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Feeling overwhelmed by faxes? Try this doctor’s fix: a mix of technology and diplomacy.

Fam Pract Manag. 2005;12(3):76-77

When our practice’s fax machine, once a symbol of office efficiency, recently turned into a practice-choking monster, we had to act. What started as a trickle of patient-specific faxes had expanded over the years into a flood of paper.

To fight the resulting administrative condition, which I diagnosed as “fax-o-rrhea,” our office used a mix of 21st century technology and old-fashioned diplomacy. It’s a solution that could work for your practice, too.

Too much information

Our office, Skyline Family Practice, opened in 1994 with an integrated electronic health record (EHR), scheduling program and medical billing program. Our telephone system and our facsimile machine were vital pieces of business equipment. However, the amount of incoming fax traffic and the necessary outbound faxes had escalated exponentially over the years.

To get a handle on who was sending us so many faxes, we mentally sorted them into two categories: medically related faxes and unsolicited junk. Medically related faxes were being sent to us by insurance carriers, pharmacy mail-order companies, nursing homes, hospitals, home health agencies and other doctors’ offices. The junk messages were being served up by stockbrokers with tips, restaurants with specials, salesmen with real estate offers and the like.

An automatic solution

We operate a highly automated office (we have a computer in every room except the bathrooms and the reception area), so it made sense to seek out an automated solution. Our answer was digital faxes. These require both a computer hooked up to a phone line and a computer program to digitally process the inbound/outbound faxes. (There is a bit more to it than that, which I’ll explain below.) Our search for a computer program led us to Zetafax. This program allows us to receive faxes digitally, annotate and digitally sign them, and send faxes digitally. It is also compatible with our EHR, Practice Partner. There are many similar programs on the market, such as RightFax and WinFax PRO; take some time and make sure you buy a product with capabilities that fit your office.

The diagram below shows how our software is set up on our network. As you can see, this made it easy for our “fax receptionist” (a staffer who can see all our incoming faxes on her computer) to receive, review and forward the faxes to the appropriate person’s computer. Junk faxes are promptly moved to a virtual trash can, never getting the chance to waste paper or toner. In addition, because we have an EHR that is accessible from every computer in the office, any specific patient-related faxes can be checked against the patient’s electronic record.

To begin our fax conversion, we needed a computer with two fax boards (one for incoming faxes, one for outgoing) and two phone lines. You could get away with one fax board and one phone line, but having two boards allows free fax flow in and out of the practice.

The software setup was not difficult once the hardware and the phone lines were installed. A cover page is set up on each computer, and we added all the phone numbers we commonly use. Also, by using the software to set up a “letterhead,” you can attach a digital signature to forms you may use in the practice. For annotating faxes you receive, creating a digital signature is a piece of cake: The doctor signs a blank piece of paper, the signature is scanned and saved as a JPG image, and the image file is added as a “rubber stamp” (that’s what our fax software calls it).

Our Digital Fax Set-Up

Fixing the faxers

With the volume of paper now under control, we turned to reducing the volume of incoming digital faxes. This required convincing outside offices to alter the way they communicated with us and our patients. In some cases we had to be diplomatic with our request, and in some we simply told them how things were going to be.

Mail-order pharmacies. Some of our biggest fax abusers were national mail-order pharmacies sending us formulary changes. We notified these companies that we would not respond to their faxes and instructed them to have the patients contact us for an appointment.

DME companies. For some of the durable medical equipment companies that offer our patients “free” diabetic supplies, we tried a different tack. We realized patients use these companies to cut costs on needed supplies. Rather than ignore these faxes, we decided to charge patients $10 to $15 to complete these forms that are faxed to us on their behalf. Patient acceptance has been better than we anticipated.

Nursing homes. Our office dealt with two medium-to-large nursing homes and many rest homes that had no formal procedures for communicating with doctors’ offices. Their faxes and phone calls were usually well-intentioned but rarely contained the precise information we needed.

To give nursing home staffers some help, we created a call protocol that outlines common problems, and how and when to call the office or the on-call doctor. For times when a fax is appropriate (i.e., non-urgent situations), we distributed a faxing protocol, which informs nursing-home staff about our policy and preferences on incoming faxes. Also, to encourage consistently useful faxes, we provided standard fax forms for clinical staff at nursing homes to use so that they could always give us the information we needed. (Click below to download both of these documents in one file.)

To initiate this process, I talked to the medical staff at our local hospital. After those doctors gave me approval to use a unified form, I called or visited the nursing and rest homes, telling them, “This is the approved form.” To make it easier, I offered to customize the forms with their logos and contact information.

This effort resulted in a more reasonable flow of faxes. Now the faxes that show up are often more focused, allowing us to respond more efficiently. In turn, the nursing homes and rest homes accept our digitally signed (and dated) fax responses, helping us cut down on duplication of signing orders. We checked our state laws on this, and we are in compliance. You may have to check your state’s laws.

Pharmacies. Our pharmacy fix actually added to our fax traffic slightly, but we feel the new process is an overall benefit to our staff and our patients. The new process is simple: Our local pharmacies fax us a list of patients and the needed refills. Our nursing staff reviews the request, we decide whether to refill the prescriptions, and the interaction is recorded in our EHR. This replaced our inefficient system of handling these requests over the phone throughout the day. We prefer the new way, and the pharmacists are happy, too.

Hospital interactions. We have created order and requisition forms using our fax software that can be filled out in the EHR and digitally signed when faxed. This gets the requisition to the hospital more efficiently than our old system (which involved printing it out for patients, who often forgot to pass it along to the hospital). We also eliminated stacks of hospital forms (I call them “paper metastases”) from our office.

Medical records. In our EHR-equipped office, responding to records requests no longer involves sorting through and photocopying a chart. Instead, we sit down at a computer, electronically select the EHR portion requested and digitally fax it to the office that needs it.

We have enjoyed this feature particularly when responding to lawyers. We fax the record (we can even do this “off peak” in the evening with a scheduled fax), count the actual pages sent and bill the lawyer our prevailing record charge – even though we’re sending virtual records.

A successful step

Our move to digital faxing increased our efficiency and reduced our costs. We still have a traditional fax machine to handle the inevitable piece of paper that needs to be faxed, but for all practical purposes we’ve removed the paper from our system.

Admittedly, digital faxing is most likely an interim step as the health care industry comes to grips with electronic communication. But by taking that step, our office has identified inefficient communications processes and made them better. And we have opened up lines of communication with the many entities we interact with daily via fax, which should make the next step easier to take.

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