Fax Technology is the Cornerstone of Interoperability. Here's Why.

John NebergallFax is the dominant information exchange technology in U.S. healthcare, outpacing secure direct messaging 25-to-1. Most of that is exchanged using inefficient and unsecure machines. With the emergence of cloud-based fax technology to facilitate secure system-to-system document transfer, the use of cloud fax needs to be part of every CTO's/CIO's digital strategy.

Interoperability in Cloud Fax Technology

The U.S. Department of Health and Human Services (HHS) set a vision and goal by 2024 to make healthcare interoperability a reality. A greater push for Electronic Health Record (EHR) interoperability would improve workflows and allow for faster, improved communication between medical practices around the world. Direct messaging provides data compatibility between systems and can play a critical role in the spread of EHR interoperability.

While the healthcare community continues to focus on reaching full participation in secure electronic interoperability, our current reality is that the use of traditional fax, along with network-based fax servers, still dwarfs the use of direct messaging as the tool of choice for document transfer between healthcare entities. Recent estimates are that in the U.S. alone roughly 9 billion healthcare-related faxes are exchanged annually, contrasted with between 200 - 300 million direct messages. Many of these faxes are the paper variety - insecure, difficult to track, and easily misplaced.

The evolution of fax from paper-based to cloud transmission and storage - Cloud Fax Technology (CFT) - is a key step that enables providers to comply with HIPAA and other regulations. Further strengthening CFT as a key component in Healthcare Information Systems (HIS) is its evolution into Direct Messaging platforms, enabling the seamless exchange of Patient Health Information (PHI) between the diverse data and document management systems used by labs, pharmacies, doctor's offices, hospitals, and billing providers. CFT supports and contributes to the goal of interoperability.


  • CFT documents sent as direct messages are consumed directly into EHR systems - for example, clinical summaries, lab results, immunization records, Continuity of Care Documents (CCDs), Continuity of Care Records (CCRs), and so on.
  • The application of sophisticated optical character recognition to CFT documents turns unstructured content into discrete structured data that streamlines document exchanges, leading to improved patient quality, safety, care coordination, and reportability.
  • Used in combination with a modern digital signature service, documents can easily be signed and returned via CFT while allowing significant streamlining of current print/sign/fax/scan/file workflows often used in a clinical setting.

Cloud Faxing Technology

The move from paper-based processes with multiple workflows - and numerous security holes - to an electronic document exchange model that facilitates HIPAA-compliant transmission of patient records directly into a patient's EHR chart has been nothing short of revolutionary. Healthcare Organizations (HCOs) have been able to sever ties with costly hardware and physical phone connections and take their faxing digital. Ease-of-use and secure transmission, access, and storage have been the hallmark of this technological sea-change. CFT, when correctly implemented is fully HIPAA compliant, is a green technology (eliminating paper) is highly secure and integrates seamlessly with virtually any EHR or practice management system - fitting easily into your workflows and allowing comprehensive reporting for regulatory compliance.

It is important to note that the full potential of CFT has not yet been completely realized. Further modernization to incorporate natural language processing (e.g. recognizing "STAT" written across a form) will allow prioritization based on urgency, supporting clinical decision making and optimizing patient outcomes. The ability for healthcare providers to use a production API to integrate customized CFT services into their native EHR tools, using state of the art transmission networks to facilitate high-volume traffic that adheres to rigid security and compliance standards, dramatically increases the ability for HCOs, payers, and pharmacies to communicate in a compliant electronic fashion.

Direct Messaging

Evolution of CFT as a direct messaging tool is central to the future of healthcare interoperability. Direct messaging will make it possible for healthcare providers using diverse EHR systems to send and receive CFT messages both as full documents (like traditional faxes) as well as direct exchanges of ingestible data from one EHR database to another.

Using digital IDs, the full interoperability of healthcare information systems running on different OS and database platforms is now possible. As long as the digital ID of the receiving Health Information Services Provider (HISP) is known, the CST transmission will be directly integrated into the receiving EHR. In this approach, the CST message will not be viewed as a traditional document or page but in the format of the EHR, with discrete record fields populated directly from the source document making each entry fully auditable.

This improved handling of the most commonly faxed documents (labs, prescriptions, surgical referrals and approvals) will enable healthcare providers to meet and surpass industry and Federal standards for patient record keeping and security.


Often lost in the interoperability discussion is that CFT products and APIs support the central goals - interoperability, usable data, HIPAA security, speed, scalability - currently being re-envisioned by the healthcare industry and the Federal government. The different data and document standards that have long been a performance and security gap to effective communication in the medical community are no longer true barriers; this "liquidity of data" will make the transfer of crucial healthcare records between doctors and patients, between hospitals and pharmacists, easier and more secure than ever.

About the Author

John Nebergall, is a Senior Vice President and General Manager of j2 Cloud Services Fax Business Unit.  Mr. Nebergall is an accomplished senior executive with over 30 years of operating experience in the compliance space, with a particular emphasis in Healthcare IT. Prior to joining j2, John held several executive level positions including Senior Vice President, Global Client Services and Solution Adoption at Orion Health, Senior Vice President, Client Services at Allscripts. John is a Certified Public Accountant and earned his undergraduate degree in Accounting from DePaul University and an MBA from the University of Chicago. More...