High quality, accurate documentation has long been a cornerstone of both patient care and the business side of modern medicine. And nowhere is this more true than in a hospital setting, where collaboration and information-sharing between referring physicians, residents, specialists, hospital staff, the business office, insurance providers and others is an absolute. 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 of the hospital on a daily basis. In the U.S., because of the requirements for security and privacy in the Health Insurance Portability and Accountability Act (HIPAA), the bulk of this information must be transmitted via fax. According to current law, other document sharing tools (particularly email) are too vulnerable to being intercepted 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. Still, faxes sent via fax machines are not without risk. Misdialing a fax number can cause a patient’s records to be sent to a car dealer instead of a consulting physician’s office. Inbound paper faxes can be lost, mis-filed, or delivered to the wrong person. Faxes sent several months prior can be difficult to track down if they are not tied to a specific patient or record number. The sheer volume of paper required to print all those faxes is also costly, going against mandates both for fiscal and environmental responsibility. And, in a high-volume location they can be inefficient since one fax must finish transmitting before the next can come in or go out. As a result, the situation is hardly ideal.

The challenge

In 1955 the Medical College of South Carolina (MUSC) opened the MUSC Medical Center, an 865-bed hospital in Charleston, South Carolina. During the 2005-2006 timeframe it admitted more than 31,500 in-patients and registered in excess of 730,000 outpatients. Describing the number of faxes sent and received by the MUSC Medical Center as “high volume” is like saying a jet engine at full power is “loud.” It doesn’t begin to explain the enormity of the number of faxes being processed each month.

According to Sujit Kar, IT manager for business development and marketing services, the Medical Center receives roughly 50,000 and sends another 10,000 faxed pages each month, with the number of outbound pages scaling up. “That’s a lot of paperwork to manage,” said Kar. “Just keeping the fax machines loaded with paper and toner was extremely labour-intensive. But the real issue came with getting the faxes from the machines to the right people in the right departments.” With so much paper coming in, it was easy for all or part of one fax to be attached to another going to a different destination, causing delays until everything was sorted out. 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,” said Kar. “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 centre. There was no way to search electronically. You just had to go into the file room, start digging and hope you found it quickly.” Kar and his team knew they needed to change the way faxes were being handled. What they needed was something simple, flexible and reliable, yet capable of handling the daily load.