Fax Integration and Workflow

The fax machine brought a revolution in communication. The fact that it maintains a place in our daily communication is a reflection of continued dependence on paper. This our health care system owes, in part, to a failure to agree on and implement the available protocols by which we could securely and privately exchange clinical communication.

Even when the above is resolved between many (and even most) points of care, some dependence on the fax machine is going to remain for the foreseeable future as is true for paper. Even in a digital office, patients may bring outside papers into the examination room. Some deaf patients will very much depend on fax machines for communication with the medical praxis.

Here are some of the considerations as they relate to EMRs…

Incoming faxes

If the incoming fax is printed onto paper, you now have a paper record to deal with. This workflow should merge into whatever is your incoming paper workflow except that some faxes will have to be handled promptly. As with other paper, the issue will be whether the staff will digitize the paper before the doctor will see it, or whether the doctor will handle the paper, optionally mark it up and initial it with a pen, and only then direct it into another "filing" workflow that will either move it into a paper file ("hybrid medical record") or scan it at the time cost of digitizing the paper, relocating the patient to whose file to attach it, and to queue up this same information redundantly, this time digitally, to the clinician. This makes a case for the clinician, during the paper document review (perhaps during or right after the patient visit) to digitize at least those papers that are of value to digitize. The GNUmed workflow for doing so is elaborated in GmManualDocumentImporter.

Assuming that the incoming fax is not to be printed onto paper, we are talking about digital files in need of handling. Each clinical group will need to

Outgoing faxes

One other key consideration is whether the fax device will need to be accessible from multiple local network computer users who may wish to initiate faxes. Not only will this require a shareable fax solution, which modern Mac and Windows software (and maybe Linux) do typically support, but you would also have to consider how your EMR would deal with the post-processing of the outgoing fax transmissions for anything that was patient-related.

Recommendations

For incoming and outgoing fax handling one of the developers (K.H.) strongly suggests looking at the HylaFAX fax server software under Linux. It offers:

It has served them well and ran without glitches for years. Software mentioned by other clinical groups has included, for Windows/Unix, Active Fax. While Apple's own Print and Fax drivers support native sending and receiving of faxes from desktop machines (as may require a USB modem). Any server functionality under Mac OS was not researched yet as part of this wiki page.

External references

  1. CanadianEMRBlog
  2. OscarEMR list archive here
  3. Threads concerning network scanners are archived
    • at an Oscar archive here and
    • at a CanadianEMR blog here