A Unique Way to Axe the Fax Through Using Business Automation Workflow to Expedite eReferral Adoption, Bridging eReferral, and Fax: Proof-of-Concept Study

Background: It is estimated that 88% of Ontario physicians still use fax technology to share patient information. Transitioning to electronic referral (eReferral) has been shown to have numerous benefits, but the major barrier to adoption of eReferral is the need for both sending and receiving clinicians on the same platform to enable information sharing. The traditional onboarding process takes time and effort. An innovative method is required to improve eReferral adoption by bridging the gap between eReferral senders and fax referral receivers. Objective: This study aimed to explore the technological feasibility of leveraging a business automation workflow (BAW) platform to connect the digital (eReferral) and nondigital referral platform (fax), enabling eReferral senders to send referrals to fax receivers, thereby improving the clinician experience. Methods: An eReferral via eFax solution was developed and evaluated on the BAW platform to connect the eReferral platform and the clinicians using fax. A selected number of fax receivers were identified and enabled on the eReferral platform as eFax receivers. Sending clinicians initiated eFaxes through the familiar eReferral workflow, with eFaxes transmitted to BAW and delivered to the target receiver via fax. Retry and reminder logic were built to improve the user experience. If the eFax failed after all retries, a message was sent to the sending clinician through the eReferral platform explaining the failure reason. The appointment information was entered into the eReferral platform by the sending clinicians to trigger patient email notifications. Surveys and focused interviews were conducted to collect clinicians' feedback. Results: From May 2022 to December 2023, 224 eFax receivers were enabled on the platform, processing 4504 eFaxes for 4132 unique patients and 843 unique senders across the province. Nearly 70% (3137/4504) of patients consented and received email notifications; 19% (875/4504) received appointment details after manual entry in the eReferral platform. On average, eFax referrals contained 5.6 pages, with a minimal 0.7% exceeding 30 pages. Initially, fax service retries were disabled to observe delivery error rates. This resulted in a 37.7% (1023/2712) fax failure. However, after implementing new retry logic in March 2023, the failure rate dropped significantly to 9.9% (304/3082), and 98.7% (2770/2806) of eFaxes were successfully delivered after automatic retries. Clinician feedback revealed a positive impact on sending clinicians' experience, maintaining their familiar workflow while accommodating fax-reliant receivers who can gradually transition to eReferral at their own pace. Conclusions: This project demonstrates the potential of the BAW platform to bridge the gap between fax and eReferral systems. It minimizes disruption for sending clinicians while allowing fax receivers to incrementally adopt the new platform. This technology can significantly expedite eReferral adoption by reducing the reliance on receiving clinics to adopt eReferral, ultimately enhancing the experience for both clinicians and patients.