INTEROPERABILITY

What do you do when you notice that something you use every day is broken?
Most people would fix it or replace it, right? But what if it seems like you don't have much choice other than to suffer through the glitches, to put up with the downtime and inefficiencies?

Welcome to the everyday life of a fax-dependent healthcare professional—and to the headaches and real-world problems that arise from such a dependency.

Four different fax machines on the ground — Over 175 years old, the fax machine accounts for the majority of all medical communications.

Invented in 1843, the fax machine is still used billions of times every year to deliver sensitive patient data. This outdated technology constantly puts health information at risk, disrupts productivity and even delays treatment when prescriptions are not filled in a timely manner.

But why? Clearly, the absurdity is obscured by the everyday ubiquity of these machines. Our healthcare system is still dependent on a technology that came of age during the era of steam-powered trains. That's not only absurd—it’s highly problematic for everyone who must interact with our healthcare system.

That's why, in the year 2020, I’m sitting at my kitchen table writing an article about fax machines.

At Surescripts, part of our job is to figure out how to get health information where it needs to be, when it needs to be there, as efficiently and seamlessly as possible. Our purpose is to increase patient safety, lower costs and ensure quality care.

And to deliver on that purpose, we have to keep asking questions in order to push past the status quo:

What if the future of healthcare didn't rely on technology from the past?
And what would happen to fax machines if they were out of our way?

To find out, the Surescripts team headed south to Hanahan, South Carolina, where we chatted with designer, artist and blacksmith, Josh A. Weston, to learn how he teamed up with Surescripts to rethink the fax—giving these old school machines a newfangled purpose.

Artist posing with knives in both hands — Josh A Weston Holding Knives

Knives on wooden board next to sketches of knives and girl — Early sketches of past projects adorn the walls of the artist’s workshop.

Artist holding fax machines in each hand — Artist Josh A. Weston has some fun with out-of-date technology.

The Man, The Myth, The Maker

It’s 9:58 a.m. on a warm September day in the South Carolina low-country as the crew checks the GPS one last time before pulling up to Josh’s plantation-style, three-story home and workshop. It’s big, like the 15-person white Ford Transit Van parked in the driveway. Often traveling with his wife and five kids or touring the country with his forging pop-up shop and oversized blacksmith equipment, I’m realizing Josh and anything ‘big’ makes perfect sense.

Anvil on top of log — Artist with his blacksmithing anvil and hammer.

Chalkboard and knives on wall in artist studio — Rough sketches and prototypes can be found throughout the workshop.

Once inside his workshop, the word ‘big’ is no longer appropriate. It’s cramped, cluttered with remnants of past projects and sketch pads. Half-used bottles of wood glue fill one corner while the other is home to a full-on fax machine graveyard. Two fully-intact fax machines sit hastily atop hundreds—maybe thousands—of fax machine parts and pieces. On the walls, more sketches, large knives and swords, a few old movie posters, a surfboard. A light dust from his almost daily grinding of metal can be seen in the beam of a standing light as it slowly floats downward like a soft blanket being pulled over the scraps of projects past laying on the cold cement floor. It feels like some sort of mix between a tornado-stricken arts and crafts store and the bedroom of a young Mad Max. It’s perfect.

Dirty hands from creating sculptures — Close-up of the artist and maker’s hands after a long day in the shop.

Artist painting artifax sculpture — Josh leans in for a few final touches to his favorite ArtiFax—the plant holder.

And now, surrounded by hundreds of former fax machine parts and pieces, it’s time to take a closer look at their transformation through a little Q&A with our artist:

As an artist and maker, what thoughts were running through your head when we first contacted you about this project?

This is probably the most bizarre request that I have had in years. I've long been fascinated with prop making and this felt pretty close without it actually being for a movie. I loved the challenge: to get these machines to "do" something more useful, to have a more positive impact than their current role in healthcare. I knew it would be a little bit of a learning curve, going from working with metals and woods to plastics and circuit boards before I could make that happen, but I was up for it.

Artist creating a fax wing — The final touches being put on an ArtiFax in the artist’s South Carolina workshop.

How did you go about turning these old fax machines into something new and more useful, into these ArtiFax? What was your process?

Imagination is really my first step. I am a bit of a lucid dreamer and find creative concepts often come when I’m half asleep. Every morning during this project, I woke up to a pencil and sketch pad beside my bed and excitedly emptied my thoughts onto paper over a cup or two of coffee. Then, I'd head into my shop to find the right fax parts and pieces to match last night’s vision. Once I had the pieces picked and laid out, I would revisit my sketches with more definition and start creating a schematic to follow. After that, it was a mix of cutting, melting, gluing, soldering, welding, more gluing and then possibly some paint. All along the way, though, I never strayed too far from my sketches.

Artist sketching keychain — Putting pen to paper to bring to life the vision for an ArtiFax.

Sketchbook on table — A glimpse into the mind and sketch pad of the ArtiFax maker.

Plant holder sculpture on top of book — Close-up of the plant holder ArtiFax, made up of multiple fax parts.

You now have a unique perspective on fax machines—you’ve been under the hood and up close and personal with their inner workings. Did that give you any pause about their use in healthcare?

For me, getting an intimate view of the inner workings of the fax machine shook the confidence I had in this technology. I once spent more than a year working on HIPAA compliance software and became quite familiar with the rules and restrictions of electronic protected health information (ePHI) in healthcare equipment. I was surprised to find sensitive patient data still legible on rollers and in the "film" left inside these machines. While it wasn't technically in digital form, it was still accessible if one was so inclined. Additionally, I found the post-printing tray capacity to be quite small. If you were sending a large packet, there's very little chance that the papers don't get mixed, out of order, or even dumped off these small trays and onto the floor.

This conversation struck a personal chord. A close family member of mine suffered a minor stroke at the beginning of the COVID-19 pandemic. We, as his family, decided to move him out of his retirement community to a family home in the country, where he'd be better protected from the virus. Doing so meant we had to get his records from one hospital system to another. Unfortunately, these two systems weren't interoperable: his 100-page health record had to be faxed to his new doctors. Making sure he was set up for the care he needed required us to make hours of phone calls and send dozens of emails. It required hospitalists to chase faxes. And it made us all worry: do his new providers have every piece of information they need? Did his records all come through? What about his medication history? His history of care? None of us—not patients, not providers—should be worrying about ink cartridges, paper spools and landline connections in the year 2020. As both beneficiaries and stakeholders in one of the most innovative healthcare industries in the world, we can and must do better.

It’s time to rethink the fax. It’s past time for a faxless future.

Let’s Exchange Fax Machines for In-Workflow Solutions that Align Better with Patient Care

The healthcare industry wastes more than $9 billion annually by continuing to use manual processes instead of electronic ones.¹

Our Electronic Prior Authorization solution avoids the need to fax or call the benefit plan by integrating directly with prescribers' and specialty pharmacists' electronic workflows. It's a faster, easier and less frustrating way to process prior authorizations.

Two-thirds of health systems use fax or mail to send records.² Faxes may be misdirected and sensitive patient data could be left on a fax machine, accessed by unauthorized individuals.³

Instead of relying on fax machines that haphazardly dispense information, our Medication History solutions give a more complete and accurate electronic picture of patients’ medication history for better informed, more efficient and safer care decisions.

Providers could save a minimum of 1.1 million labor hours per week by employing electronic transactions. Each fax or phone call requires an average of 8 minutes to handle, and can be as much as 30 minutes.⁴

Instead of multiple time-consuming faxes and phone calls between parties, our Specialty Patient Enrollment automates the enrollment process by sending clinical enrollment data from prescribers to specialty pharmacies and hubs for a streamlined experience and faster time to fill for patients. And, our Specialty Medications Gateway allows specialty pharmacists to run a query to retrieve clinical enrollment data directly from the prescriber’s electronic health record (EHR).

Nearly three-quarters of non-federal acute care hospitals routinely use fax or mail to receive summary of care records from providers outside their system.⁵

Instead of relying on potentially unsecure communication via fax, our Clinical Direct Messaging solution connects clinicians, pharmacists and other healthcare professionals with secure, HIPAA-compliant exchange of protected health information.

The fax accounts for about 75% of all medical communications⁶ and two-thirds of health systems use fax or mail to send records.⁷

Instead of relying on fax machines to send and receive records, our Record Locator & Exchange solution lets healthcare providers quickly see where patients have received care and locates medical records from across all 50 states, regardless of care setting and EHR.

The conversation doesn’t end here. Join us on LinkedIn Live on November 17 at 11 a.m. ET, as we sit down with artist Josh A. Weston and Surescripts Chief Medical Information Officer, Dr. Andrew Mellin, to talk a little bit more about the benefits of a Faxless Future.

¹ Medical Practices Have a Love-Hate Relationship with The Fax Machine, Physicians Practice, 2019
² Methods Used to Enable Interoperability among U.S. Non-Federal Acute Care Hospitals in 2017, ONC Data Brief, no. 43, 2018
³ Faxing Error Sees PHI Sent to Local Media Outlet, HIPAA Journal, 2017
⁴ Reducing Manual Business Transactions Could Save Healthcare $9.4 Billion, CAQH, 2017
⁵Methods Used to Enable Interoperability among U.S. Non-Federal Acute Care Hospitals in 2017, ONC Data Brief, no. 43, 2018
⁶ The Fax of Life: Why American Medicine Still Runs on Fax Machines, Vox, 2018
⁷ Methods Used to Enable Interoperability among U.S. Non-Federal Acute Care Hospitals in 2017, ONC Data Brief, no. 43, 2018

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