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Healthcare Doesn’t Have a Fax Problem. It Has a Workflow Problem.
Why replacing fax won’t solve healthcare’s communication challenges, and how AI can transform the systems providers already use.
For more than 30 years, I’ve worked in the fax industry, watching healthcare organizations invest billions of dollars in electronic health records, interoperability initiatives, secure messaging platforms, and technologies designed to eliminate the need for fax. Yet fax remains one of the most widely used ways to exchange healthcare information.
That raises an interesting question. If fax is supposedly the problem, why haven’t decades of investment in alternatives made it disappear?
I believe the answer is relatively straightforward. We’ve spent an enormous amount of time and money trying to change how healthcare documents travel between organizations, while paying too little attention to what happens after those documents arrive.
A referral can arrive successfully and still wait days to be processed. A physician’s order can reach the correct facility but require several employees to move it through the organization. A patient’s medical records can be transmitted securely, only to be manually reviewed, classified, and entered into another system.
In each case, the communication worked. The workflow didn’t.
Healthcare doesn’t fundamentally have a fax problem. It has a workflow problem. And until we address that distinction, replacing one communication technology with another will produce far less improvement than we expect.
We’ve Been Trying to Solve the Wrong Problem
Healthcare interoperability is an important objective, and considerable progress has been made. Electronic health records are now commonplace, standards such as FHIR have expanded opportunities for structured information exchange, and secure communication technologies have improved how providers share clinical information.
These are meaningful accomplishments. But interoperability and operational efficiency are not the same thing.
Moving information between two systems doesn’t necessarily mean the receiving organization can act on it efficiently. The information still needs to be recognized, interpreted, assigned to the appropriate workflow, and delivered to someone who can take the next step.
Consider a specialist receiving a referral from a primary care provider. Whether that referral arrives by fax, secure Direct messaging, an EHR interface, or another electronic exchange mechanism, the receiving practice still needs to determine which physician should see the patient, whether the referral contains the necessary information, whether authorization is required, and how quickly to schedule the patient.
Changing the delivery mechanism doesn’t eliminate those responsibilities.
Yet much of the industry’s conversation about modernization still focuses on replacing the communication channel rather than improving the operational process around it.
That’s an important distinction because patients don’t particularly care how their referral was transmitted. They care whether someone receives it, acts on it, and gets them the care they need.
Direct Secure Messaging Is Valuable. But It Doesn’t Solve Every Workflow Problem.
One technology frequently presented as an alternative to fax is Direct Secure Messaging, commonly called Direct.
Direct provides a standards-based way to securely exchange healthcare information between trusted participants. It can be particularly useful for transmitting clinical documents, supporting transitions of care, and exchanging information between organizations with compatible systems and established workflows.
It deserves a place in healthcare’s interoperability strategy.
However, practical challenges are sometimes overlooked when Direct is discussed as a universal replacement for fax.
The first is addressing and discovery. A fax number generally identifies an established destination within an organization. Direct messaging relies on electronic addresses that must be known, discoverable, and appropriately maintained. Depending on the directory infrastructure and participating organizations, identifying the correct Direct address for a specific physician, department, or workflow can be more complicated than expected.
The second challenge is workflow integration. A Direct message may arrive in an EHR inbox or another application, but that doesn’t guarantee prompt processing. Someone may still need to review the contents, reconcile patient information, identify the appropriate destination, and initiate the next clinical or administrative action.
The third challenge involves the diversity of healthcare organizations. Large health systems may have sophisticated EHR environments and dedicated interoperability teams, while smaller practices, rural clinics, and under-resourced providers may have fewer technical resources and less integrated workflows.
A communication strategy that works beautifully between two large health systems may not work equally well for every provider in the country.
None of these observations diminish Direct’s value. They simply illustrate why no single transport mechanism can solve the full range of healthcare’s operational challenges.
Direct, FHIR-based APIs, health information exchanges, and fax can all play valuable roles. In many cases, the most practical solution is to support multiple communication methods while creating a consistent, intelligent workflow for processing the information they deliver.
The objective shouldn’t be to declare a winner between fax and Direct.
The objective should be to make healthcare information actionable, regardless of how it arrives.
Fax Is Already Interoperable. We Need to Use It Better.
One of fax’s greatest strengths is also one reason it has survived repeated attempts to replace it: nearly every healthcare organization can participate.
A small rural clinic can send a referral to a major academic medical center without purchasing the same EHR system, negotiating a specialized integration, or joining a particular health information exchange. A behavioral health provider can communicate with a hospital. A Tribal healthcare organization can exchange records with specialists hundreds of miles away.
The organizations don’t need to use the same software or have the same technology budgets. They need a working fax connection and an appropriate process for handling the information.
That is a form of practical interoperability, even if it doesn’t meet every technical definition of structured data exchange.
The numbers demonstrate why fax remains relevant.
2025 U.S. hospital survey
Fax Remains an Important Part of Healthcare Communication
These figures don’t suggest that healthcare has failed to modernize. They suggest that healthcare organizations operate in a diverse environment where multiple methods of exchanging information remain necessary.
Fax’s strength is its accessibility. Its limitation is that the information it carries is frequently unstructured, requiring additional work before it can be incorporated into clinical and administrative systems.
That limitation is real, but it is increasingly addressable.
We don’t need to choose between preserving the reach of fax and achieving the efficiency of modern digital workflows. With the right technology, we can have both.
The Real Cost Is Hidden in the Work Nobody Sees
When healthcare executives evaluate communication technology, they often focus on infrastructure costs, licensing fees, security, and transmission reliability. Those are important considerations, but they can represent a relatively small portion of the total operational expense associated with processing healthcare documents.
Think about the work performed by a typical referral coordinator.
A document arrives. Someone opens it, determines whether it is a referral, verifies the patient information, identifies the requested specialty, checks whether the required supporting documentation is present, and routes it to the appropriate team. Another employee may enter information into the EHR or practice management system. Someone else may contact the referring provider for missing information.
Each individual task may take only a few minutes, but multiplied across hundreds or thousands of documents every day, the cumulative labor requirement becomes significant.
The financial impact of manual administration is well documented, even though not every industry benchmark measures fax processing specifically.
$18.4 billion
Estimated annual potential savings from further automation of medical administrative transactions
2024 CAQH Index Report. Covers specific administrative transactions, not savings attributable to fax automation alone.
The 2024 CAQH Index identified an estimated $18.4 billion in annual potential savings from further automation of medical administrative transactions. That estimate covers specific administrative transactions rather than fax workflows alone, but it illustrates the enormous economic opportunity associated with eliminating manual processes.
And the financial implications extend beyond administrative labor.
When referrals are delayed, patients may seek care elsewhere. When orders are processed slowly, diagnostic services can be postponed. When documentation is misrouted, staff must spend time locating information that the organization may have already received.
Healthcare organizations are businesses as well as care providers. They need sufficient revenue to hire clinicians, invest in facilities, and serve their communities. There should be nothing uncomfortable about acknowledging that operational inefficiency affects both financial sustainability and patient care.
A missed referral can represent lost revenue for a specialist, but it can also represent a patient who didn’t receive timely treatment.
Those are two sides of the same problem.
AI Is Changing What Happens After the Document Arrives
This is where I believe artificial intelligence can make a meaningful difference in healthcare, and it doesn’t require replacing the communication infrastructure that providers already use.
Modern document intelligence combines optical character recognition (OCR), machine learning, and AI-assisted interpretation to turn unstructured healthcare documents into information that can support automated workflows.
A traditional fax system receives a document and delivers it to a destination. An intelligent workflow platform can go further by identifying the document type, extracting relevant information, and determining which operational process should follow.
For example, an incoming referral can be recognized as a referral rather than a medical records request or prescription renewal. The system can extract patient demographics, identify the referring provider, determine the requested specialty, and route the information to the appropriate intake queue.
Depending on the organization’s integration capabilities and workflow rules, that information can populate downstream systems, initiate follow-up tasks, or flag documents for human review.
This isn’t about removing healthcare professionals from important decisions. It’s about reducing the administrative work that prevents them from focusing on those decisions.
AI systems still require validation, monitoring, appropriate safeguards for protected health information, and human oversight when information is ambiguous or clinical judgment is involved. But when properly implemented, they can reduce repetitive work while helping organizations process information more consistently.
AI-powered healthcare document workflow
From Document Delivery to Actionable Workflow
- Healthcare document arrivesFax or another supported communication channel
- AI interprets the documentDocument classification, OCR, data extraction, information validation
- Workflow automation takes actionIntelligent routing, task creation, EHR integration where supported
- Staff can act soonerReview exceptions, coordinate patient care, follow up with patients
At WestFax, this is the thinking behind WestFax Orchestrate. We recognized that reliably delivering a fax, while essential, was only part of the opportunity. Healthcare organizations also needed help understanding and processing the documents they received.
By combining cloud fax with OCR, AI-powered document processing, and workflow automation, Orchestrate helps organizations move beyond document delivery and toward more actionable information.
Importantly, this approach doesn’t require every referring provider to change how they communicate. A small practice can continue sending a fax, while the receiving organization can use modern automation to process the information.
That’s a practical way to modernize healthcare without making participation harder for providers with the fewest resources.
A Lesson From Physicians Who Built Their Own Solution
At HIMSS, I had an opportunity to meet with a large hospital network to demonstrate WestFax Orchestrate.
As we explained how the platform uses AI to interpret and automate healthcare document workflows, the physicians smiled knowingly. They had recognized the same problem and invested in building their own AI workflow solution to address it.
I found that conversation particularly revealing.
Physicians at a major academic medical institution had independently arrived at essentially the same conclusion we had: the challenge wasn’t simply moving healthcare documents between organizations. It was turning the information inside those documents into something their teams could use efficiently.
They had devoted resources to solving a problem we had already been addressing through a commercial platform.
For me, the experience reinforced something important about the direction of healthcare technology.
The demand for intelligent document workflows isn’t being created by vendors trying to introduce another product category. It’s coming from healthcare professionals who are tired of spending valuable time managing information that should be easier to process.
And it suggests that the next significant improvement in healthcare interoperability may come not from replacing every existing communication method, but from making the information flowing through those methods considerably more useful.
The Missing Metric: Time to Action
At WestFax, fax completion rate is one of the first metrics I look at every day. I’ve always believed that successful document delivery is fundamental to reliable healthcare communication.
Our business model reinforces that commitment. We charge for successfully completed fax transmissions, aligning our financial interests with our customers’ need to deliver documents.
But as healthcare workflow technology advances, I believe organizations should start measuring more than successful transmission.
How long does it take for a received document to become an actionable task?
That question introduces a different set of operational metrics.
Instead of measuring only whether a referral arrived, healthcare organizations could measure the time between receipt and classification, the time required to route it to the appropriate team, the percentage of documents requiring manual intervention, and the time between referral receipt and patient contact.
| Time-to-action metric | What it measures |
|---|---|
| Time to classification | Time between a document’s receipt and identifying what it is |
| Time to routing | Time required to deliver the document to the team that owns the next step |
| Manual intervention rate | Percentage of documents that need a person to sort, key, or correct them |
| Referral receipt to patient contact | Time between a referral arriving and the patient being contacted |
These measures tell us much more about whether information exchange is actually improving healthcare operations.
They also help organizations identify where automation can produce measurable benefits.
A healthcare organization might have an excellent fax completion rate and still struggle with referral processing delays. Another might exchange information electronically through sophisticated EHR integrations while experiencing similar bottlenecks because incoming documents and messages aren’t consistently routed or acted upon.
Both organizations can improve, but neither will necessarily solve its problem by changing the transport mechanism.
The more meaningful objective is to shorten the time between receiving information and doing something useful with it.
The Future of Interoperability Should Include Everyone
One concern I have about some discussions of healthcare modernization is that they implicitly assume every provider has access to the same technology resources.
That simply isn’t the case.
Major health systems can invest millions of dollars in EHR integration, interoperability infrastructure, and custom software development. Smaller practices, rural healthcare organizations, and providers serving underserved communities frequently operate under very different financial and technical constraints.
WestFax works with healthcare organizations across this spectrum, including Tribal Nations and rural providers. Those experiences reinforce the importance of communication technologies that don’t require every participant to maintain an expensive or sophisticated IT environment.
A national interoperability strategy should make it easier for these organizations to participate, not create additional barriers.
That doesn’t mean healthcare should stop investing in Direct Secure Messaging, FHIR, health information exchanges, or other standards-based technologies. Quite the opposite. These technologies offer important capabilities, particularly when structured information can move directly between compatible clinical systems.
The evidence shows substantial progress. According to federal health IT data, 76% of non-federal acute care hospitals engaged in all four measured domains of electronic information exchange in 2025, compared with 23% in 2014.
Growth in hospital electronic information exchange
Hospitals Engaged in All Four Domains of Electronic Exchange
Yet technical exchange doesn’t automatically translate into effective use of the information.
A peer-reviewed study of 2,420 hospitals using 2023 data found that 62% experienced at least one major barrier to exchanging information. The research identified issues involving vendor differences, exchange partner capabilities, patient matching, and costs.
62%
Hospitals experiencing at least one major barrier to exchanging information
- Differences between technology vendors
- Exchange partner capabilities
- Patient matching challenges
- Costs associated with information exchange
Everson J, Richwine C. Journal of the American Medical Informatics Association, 2025. 2023 AHA IT Supplement data, 2,420 non-federal acute care hospitals.
That is why I believe the most practical approach is inclusive, not exclusive.
We should continue developing sophisticated standards-based interoperability while improving the workflows associated with existing communication methods. When structured data exchange is available and appropriate, organizations should use it. When fax remains the most accessible communication method, intelligent automation should make that information as operationally useful as possible.
Healthcare doesn’t need every provider to use identical technology.
It needs information to reach the right people, in a usable form, at the right time.
Technology Should Give Healthcare Professionals More Time for Patients
Another dimension to this conversation sometimes gets lost in discussions about infrastructure, standards, and interoperability.
Every minute a healthcare professional spends locating a document, copying information between systems, or resolving an administrative routing problem is a minute they could spend on work more directly related to patient care.
Physicians already face substantial documentation responsibilities. Nurses, referral coordinators, and medical office staff manage an extraordinary amount of information while trying to keep clinical operations moving.
We shouldn’t assume that adding another inbox, application, or electronic communication channel automatically makes their jobs easier.
In fact, poorly integrated technology can create additional work, even when the underlying technology is technically sophisticated.
The real opportunity for AI is to reduce the friction between systems so that healthcare professionals don’t have to serve as the human integration layer connecting them.
When a referral arrives, staff shouldn’t have to spend unnecessary time determining where it belongs. When clinical information is available, they shouldn’t have to repeatedly enter the same data. When a document requires attention, the appropriate person should be able to identify and act on it without searching through multiple disconnected systems.
This is where I see the greatest potential for intelligent workflow automation.
Not to replace healthcare professionals, but to give them more time to do the work that requires their expertise, compassion, and judgment.
Stop Trying to Replace the Fax. Start Fixing the Workflow.
I don’t believe fax will remain unchanged forever, nor should it be the preferred communication method for every healthcare transaction.
Structured interoperability has clear advantages when clinical information needs to be exchanged in machine-readable formats. Secure Direct Messaging provides a valuable communication mechanism. Modern APIs can enable capabilities that traditional document exchange cannot.
These technologies will continue to evolve, and healthcare organizations should embrace them where they improve care delivery and operational performance.
But after three decades in this industry, I’ve learned that the most successful technologies aren’t necessarily the ones that demand the greatest changes from their users. They’re often the ones that solve important problems while fitting naturally into the way people already work.
Fax remains widely used because it provides a practical, accessible way for healthcare organizations to exchange information. Its continued use doesn’t mean healthcare can’t modernize.
It means the industry still needs communication methods that work across a remarkably diverse provider community.
Rather than treating that reality as an obstacle, we should recognize the opportunity it creates.
We now have technologies that can interpret documents, extract meaningful information, initiate workflows, and connect existing communication channels to modern clinical systems.
We can preserve fax accessibility while reducing the manual work historically associated with it. We can support Direct and other electronic exchange methods without assuming that every provider must use the same technology. And we can measure success not simply by whether information moved between organizations, but by whether it helped someone deliver care more efficiently.
At WestFax, that’s the future we’re working toward.
Because ultimately, a successfully delivered document is only the beginning.
The real measure of healthcare interoperability is what happens next.
Frequently Asked Questions
Fax lets almost any healthcare organization exchange documents without sharing an EHR vendor, building a custom integration, or joining a particular health information exchange. In the 2025 AHA IT Survey reported by ONC, 74% of hospitals often or sometimes sent care summaries by mail or fax and 81% often or sometimes received them that way. ONC combines mail and fax in that measure.
Direct Secure Messaging is a valuable, standards-based way to exchange clinical documents between trusted participants, and it belongs in a healthcare interoperability strategy. It is not a universal replacement: Direct addresses must be known and maintained, messages still need to be processed once they arrive, and smaller practices may lack the integrated systems to use it well. Most organizations benefit from supporting several exchange methods.
Healthcare fax workflow automation uses OCR, document classification, and AI-assisted data extraction to turn incoming faxes into structured, routed work. A referral, order, or records request can be recognized, have key patient and provider details extracted, and be sent to the right queue or system, with uncertain items flagged for human review.
Time to action is the time between receiving a healthcare document and someone taking the next meaningful step on it, such as contacting the patient or scheduling care. It can be broken into time to classification, time to routing, the share of documents needing manual intervention, and time from referral receipt to patient contact.
No. AI document processing reduces repetitive administrative work such as sorting, keying, and routing documents. Healthcare professionals remain responsible for clinical decisions, and AI systems still require validation, monitoring, safeguards for protected health information, and human review when information is ambiguous.
Sources and Further Reading
- Office of the National Coordinator for Health Information Technology. “Methods Used by Hospitals to Engage in Interoperable Exchange.” Health IT Quick Stat #70, 2025 AHA IT Survey.
- Office of the National Coordinator for Health Information Technology. “Electronic Health Information Exchange by Hospitals.” Health IT Quick Stat #66, 2014–2025 AHA IT Survey.
- CAQH. 2024 CAQH Index Report.
- Everson J, Richwine C. “Barriers to obtaining and using interoperable information among non-federal acute care hospitals.” Journal of the American Medical Informatics Association, 2025;32(1):20–27.
- Arvisais-Anhalt S, et al. “Direct Secure Messaging in Practice: Recommendations for Improvements.” Applied Clinical Informatics, 2022;13(3):767–773.
- DirectTrust. Directory Services.
Disclaimer: This article is provided for general informational purposes only. Research findings are cited as published and may not generalize to every organization. ONC hospital figures combine mail and fax, and the CAQH savings estimate covers specific administrative transactions rather than fax automation alone. The AI workflow shown is illustrative; actual capabilities depend on system configuration and integrations, and clinical decisions remain subject to human review.