Every wave of healthcare interoperability investment has been accompanied by predictions that fax would be its casualty. HL7 interfaces would replace fax. Health information exchanges would replace fax. Meaningful Use and EHR adoption would replace fax. FHIR-based APIs would replace fax. Each prediction has followed the same pattern: the new capability would cover what fax was doing, fax volume would decline, and eventually fax infrastructure would be retired.
Each prediction has been wrong in the same way. Not because interoperability initiatives have failed, but because fax and interoperability serve structurally different communication functions, and the growth of one does not diminish the need for the other.
What Interoperability Is Designed to Do
Healthcare interoperability initiatives, whether HL7 interfaces, health information exchanges, Direct Trust secure messaging, or FHIR-based API connections, are designed to move structured clinical data between organizations that have established a technical connection. They work exceptionally well for that purpose within their scope.
When a hospital and a specialist group have implemented a mutual HL7 interface, referral documentation can flow between them as structured data that populates directly into the receiving EHR without manual entry. When a patient’s records are in a Health Information Exchange, a treating physician at any connected facility can access them without requesting a record release. When two organizations have completed Direct Trust onboarding, they can exchange clinical documents through a secure, standards-based channel.
The operative phrase in each case is that both parties have established a technical connection. Interoperability is a bilateral capability. It works between organizations that have invested in making it work between them.
What Fax Is Designed to Do
Fax is a unilateral capability. Sending a fax to an organization requires knowing their fax number. It does not require a prior technical relationship, a shared platform, a compatible data standard, or a mutual investment in integration infrastructure.
That unilateral reach is the function that interoperability cannot replicate. A health system with hundreds of affiliated providers and hundreds of referring physicians communicates routinely with many organizations it has never established a formal interoperability connection with. A patient is referred by a physician who has never sent a referral to that health system before. A laboratory result needs to reach a community provider who is not in any connected network. A prior authorization needs to reach a payer whose portal is down.
In each of those scenarios, fax is the channel that works without negotiation, without setup, and without requiring the other party to have implemented any specific technology.
Why They Complement Rather Than Compete
The organizations that have made the most significant investments in interoperability are also the organizations with the most sophisticated fax infrastructure. Large academic medical centers that have invested heavily in Epic’s interoperability features, health information exchange connections, and Care Everywhere network participation are also running enterprise fax platforms with sophisticated routing, monitoring, and compliance architecture.
That is not a contradiction. It reflects a practical understanding that interoperability covers communication within established networks and fax covers communication outside those networks. Both are necessary because organizations exist simultaneously inside and outside different networks depending on who they are communicating with on any given day.
Lane’s integration with Epic’s Connection Hub illustrates the complementary relationship directly. The integration allows faxes to be sent and received from within the Epic workflow, connecting the interoperability-native EHR environment to the universal reach of fax infrastructure. Organizations do not choose between Epic’s interoperability features and Lane’s fax platform. They use both because they serve different communication contexts.
The Same Logic Applies to FHIR
The current generation of interoperability investment centers on FHIR-based APIs. CMS mandates have required payers and providers to implement FHIR-compliant patient access and provider directory APIs. The infrastructure being built is valuable and consequential. It will improve structured data exchange between organizations that implement compatible APIs.
It will not make fax unnecessary for the same reason that every previous interoperability wave has not. FHIR API connections require both parties to have implemented the API. Not every physician practice, post-acute facility, behavioral health provider, or specialty clinic that a health system communicates with will have implemented compatible FHIR APIs in the near term. Fax will continue to reach those parties while FHIR adoption expands, and likely after it has reached whatever ceiling it reaches.
The post on why healthcare will not eliminate fax anytime soon covers the structural dynamics in detail. The practical takeaway for organizations is that investing in fax infrastructure and investing in interoperability are not trade-offs. They are parallel investments in communication capabilities that serve different contexts.
Schedule a strategy call with the Lane team to discuss how Passport complements your organization’s interoperability investments rather than competing with them.
