Ax the Fax, or in Praise of Interoperability

Posted on Tuesday, May 5, 2015 under Healthcare

By Jim Murphy Vice-President Healthcare Strategy & Business Development

A couple of years ago while at a conference I was given a button that read Ax the Fax, Support Telemedicine.   At the time I liked the simple message that telemedicine, “the delivery of healthcare solutions at a distance” should replace faxes. At the time however, it seemed to me that comparing telemedicine to fax communication was a bit simplistic because of the breadth of services that could be delivered by telemedicine vs what was accomplished by sending a fax. As I began to think about it, how else does one share paper documents and even images in much of today’s healthcare system in real time if not by fax?  Then I asked myself “how many faxes do we send in a year” and was amazed by the answer.  At Sykes Assistance Services our telehealth division provides services that are available to almost 18 million Canadians.  As a means to provide continuity of care we communicate with sites and agencies that help us support our users.  These sites include public health agencies, counsellors, emergency departments, primary care sites or ambulance services.  The rationale for the communication is to help to eliminate duplication of services, to facilitate diagnosis, to support advanced access or to make it so that our clients do not have to answer the same questions over and over again. 

How Many Faxes?

Each year we send approximately 160,000 three page faxes to emergency departments which represents about 18 to 20% of the people that call our telephone triage services. To provide information to primary care providers we send an additional 100,000 faxes for programs where we provide after-hours service to callers on behalf of their family practice team. This equals 780,000 sheets of paper and based on information that can be found at represents the wood of about 94 full-grown trees. While we are concerned about the environmental impact of using paper to transmit the outcomes of our services we are even more concerned about the impact of this on the quality of our communication. By definition our facsimile based communications are not easily integrated with the patient’s health record and often do not even get inserted into their file. If we want to be a true member of the patient’s provider team we must be able to contribute to what has become known as an interoperable electronic health record (iEHR). Today the quality of our intervention is based almost entirely on the information that we are able to obtain from the caller during the call. Here are just a few examples of how we could both contribute to and learn from an iEHR.

  • We could improve access to primary care by directly booking appointments for people that need to be seen within the next 24 to 48 hours after they contact us.
  • By having access to the caller’s health history we could provide a more informed assessment and clinically appropriate care advice.
  • We could more effectively support patients after they have been discharged from hospital if we had access to the discharge plan
  • We could help interpret physician orders, the results of diagnostic tests, and other aspects of the patient’s care plan
  • We could actively participate in a patient self-management support process by coaching patients in between offices visits.
  • We could improve practice efficiency by helping to remind patients about upcoming appointments, diagnostic tests, etc.

In 2012 in an attempt to be prepared for what we believed to be the imminent transformation of the Canadian healthcare system precipitated by the implementation of an iEHR we invested in the capability and infrastructure to support real time standards-based integration.  

We see near real time integration, especially into primary care, as the best way for our telehealth solutions to add value to the patient experience. When integrated with primary care services we will be able to extend the reach of multidisciplinary teams in terms of the scope and hours of their operation as well as the locations of the patients to which they will be able to provide service.

Imagine a family practice where you would never get a busy signal, where you could talk to a member of the care team at any time of day or night, and that person could book you an appointment, help you understand about your condition, help you find your way in the system and finally to help you make difficult decisions about your care. We could go a long way to providing just these types of solutions if only we had the access that would help make us a true partner in the patient’s care. The technological aspects of this are available today. So let’s axe that fax.