Interoperability has been the defining goal of healthcare IT investment for more than a decade. The vision is straightforward: patient data should move between systems, providers, and organizations without friction, without manual intervention, and without creating gaps in the clinical record. HL7, FHIR, health information exchanges, and EHR API layers have all expanded what is possible. And yet, in the average clinical laboratory, fax remains one of the most active communication channels in daily operations.
This is not a contradiction. It is the practical reality of how healthcare interoperability actually works in 2025, where connectivity is advancing unevenly across provider types, geographies, and system generations. Understanding where fax fits in the modern laboratory interoperability stack, not as a legacy workaround but as a deliberate component, is important for any IT or informatics leader responsible for laboratory data delivery.
The Interoperability Stack in a Clinical Lab Context
A modern clinical laboratory’s data exchange environment typically includes several layers. The laboratory information system (LIS) manages specimen tracking, result entry, quality assurance, and reporting internally. HL7 messaging connects the LIS to hospital EHRs within the same organization, enabling result delivery into patient records without manual intervention. Health information exchange networks like CommonWell or Carequality extend connectivity to participating organizations outside the lab’s direct network. FHIR APIs support newer integration patterns, particularly for patient-facing applications and external developer connectivity.
Each of these layers serves an important function. Together, they handle a significant portion of intra-organizational and network-participant data exchange. But they do not cover the entire universe of recipients who need laboratory results. And that gap is where fax earns its continued place in the interoperability stack.
Where HL7 and HIE Fall Short
HL7 interfaces work well between systems that have been deliberately connected through a managed interface project. The problem is that not every ordering provider is connected to the same HL7 interface, health information exchange, or EHR portal as the lab sending them results. Small independent practices, specialty clinics in rural areas, long-term care and skilled nursing facilities, behavioral health providers, and providers using older or niche EHR systems frequently fall outside the reach of the network layers a hospital lab has built.
Health information exchange participation is not universal. Even within a single metropolitan area, a lab may routinely send results to providers who are not participants in the regional HIE. FHIR connectivity, while growing, is not yet a universal capability among the full range of provider types that laboratories serve.
Fax reaches all of them. A fax number is the common denominator that exists across provider types, system generations, and geographic coverage areas. This is why 75% of medical communications in the U.S. still travel by fax, and why labs specifically remain among the highest-volume fax users in all of healthcare.
Fax as a Managed Integration, Not a Manual Process
The distinction that matters for a modern laboratory’s interoperability approach is between unmanaged fax (standalone machines, shared fax numbers, paper output) and integrated fax that functions as a deliberate layer in the data delivery stack. The goal is not to preserve the fax machine. It is to treat fax delivery as a structured, integrated, auditable process that connects to the LIS and operates with the same reliability expectations as any other data exchange method.
Lane’s Passport platform delivers this through direct integration with major LIS and EHR systems. Lane’s long-standing partnership with Clinisys means that labs running Clinisys can route finalized results to fax delivery automatically, without manual intervention, as part of the standard result distribution workflow. Lane’s Epic integration through the DirectFax API does the same for hospital labs on Epic, with Lane listed as a preferred fax integration solution on Epic’s App Orchard.
For labs not using Epic or Clinisys, Lane’s ERIS solution provides a containerized integration layer that processes outbound fax jobs from the file system and delivers them through the etherFAX network, connecting to existing LIS output workflows through file-drop APIs and web service REST APIs without requiring custom development.
Security and Compliance at the Integration Layer
Interoperability in healthcare is not just about connectivity. It is about moving data securely between parties in ways that satisfy HIPAA’s technical safeguard requirements, including access controls, transmission security, and audit controls. Each integration layer in the laboratory’s data delivery stack needs to meet these requirements, and fax is not exempt.
Lane is ISO 27001 certified, and the etherFAX network through which Lane delivers fax transmissions holds HITRUST certification, the information security standard specifically designed for healthcare data. The transmission security model includes multi-level encryption at both the transport layer and the message layer using elliptic curve cryptography, which is stronger than standard SSL-only approaches used by many fax vendors.
For informatics and IT leaders who are assembling a defensible interoperability stack, this matters. Every data exchange pathway needs to be documented, secured, and auditable. Fax managed through Lane’s infrastructure is as auditable as any other exchange method, with full transmission logs, delivery confirmations, and access records available through Passport’s Enterprise Status Manager.
DirectTrust and the Formalization of Fax in Health Information Exchange
An important development for understanding fax’s role in the interoperability stack is DirectTrust, the non-profit alliance that manages trust frameworks for secure health information exchange. Lane is a DirectTrust member as a secure fax provider, which positions fax delivery within the formal trust infrastructure that governs how providers exchange health data across organizational boundaries.
This is meaningful because it means fax, when implemented through a DirectTrust participating vendor, is not operating outside the structured trust framework of health information exchange. It is operating within it, with the same identity verification and security expectations that govern Direct Secure Messaging and other HIE communication methods. For labs that participate in health information exchange and need fax to coexist within that governance framework, Lane’s DirectTrust participation is a relevant credential.
Practical Implications for Lab Informatics Teams
For laboratory informatics teams designing or evaluating their data delivery architecture, the practical implication of fax’s role in the interoperability stack is this: plan for it deliberately rather than treating it as an exception. Identify which of your result recipients are reachable through HL7 interfaces, HIE connections, and EHR portals. Identify which ones are not. For the second group, fax is your delivery method, and it should be integrated, tracked, and secured to the same standard as every other method in your stack.
Lane’s enterprise fax solutions are designed specifically for this approach, with integration capabilities that connect fax delivery to LIS and EHR workflows, security architecture that satisfies HIPAA and HITRUST requirements, and monitoring tools that give IT teams the visibility they need to manage fax as an operational component rather than a background process.
To discuss how fax can be structured within your laboratory’s interoperability architecture, contact Lane or schedule a demo with the team.
