Health IT Interoperability Reimagined!

Interoperability with CloudFaxing

John NebergallThe U.S. Department of Health and Human Services (HHS) set a vision and goal by 2024 to make healthcare interoperability a reality. A greater push for Electronic Health Record (EHR) interoperability would improve workflows and allow for faster, improved communication between medical practices around the world. Direct messaging provides data compatibility between systems and can play a critical role in the spread of EHR interoperability.

While the healthcare community continues to focus on reaching full participation in secure electronic interoperability, our current reality is that the use of traditional fax, along with network-based fax servers, still dwarfs the use of direct messaging as the tool of choice for document transfer between healthcare entities. Recent estimates are that in the U.S. alone roughly 9 billion healthcare-related faxes are exchanged annually, contrasted with between 200 - 300 million direct messages. Many of these faxes are still of the paper variety - insecure, difficult to track, and easily misplaced.

The evolution of fax from paper-based to cloud transmission and storage (CloudFax) is a key step that enables CloudFax providers to comply with HIPAA and other regulations. Further strengthening of CloudFax as a key component in Healthcare Information Systems (HIS) will be its evolution into a Direct Messaging platform that enables the seamless exchange of Patient Health Information (PHI) between the diverse data and document management systems used by labs, pharmacies, doctor's offices, hospitals, and billing providers. CloudFax will support and contribute to the goals of interoperability. Consider:

  • CloudFaxes sent as direct messages will be consumed directly into EHR systems - for example, clinical summaries, lab results, immunization records, Continuity of Care Documents (CCDs), Continuity of Care Records (CCRs), and so on.
  • Direct messaging will turn unstructured content into discrete structured data that streamlines document exchanges, leading to improved patient quality, safety, care coordination, and reportability.


The move from paper-based processes with multiple workflows - and numerous security holes - to an electronic document exchange model that facilitates HIPAA-compliant transmission of patient records directly into a patient's EHR chart has been nothing short of revolutionary. Healthcare Organizations (HCOs) have been able to sever ties with costly hardware and physical phone connections and take their faxing digital. Ease-of-use and secure transmission, access, and storage have been the hallmark of this technological sea-change. The following table lists a number of the advantages of CloudFaxing over traditional paper-based transmissions:

  1. Delivery by direct message, digital fax or traditional fax depending on the receiving organization's preference;
  2. HIPAA compliant;
  3. Eliminates paper and all the associated security issues not to mention the improvement in promoting sustainability;

It is important to note that the full potential of CloudFax has not yet been completely realized. Further modernization of CloudFax to contain discrete data will allow providers to gain critical patient information at the point-of-care, supporting clinical decision making and optimizing patient outcomes. The ability for healthcare providers to use a production API to integrate customized CloudFax services into their native EHR tools, using state of the art transmission networks to facilitate high-volume CloudFax traffic that adheres to rigid security and compliance standards, dramatically increases the ability for HCOs, payers, and pharmacies to communicate in a compliant electronic fashion.

Direct Messaging

Evolution of CloudFax as a direct messaging tool will be critical to the future of healthcare interoperability. Direct messaging will make it possible for healthcare providers using diverse EHR systems to send and receive CloudFaxes both as discrete entities (traditional faxes) as well as direct exchanges of ingestible data from one EHR database to another.

Using digital IDs, the full interoperability of healthcare information systems running on different OS and database platforms is now possible. As long as the digital ID of the receiving Health Information Services Provider (HISP) is known, the CloudFax will be directly integrated into the receiving EHR. The CloudFax will not be viewed as a traditional document or page but in the format of the EHR, with discrete record fields populated directly from the CloudFax source.

This improved handling of the most commonly faxed documents (labs, prescriptions, surgical referrals and approvals) will enable healthcare providers to meet and surpass industry and Federal standards for patient record keeping and security.


Often lost in the interoperability discussion is that CloudFax products and APIs support the central goals - interoperability, usable data, HIPAA security, speed, scalability - currently being re-envisioned by the healthcare industry and the Federal government. The different data and document standards that have long been a performance and security gap to effective communication in the medical community are no longer true barriers; this "liquidity of data" will make the transfer of crucial healthcare records between doctors and patients, between hospitals and pharmacists, easier and more secure than ever.

Author Bio

John Nebergall, is a Senior Vice President and General Manager of j2 Cloud Services Fax Business Unit.  Mr. Nebergall is an accomplished senior executive with over 30 years of operating experience in the compliance space, with a particular emphasis in Healthcare IT. Prior to joining j2, John held several executive level positions including Senior Vice President, Global Client Services and Solution Adoption at Orion Health, Senior Vice President, Client Services at Allscripts. John is a Certified Public Accountant and earned his undergraduate degree in Accounting from DePaul University and an MBA from the University of Chicago. More...