The concept of the last mile comes from telecommunications infrastructure. Building fiber optic cable to a neighborhood is technically and economically feasible. Getting that fiber into every individual home is the hard part, the last mile where the cost and complexity per connection is highest and where the aggregate infrastructure investment cannot easily scale.
Healthcare interoperability has a last mile problem. The major health systems, large payers, and well-resourced physician groups that have invested in EHR interoperability, Direct Trust messaging, and FHIR-based APIs can exchange structured clinical data with each other relatively efficiently. The community provider, the small behavioral health organization, the independent specialist, and the rural clinic that generates a significant share of the cross-organizational communication volume in any given market are the last mile. They are connected to the larger ecosystem primarily through fax.
Where Interoperability Has Made Progress
The progress that healthcare interoperability has made in the past decade is real and significant. Epic’s Care Everywhere network connects a large and growing share of the hospital and health system market. CommonWell and Carequality have expanded the reach of clinical data sharing across EHR platforms. The CMS Interoperability and Patient Access Rule has driven FHIR API adoption among major payers and providers. Health information exchanges have improved data sharing in several regional markets.
Within those connected networks, the exchange of structured clinical data has improved substantially. A patient seen at one large health system who is referred to a specialist within the same network or within a connected HIE can have their records follow them electronically in a way that was not reliably possible fifteen years ago.
That progress is meaningful and worth recognizing. It is also incomplete in ways that matter for the daily communication needs of clinical organizations.
Where the Gap Remains
The Office of the National Coordinator for Health IT and healthcare interoperability advocates frequently describe interoperability progress in terms of how many providers or patients are connected to some form of electronic exchange. What those numbers often do not capture is whether those providers can exchange data with every other provider they need to communicate with in the course of their daily operations.
A primary care physician referring a patient to a community acupuncturist, a pain management clinic, or a substance use treatment program may not be able to send that referral through any electronic exchange. Those providers may not be on a connected EHR, may not have implemented Direct messaging, and may not be in any HIE network the referring physician’s system is connected to. The referral goes by fax.
A hospital discharging a patient to a small home health agency in a rural area may have no electronic exchange connection to that agency. The discharge summary goes by fax.
A payer authorizing a procedure needs to communicate that authorization to a small specialist practice that is not on a FHIR-enabled platform. The authorization goes by fax.
Each of those scenarios involves the last mile: the communication that happens between organizations that have not built a formal electronic exchange connection, which in a fragmented healthcare ecosystem is a large share of all cross-organizational communication.
Why the Last Mile Is Structurally Persistent
Building electronic exchange connections requires investment on both sides of the connection. The large organization that has made that investment for its major partners has not necessarily made it for every community provider in its referral network, and those community providers have not necessarily invested in compatible infrastructure.
The economic logic of interoperability investment is that the return is proportional to the volume of communication with a given partner. High-volume relationships justify integration investment. Low-volume relationships do not, even when those relationships are clinically important for individual patients.
Fax reaches every provider in the healthcare ecosystem regardless of the volume of the relationship and regardless of whether either party has made interoperability investments. That universality is precisely what makes fax the last mile: it is the channel that serves the communication relationships that interoperability investments do not cover.
What This Means for Organizations Investing in Both
The organizations that have thought carefully about this tend to treat fax and interoperability as complementary infrastructure, each serving the communication relationships it is suited for. Large-volume, structured data exchange between major institutional partners flows through EHR interfaces and FHIR APIs. Community provider communication, cross-market referrals, payer-provider correspondence, and external organization communication where no electronic connection exists flows through fax.
Lane’s Epic integration is a concrete example of how these two layers work together. The integration allows faxes to originate and arrive within the Epic workflow, connecting the interoperability-native EHR environment to the universal reach of fax. The organization does not choose between Epic and fax. It uses Epic’s interoperability capabilities for the partners Epic can reach and fax for everyone else.
Passport’s workgroup routing, delivery confirmation, and audit trail make fax infrastructure reliable enough to serve as the last mile without creating the compliance and operational risks that poorly managed fax creates. The last mile is only a problem when the infrastructure running it is inadequate.
Schedule a strategy call with the Lane team to discuss how Passport fits alongside your organization’s interoperability investments.
