The NHS announced that it is banning the purchase of fax machines next month with the aim to phase them out entirely by April 2020. This was met with near-universal approval on social media among physicians, policy-makers and patients. At ConsultLoop, we are certainly pleased to see this as well, but believe that a more careful approach is needed to be effective.
ConsultLoop was started to address gaps in communication between healthcare providers. As family doctors new in practice, we were surprised at how commonplace these gaps were, and how universally accepted they seemed to be. Since virtually all communication between doctors’ offices occurs by fax, this had to an important area to learn more about.
We came across a study done in Hamilton, Ontario, which reported that 21% of all faxed referrals “get lost”. We read the news stories about patient records being faxed to a wrong number for years. We then decided to create a referral platform to replace the fax.
With the announcement of the NHS’ ban on new fax machines, the question is whether we will see the same change in Canada. Let us first ask why we are in this situation to begin with. As Andre Picard rightfully points out, “… the single biggest impediment to banning the fax is that the computer systems and electronic health records that we have are rarely able to communicate with each other. Interoperability has not been a priority and that has left us beholden to largely paper-based technology.”
Given that our computer systems don’t talk to each other, and have no incentive to do so, let’s ask how we can wean off, rather than axe, the fax. Yes it’s less dramatic, but it’s possible, and possible now, and much more promising.
The ConsultLoop platform helps clinics manage the referrals that they send and receive by providing a simple dashboard that shows the status of all referrals, and what the next step is. This also includes a patient notification system, so that patient can track the status of their referral much like they would track delivery of a package, and get email or text-based notifications. We also developed Ontario’s largest specialist directory that includes clinical scope of practice, wait times, and response times. (We published a report last month on wait times and response times for 26 specialties.) In October 2018, we reached a milestone of 25,000 referrals.
So how do we as a health care system move on from fax? Well, given that EMR companies in Canada do not readily integrate with third-party vendors like their international counterparts do, we chose to augment rather than outright replace the fax. After all, a key feature of any new system is that it must facilitate communication to anyone in the healthcare system. A purely digital system would remain unused otherwise – imagine Ebay with no sellers, AirBnB with no apartments, Uber with no drivers.
ConsultLoop works best when the sending and receiving clinic are on the platform. They can write messages to each other, for example to request additional information, can reply to referral requests within the platform so it’s instantly communicated to the patient and referring clinic, and of course all this is secure, encrypted and audited for patient safety and privacy. When a specialist is not on ConsultLoop, we will send the referral along by fax, but augment it in four key ways:
- Every referral is sent to our one fax intake number – no wrong numbers, changed numbers, etc.
- A referral is flagged until the referral documents are received by the sending clinic.
- We perform audits of our e-fax logs twice a week to ensure all transmissions were successful.
- We send a follow-up fax at 2, 3, and 4 weeks if the referral has not been booked, often re-sending referrals lost in the pile of papers at the specialist’s office.
- (For some paying customers) We will call the specialist’s office to follow up, which we can do at scale for all our customers who referred to that office.
We are creating a digital platform for referrals, and eventually, all communication between offices. Right now, we, like other new-wave digital health companies, are beholden to EMR integration and the lack of it. However, we are providing an essential security layer above the fax, and as more clinics join the platform, we will evolve into a fully digital communication system for clinics, doctors, and patients. Whether EMRs participate is their choice to make.
We should aim to #axethefax. But a fax-free future begins by augmenting it with a digital layer and slowly cutting the ties that bind. After all, the fax is universally accepted, and for a digital platform gaining traction, that’s an essential feature. Let’s move on from fax with with surgical, rather than lumberjack precision.
To learn more about how ConsultLoop can add security, efficiency and transparency for your clinic-to-clinic communication, email us at firstname.lastname@example.org.