, determination, persistence and the political will to eliminate it.
A couple of months back I saw Bill and Melinda Gates featured on “CBS Sunday Morning,” discussing the Gates Foundation’s work with polio. They said it was an excellent example of how, as a society, we can gather the political will, courage and hard work to take on a healthcare issue. Recently, I met with advocacy groups, state representatives and senators to discuss moving the needle on improving healthcare in Ohio. Thinking back to that segment, it became clear to me that there is something simple and non-partisan that we can do that will meaningfully improve patient care while substantially reducing healthcare costs: We need to eradicate fax machines from the healthcare industry.
Fax machines do not improve wellness in this country — they impede it. Ask any clinician, nurse, doctor or health insurance claims examiner and you will hear the same refrain, “I hate fax machines.” It’s one of few issues that hospitals, doctors, lawyers, government representatives and health plan executives equally agree on. So, how did we get here?
Why Do We Fax In Healthcare?
In spite of the fact that most people involved in healthcare detest the fax, it is important to understand the two primary reasons healthcare uses the fax:
Wellness (Clinical): Clinicians send medical documentation for a variety of reasons. Since most electronic medical record (EMR) systems do not talk (i.e. interoperate) with other systems, fax remains a primary means by which doctors and nurses collaborate. Even if EMRs could “talk,” health plans typically do not have access to provider EMRs and the doctors and nurses who work for health plans send medical documentation as well. Faxes dominate payer areas such as care management, disease management, prior authorizations and other clinical activities. Money (Payment): Like you, doctors, nurses and hospitals need to pay their bills, too. Health plans make sure healthcare dollars correctly go to providers and often want medical documentation to support office visits, procedures and prescriptions.
Should We Blame 19th Century Scotland?
The fax machine was patented by Scottish inventor Alexander Bain on May 27, 1843. He called it the “electric printing telegraph.” The first commercial fax service was introduced in France in 1865, 11 years before the invention of the telephone. Yes, our healthcare system operates on a technology that is almost 175 years old and predates the telephone.
The fax has had modest tweaks throughout the next century until Xerox fully commercialized the technology to the business marketplace in the early 1960s. In the 1980s, computer faxing was invented, and now many faxes transmit to or from fax servers. Even though the fax machine has seen updates over the past almost two centuries, the fax still has some major flaws for healthcare.
Surprisingly slow: While, on average, it only takes 1.7 seconds to send a single page via fax, it often takes several minutes to print and prepare a cover page. Of course, once sent, it’s common to spend additional time gathering the fax from a public machine and confirming receipt via phone or email. The recipient has a similar experience. In their simplest forms, paper faxes spill out of a centrally located fax machine and workers must then distribute them. They then need to be reviewed, possibly re-routed and before being keyed into another system and filed in a paper filing system or scanned to an electronic repository.
While you might think the opposite would be true, the process can be even more time consuming if computer-based fax servers are involved. Inbound faxes take a great deal of time. Often, they’re delivered to an email address from which they must be routed to the appropriate reviewer’s inbox for review before being keyed in and filed.
When taking into consideration all of the related tasks, a single fax may take up to 10 minutes per party. Considering that, in a clinical setting, faxes might hold the medical fate of a patient in the balance, 20 minutes can be a lifetime. Faxes also slow down the administrative side of healthcare. Specifically, faxes prior authorizations, claims and a number of other administrative activities that keep healthcare financed.
Deceptively expensive: We rarely take into account the true costs of faxing. First, the labor cost. In a clinical setting, using a fully blended and burdened cost mix of clerical, nurse and doctor labor, we can ballpark about $40 per hour. Using the crude math above, it is fair to assume that to send or receive a fax is $6.67 in labor costs alone. Now, while it’s important to note the lost opportunity costs of having a nurse or doctor push paper rather than attend to the care of patients, we won’t factor that in here.
The fax machine (or server), phone line(s), machine maintenance and consumables like ink and paper all have hard costs. Let’s estimate that it adds $2 to each fax. Add these to the labor costs and you approach $9 per fax. Add 10 percent to account for paper jams, resends, lost faxes, unreadable faxes. Now, we’re looking at $10 per fax. With some organizations sending and receiving thousands of faxes each day, this quickly adds up. And, it does not factor in any medical complications that may have been caused by faxes delaying necessary clinical actions.
Hackable and unsecured: While an enormous amount of Protected Health Information (PHI) distributes by fax each day, faxing is simply not secure. Most fax machines are centrally located for productivity reasons. In these locations, faxes are easily visible to those who should not have access. They could be misrouted, lost, misplaced or stolen. Faxes fail miserably in this most basic layer of security.
Aside from not being physically secure, the vast majority of faxes aren’t encrypted. Anyone who can use Google and has some basic understanding of telephone technology can intercept and read just about any fax. In the past, an argument could be made that in order to hack a fax, one would need to tap a phone line – a difficult technical task. Now with many (most) phone lines traversing the internet, this traffic is easily intercepted. Who’d want to know about your yearly checkup you ask? The same person who wants to tap into your bank account. All your personal information is valuable to a hacker.
Do We Need The Gates Foundation To Eradicate Faxes From U.S. Healthcare?
With so many solid, factual reasons to eliminate fax, how do we get started? Do we need the Gates Foundation? Or start a Global Fax Eradication Initiative? No. But, we do need to begin taking a few simple, actionable steps to get us started down the path to eliminating the fax from U.S. healthcare.
With over 17 million fax machines in the U.S. alone, it will be not be an overnight obliteration, either — but it can, and should, be done. It only requires a simpler, faster, less expensive, and more secure solution to take its place.
About The Author
Mike Hurley is a healthcare industry manager at Hyland. For the past four years, he has been part of a team focused on eliminating fax machines from healthcare to improve wellness and reduce cost with a solution that (literally) does not require an Act of Congress. You can reach him at mike.hurley@hyland.com.