To Advance Health Equity, We Must Stop Shaming Fax

In the push to accelerate data interoperability, “ax the fax” is a common battle cry. Many healthcare stakeholders view fax — or the healthcare industry’s overreliance on it — as an obstacle to seamless information exchange. 

What leaders in this space sometimes forget is that there are many healthcare players that don’t have a choice but to use fax. These include healthcare’s “digital have-nots,” organizations like post-acute care facilities, substance use disorder clinics and birthing centers that weren’t eligible for EHR implementation incentives and can’t afford the high cost associated with EHR adoption.

Unless we acknowledge the essential role fax still serves in these facilities — and invest in tech that bridges the gap between digital fax and the EHR — we will struggle to advance health equity. Without equal access to information that can improve health outcomes and quality of care, the health of communities will suffer.

Health equity depends on tech equity

Bashing fax has almost become a luxury belief in healthcare. Federal officials, health startups and even healthcare organizations point to statistics such as, “healthcare organizations fax more than 9 billion pages of information each year” and “seven out of 10 hospitals still rely on fax to transfer records or prescription orders.” They then use these numbers to point out what’s wrong in healthcare.

But “ax the fax” proclamations often fail to distinguish between paper fax machines, which should be sidelined in healthcare, and digital fax.

The truth is that there are many healthcare players for which digital fax — not the paper fax machines of old — remains a vital conduit for health information. When we as an industry fail to recognize that reliance on digital fax is necessary for these “digital have-nots,” we judge unjustly. And it’s this attitude of tech superiority that holds our industry back from applying pragmatic solutions that already exist.

We witnessed a sharp divide in feelings about fax during two of the industry’s largest conferences, ViVE and HIMSS, this year. One leader shared during a ViVE panel that he gets “intense nausea whenever I have to look at that [cloud fax] contract that we sign every year.” Yet during HIMSS, a medical records administrator for the organization acknowledged that nurses in community care still need a simple fax service to be able to perform their work efficiently.

Same institution. Two worlds: an executive leader on the stage and a medical records administrator in the field. 

The disdain for fax in all its forms isn’t new. But at a time when small healthcare organizations struggle to afford an EHR, the question remains: Who are the digital haves to judge the digital have-nots? 

Eliminating the health tech blame game

It’s time to face reality. Fax isn’t going anywhere anytime soon. So while we continue to promote FHIR and new means, protocols and standards of communication, we also need to look for ways to bring digital fax into the interoperability fold. 

One of the most practical ways to achieve tech equity is by applying artificial intelligence (AI) — specifically, natural language processing (NLP) and machine learning (ML) — to digital fax. AI can transform even handwritten notes sent via digital fax into structured data. This ensures the data can be consumed easily by any system. It’s a process known as intelligent data extraction, and it can also be applied to PDFs and other images that contain unstructured data.

This capability is critical to making more information available to clinicians at healthcare’s digital have-not facilities faster. It’s also vital in telling the story of the patient. And, at a time when 80% of healthcare data is unstructured data — data that isn’t captured or stored in a standardized format — AI is an affordable, practical solution that matters for both tech equity and health equity.

Upleveling digital fax with NLP and ML is an affordable approach to closing the gap between healthcare’s digital haves and have-nots. It’s an investment that healthcare’s digital “haves” should consider making on behalf of their smaller, under-resourced counterparts to ensure all stakeholders have the information they need to make informed decisions around care and treatment. Only then can we take significant steps toward achieving tech equity — and with it, health equity.

In a highly fragmented and regulated industry like healthcare, technology adoption is slow and always will be. We have to prevent the different velocities of technology deployment from impacting patient care and strive for more, not less, health equity. Bridge fax to new tech; don’t shame it. Shaming only drives the divide. It doesn’t deliver solutions.

Photo: horstgerlach, Getty Images

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