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7 Responses

  1. On MyFax eHR/fax hybrid system – a Nobel-worthy idea

    At the end of an interview with blogger Matthew Holt last week, Mark Leavitt, the head of CCHIT, stated that he anticipates that by 2014, only 50% of the nation’s physicians will be using interoperable, CCHIT-approved electronic health record systems (He failed to mention dentists; sorry).

    It is my guess that by 2014, less than 5% of dentists will have paperless practices and none will be interoperable with anyone but insurers – predictably causing dentists to avoid interoperability. Even if it means laterally by-passing a mandated system, is it important for dentists to have the opportunity to share in handy communications with physicians as well as other dentists? I say yes. Is it possible for even dentists with paper practices to take part in magic discoveries that can only happen with more efficient professional communications? I say yes, yes. Thanks to innovative companies like MyFax.

    I present to you a brand-new idea, never widely discussed as far as I know. Whoever thought of this deserves a Nobel Peace Prize and a lot of money. MyFax now offers a platform for a hybrid solution to interoperability in healthcare in the nation that encourages participation instead of fear of HIPAA. All that is required is a phone line and a $200 fax machine.

    In addition, one doesn’t even need an NPI number or signed and dated HIPAA forms. That means that sharing medical information will soon be not only cheaper than going through the Internet, but it will also be safe, simple and adaptable to whatever record system a provider might have. What more does healthcare reform need? The adoption of variations of the MyFax product would certainly cost much less than the $20 billion our children will spend on CCHIT-certified eHRs.

    The following PR piece advertises a common sense product that is not likely to become CCHIT-certified. So who cares? What is more important, the package or its contents?

    D. Kellus Pruitt


    April 16, 2009

    MyFax Gives Medical University a Healthy Dose of Fax Management

    Internet fax service helps Medical University of South Carolina meet HIPAA requirements, organize and manage more than 60,000 faxed pages per month

    OTTAWA–(BUSINESS WIRE)–The Medical University of South Carolina (MUSC) Medical Center, which receives 50,000 faxed pages per month and sends another 10,000, recently found that faxing was rapidly becoming both a cost issue and a logistical nightmare. A full cost analysis based on current fax volume and anticipated future growth resulted in the selection of Internet fax service MyFax.

    Many industries like healthcare still rely heavily on faxing to transmit sensitive information. Because of requirements for security and privacy in HIPAA, email is considered too vulnerable to interception without having a costly and complex secure messaging system in place, thereby putting patient privacy at risk. Faxes are considered more secure since they cannot be pulled out of cyberspace. That meant Sujit Kar, IT manager for business development and marketing services at MUSC, had to find another solution for managing faxes more efficiently and cost-effectively.

    When reviewing alternative faxing options, Kar determined eliminating fax machines at MUSC was in order. The question was whether to replace them with email, fax servers or an Internet fax service. The option of moving to fax servers was eliminated due to the volume of faxes.

    “We didn’t want to get into managing fax servers,” said Kar. “We wanted an outsourced solution, where we could get some help with development, and once it was running all the technical management would be handled for us.”

    Kar ultimately chose Internet fax service MyFax to initially serve the inbound fax needs of 700 users. Since making the move to MyFax, Kar reports that potential HIPAA violations have been reduced significantly.

    Today when faxes come in, they are tagged with medical record numbers, if required, critical patient information is pulled in from the medical records system. The faxes are then routed automatically to the right department by software that scans the cover sheets and determines where they should go, regardless of the fax number it was sent to originally.

    There has also been a direct cost benefit to the Medical Center. Paper consumption has been reduced by a total of nearly 60,000 sheets per month, which works out to nearly three quarters of a million sheets of paper per year. The organization is also saving the energy needed to power all the old fax machines. Kar says there are the labor savings too, particularly in the ability to fax directly out of an application and MyFax’s ties to other systems such as Doctor Manage.

    Including both incoming and outgoing faxes, MUSC today has more than 3,500 MyFax users. “Anyone who uses MyFax is hooked on it,” Kar said. “And the support we’ve received from the company has been beyond excellent. I wish all enterprise-level tools worked this smoothly and were supported this well.”

    Darrell K. Pruitt; DDS


  2. I wanted you to see this press release from MyFax. I’ve said before that a CCHIT requirement should be interoperability with fax machines. Otherwise, there is no interoperability with dentists.


    “Removing HIPAA Risks from High-volume Faxing”

    By Steve Adams

    Describing the number of faxes sent and received each month by the Medical University of South Carolina (MUSC) Medical Center as “high-volume” is like saying a jet engine at full power is “loud.” In other words, it doesn’t begin to explain the number of faxes being processed each month.

    “We receive roughly 50,000 faxed pages every month,” said Sujit Kar, IT manager for business development and marketing services at the medical center. “Plus we send another 10,000 faxed pages — and growing. That’s a lot of paperwork to manage.”

    With so much paper coming and going, and fax machines running constantly, Kar was concerned. He realized how easy it would be for all or part of one fax to be attached to another going to a different destination. If that occurred, it could cause delays in verifying insurance information, processing bills or even in patient treatment. More important, he knew it could also potentially create a HIPAA violation, depending on the contents of the fax.

    The same was true for outbound faxes. Users dialing phone numbers on a fax machine could accidentally transpose numbers or have their fingers slip. If an inputted number connected to a fax machine instead of a voice line, there was a risk that confidential patient information could accidentally wind up at an auto repair shop, a construction company or other destination, putting MUSC at risk.

    Even if all went as it was supposed to, the concerns didn’t end once the fax was properly delivered, either.

    “Medical issues tend to have a long shelf life,” Kar said. “Information that was contained in a fax, especially background data such as a copy of the patient’s insurance card, might be needed six months or more later. When that happened, it could be extremely time-consuming to track down the right fax within all the paper files spread all over the medical center. There was no way to search electronically. You had to go to the file room, start digging and hope you found it quickly.”

    With so many risks — business, medical and legal — it became apparent that MUSC Medical Center needed to find a better way to handle its high volume of faxed material.

    Why fax at all?

    At first glance, it would appear that e-mailing the information would provide an answer. After all, e-mail can be sent directly to the recipient, and it can be stored electronically making it easier to search.

    The problem is unless the provider puts a costly and secure messaging system in place, e-mail is not considered secure enough to meet the privacy requirements of HIPAA. It is still too easy for a message to be intercepted. Faxes are viewed as being more secure since they cannot be pulled out of cyberspace.

    Another issue preventing the use of e-mail is that doctors are reluctant to give their personal e-mail addresses to hospitals, insurance companies and others for fear of having their inboxes inundated with irrelevant or promotional information. Since many also still hand-write patient charts and other notes, faxing is a more convenient way of transmitting information quickly as well.

    For the medical center, treatment of a single patient often requires passing that person’s medical history, insurance card information, referrals, verification documents and other notes on to several parties. Multiply that by thousands of patients and it becomes a huge volume of information going in and out on a daily basis. Since it was obvious that faxing would continue to be the transmission method of choice, Kar began looking for an alternative that would improve efficiency and minimize the risk of HIPAA violations while maintaining security and privacy.

    Internet fax service provides the answer

    After performing an Internet search, Kar narrowed his choices to a fax server or Internet fax service. He quickly eliminated the former.

    “Because of the volume we have, we didn’t want to get into managing fax servers,” he explained. “We wanted an outsourced solution, where we could get some help with development and have all the technical management handled for us once it was in place.”

    That left Internet fax services — online applications that allow users to send and receive faxes via e-mail accounts or a secure online server. Unlike regular email, however, all messages are encrypted, making them virtually impossible to intercept in cyberspace. After reviewing and talking to several of the leading Internet fax service providers, Kar selected MyFax.

    “We performed a full cost analysis and MyFax was shown to be the most cost-effective,” he said. “We discovered after piloting the program that it was a great choice on many levels — particularly in development and customer support. We knew it wouldn’t be an off-the-shelf solution for us. Their developers were extremely helpful and easy to work with, not only making modifications as we asked for them but also providing guidance and suggestions to us. We received a lot more support than we were expecting.”

    Because of the size of the project and the pressing need for searchability, the medical center decided to start with inbound faxes. The solution went live after six months of planning and development time, and has been serving its 700 users successfully for three years. The outbound fax service was launched at the end of 2007; it currently serves approximately 3,500 users.

    Managing inbound faxes

    The mechanics of the service are simple. MyFax activates a fax number for MUSC Medical Center and forwards that information to an administrator. The administrator then assigns the number to a fax queue that is tied to a specific person, area or department. The medical center currently has 40 fax numbers feeding 76 fax queues; its old fax numbers are forwarded to the new MyFax numbers, eliminating the need for people outside the medical center to change their old habits.

    When faxes come in, they are tagged with medical record numbers. If required, critical patient information is pulled in from the medical records system. The faxes are then routed automatically to the right department by software that scans the cover sheets and determines where they should go, regardless of the number each fax was sent to originally. This capability not only helps improve efficiency; it also helps reduce potential HIPAA violations.

    Once a fax gets into the queue it is monitored on a regular basis, and the appropriate action (such as attaching it to a patient’s chart) is taken. When medical personnel are finished with it, the fax is marked complete, taken out of the queue and stored electronically.

    Assigning medical record numbers also helps the medical center locate faxes weeks, months or even years later. Because information is contained in electronic files, they can now be searched by number, patient last name or other criteria, taking a process that used to require hours or even days down to one minute or less.

    Sending Simplified

    The move to MyFax has had a big impact on outbound faxes as well — particularly in helping reduce potential HIPAA violations according to Kar.

    “Making sure we had the right fax numbers for all the physicians we work with was a huge issue in the past,” he commented. “Physicians move their offices and/or change their fax numbers for other reasons all the time. People also can mis-dial a number from time to time.”

    To overcome those issues, MUSC Medical Center has installed a central database called Doctor Manage that is used to keep numbers up to date. It is tied into MyFax in a way that allows users to type in the first few letters or the doctor’s last name, or the first few digits of the phone number, and have the right fax number fill in automatically.

    “We have two full-time resources who maintain that ‘white list’ of physician information,” said Kar. “There’s also a tool that lets users send me a notice that a number needs to be updated.”

    When a user wants to send a fax, an icon on the toolbar connects to MyFax as though it were another printer. Users can send a fax directly from any application, without having to open up any additional windows — or leave their desks to walk to a fax machine.

    Saving privacy — and costs

    Since making the move to MyFax, Kar said that potential HIPAA violations have been reduced significantly.

    “Anytime humans are involved, there is the potential for a violation,” he noted. “But MyFax has helped us reduce that risk as much as I believe is realistic. When an issue does arise, we know about it immediately so we can trace it right away and take steps to rectify the situation.”

    Moving to an Internet fax service has also helped MUSC Medical Center meet another area of responsibility — environmental concerns. The organization has reduced paper consumption by a total of almost 60,000 sheets per month, which translates into nearly three quarters of a million sheets of paper per year.

    “We’re saving the energy needed to power all those separate fax machines too,” Kar added. “Hospitals are always under scrutiny to be environmentally responsible. MyFax helps us meet that obligation while also keeping our costs down. Everybody wins.”

    While he doesn’t have hard numbers for the labor savings, Kar believes MyFax has made a significant impact there as well. Between the search function, the ability to fax directly out of an application, and the ties to other systems such as Doctor Manage, it has simplified the entire process of sending and receiving faxes.

    Note: Mr. Adams is vice president of marketing for MyFax (www.myfax.com), a provider of Internet faxing services for individual home users, small businesses, and large corporations. He can be reached at sadams@protus.com.

    Darrell K. Pruitt; DDS


  3. MyFax hybrid permits interoperability

    As dentistry’s unavoidable collision with massive HIPAA and FTC problems approaches, I can tell that I win over an increasing number of fans for investigating the feasibility of a fax-Internet hybrid solution. Thanks for hanging with me – some of you for almost four years now. Here’s some fresh stuff from the event horizon.

    Yesterday, I sent the following email to my friend, Dr. Tom Cockerell. Dr. Cockerell is the founder of DentalSymphony, an electronic dental record firm which actually stands a chance at success, in my opinion. He’s got good people.


    I hear what you’re saying, Tom, but I’m pretty sure you are underestimating a couple of things about MyFax and why an analog/digital translator like this could be beneficial for dentists and their patients. In addition, as you will see, it could be made integral to your great flash-drive idea.

    First of all, phone lines are very safe and not a threat to identity loss, at least not yet. That means electronic transmission of personal information over the telephone or fax is universally considered secure. And we should be thankful that HIPAA does not cover fax machines.

    Here’s something I’m playing with today.

    What follows are recent considerations, so I haven’t fully explored the benefits or the hazards of what I describe. Feedback is appreciated.

    MyFax sorts and correlates large numbers of pages of fax transmissions, converts them to encrypted digits and forwards them to the appropriate provider over the Internet – where a paperless dentist can have the information instantly added to patients’ eDRs without any effort – or the signal could be sent to a fax machine for a paper copy.

    About those dangerous health histories

    One of the issues I have with pure eDRs is the danger of a contaminated health records which contain allergies as well as other critical information.

    Imagine this: Instead of emailing patients’ health histories along with the rest of CCHIT-approved eDRs, let’s step half-way onto the unshaven side of HIT and consider hybrid eDRs with an inherent fax component. But why stop with just the health histories? What if those dangerous PHI items such as birthdates and social security numbers were stripped from the rest of the record and also routed through a fax – even for paperless practices?

    How’s this for a raw idea: What if the faxed PHI and medical history were isolated to the flash drive on the dentist’s end, and never touches an unsecured computer? How’s that for double-key security?

    It is my soft opinion that incredible flexibility in addition to the parallel fax feature could save lives for minimal cost, and promote interoperability instead of proprietary silos. Does this sound plausible to you? Does it sound doable?

    It’s not likely that a general dentist like me who files paper will require much fax volume – at least not for the first few years. That means a company like MyFax probably would not be needed to intercept and sort faxes before forwarding them. However, if interoperability is to be achieved, it goes without saying that it will demand more traffic.

    And that’s not all! For dentists who have paperless practices with numerous brands of software that will never be compatible with each other, another service a translation company like MyFax could provide would be to convert patient data into the digital format that the dentists’ software requires rather than Allscripts’ CCHIT.

    In my mind, MyFax promises flexibility and accountability as well as avoidance of liabilities from HIPAA and the Red Flags Rule. Without flexibility we’ll never be interoperable. It was so silly of us to have assumed otherwise for so long. As I look back on the miserable history of HIT, it appears to me that rigidity is a symptom of the terminal belief that eDRs are inevitable no matter what. When the 1996 Rule was quietly amended in 2003 to artificially keep that belief alive, HIPAA set in like rigor mortis, and has been dentistry’s sleeping zombie for years. In 4 days, it will be reanimated by an ADA Online article which will spell out dentists’ obligations under the HITECH HIPAA. It’s alive!

    MyFax the monster killer

    You’re not thinking far enough ahead, Tom. There is very little demand for fax transmissions in dentistry today, but dentists as well as patients are going to increasingly desire more interoperability than we have. Yet as it also becomes more expensive to maintain and transmit patients’ digital information, fewer dentists are going to risk going paperless. That is where a MyFax-like company comes in handy.

    Just because it is a fax, doesn’t mean it has to be printed on a piece of paper – but that option is better than nothing at all, isn’t it?

    (You’ll probably see some of this again in a future spamphlet. Thanks for giving me the motivation to put something together.)

    D. Kellus Pruitt; DDS


  4. Darrell,

    I Agree. Doctors live with faxes in their offices.

    A fax server allows you to centrally manage all incoming and outgoing faxes. This is one of the fastest financial investments you can recoup.



  5. Fax error leads to PHI exposure

    Oakland, Calif.-based WestCoast Children’s Clinic has notified patients of a HIPAA breach after it sent a patient’s protected health information to an incorrect fax number.


    Ann Miller RN MHA


  6. Fax machines represent medical waste, error, and expense

    In a scene from the 1999 cult classic “Office Space,” three burned-out cubicle drones take a baseball bat to a malfunctioning printer.


    While I do not condone violence against innocent peripheral hardware, I admit I secretly fantasize about destroying medical center fax machines.



  7. Who still uses faxes?
    [The medical industry does]

    Here is a picture from today in the office: 27 faxes received and about 20 sent, and that is only counting the afternoon, from the practice of P.J. Parmar, MD


    Some days are worse, with up to 40 faxes to handle in a small medical practice.



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