Why Faxing Instead of Direct Messaging Puts Your Practice at Risk for Not Meeting New Federal Requirements

By James E. Grue, OD,
Ronald P. Snyder, OD, FAAO,
and Michael J. Lipson, OD, FAAO, FSLS

March 3, 2021

The fax machine is not just a technology of the past, but one which is inefficient and does not provide the needed documentation when communicating with other healthcare offices. Here is why sending direct messages through your electronic health record is the best way to communicate with other practices for the management of your patients.

A Better Way to Communicate
January 1, 2021, saw an important transition toward delivering value-based healthcare that directly affects how providers share patient health information. As a policy, faxing is being discouraged by health systems, as well as payers. Last year, there was considerable discussion in Congress about banning the use of faxes for communication between healthcare offices.

When received, faxes contribute to provider burden, are rarely seen by the receiving physician and the information they contain is usually not utilized during the patient encounter. The preferred and better way of communicating is already built into your certified EHR. It is called Direct Secure Messaging.

To use Direct Messaging, contact your EHR support center and request they turn it on. The use of Direct Messaging is exploding in medicine, largely as a result of the new CMS E/M coding guidelines and by the 21st Century Cures Acts’ information blocking regulations, which become effective on April 5, 2021. The level of billing and reimbursement in the new CMS E/M Coding Guidelines is now based on three things, 1) the amount of data that has to be reviewed, 2) the number of conditions (diagnoses) and 3) the level of risk for future complications for the patient.

This following graph demonstrates the acceleration of Direct Messaging utilization from 2004 to 2020:

Healthcare providers have used Direct Messaging to communicate over 2 billion times, with much of that utilization being done in the last quarters of 2020.

Meeting a New Requirement
Effective April 5, 2021, the 21st Century Cures Act will require that you be able to send a lot more information than you ever did in the past. Faxing does not meet the new requirements and is impractical. The new E/M coding guidelines now pay you and other providers for:
• Coordinating care

• The number of health conditions that are documented in the patient’s record that could affect the condition for which you are seeing the patient.

• The amount of data on the patient that you have reviewed to understand the patient’s condition and needs.

Enabling Delivery of C-CDA
Direct Messaging can send any type of document including PDFs, images, but most importantly, it delivers a C-CDA (Consolidate Clinical Document Architecture). It is this document which every certified EHR is required to create for sending and receiving patient health information. You likely know these documents as the exam summary reports and transition of care documents that your EHR’s system creates. These documents can be sent and received through Direct Messaging. You can read a C-CDA, however, it can also be read by your EHR system.

To learn more: 844.393.3282. (toll free) or

The 21st Century Cures Act mandates that you be able to share all the patient health information contained in the USCDI (United States Core Data for Interoperability) with any provider or organization that your patient requests. What is important is that when you receive a C-CDA, likely in the form of a referral letter or a transition of care document from another provider, with a simple click of the mouse, you should be able to populate all this information into the patient’s record in your EHR. This can be done without you or your staff having to do anything other than clicking “import.”

For a new patient referred to you for a comprehensive dilated eye exam, a simple click of the mouse will populate the exam you are about to do. In addition to patient demographic data, the information below will also be automatically entered.

  • A complete medication list
  • A complete problem list (you already can bill a higher amount just from this)
  • A list of all procedures that have been done on the patient
  • Smoking Status
  • Vital signs Family Hx and Travel Hx
  • Allergies
  • Unique Device Identifier(s)
  • Names of the other care team members
  • Clinical notes including goals of care
  • Patient and provider health concerns
  • Medical laboratory results

Having access to this information enables you to bill and validate your exam at a higher level. Also, without actually asking the patient, you will have more accurate information, and the increased efficiency of this process will give you more time to see more patients and with less effort.

In summary, there are numerous advantages to discontinuing the use of faxing and switching to Direct Messaging to electronically share patient health information with other healthcare providers:
1) Communications are more efficient and less burdensome.

2) Allows you to see more patients per day with less effort.

3) Ability to increase your level of billing under the new E/M coding guidelines.

4) Helps other providers who are involved in the care of the patient to bill at a higher level (You have the option of billing under the 92XXX codes, but the primary care physicians and other specialist do not, so your electronic reports are valuable to them.)

5) Additional information will be available to you to understand and describe “risk” under the new E/M Coding guidelines, which will also help you bill at a higher level.

6) Once you have learned how to implement direct messaging, if a patient requests their information be sent to another provider, you will have an easy solution to meet that request. You will also avoid the future information blocking financial penalties that are put in place by the 21st Century Cures Act.

Think back to a recent visit to your physician. Did you have to complete a lengthy questionnaire on the physician’s website? When in the office, did you fill out a litany of health history questions on a clipboard? Probably not. The modern patient’s expectation is that their healthcare provider already has their health information. This includes you, their eyecare practitioner.

Resistance to change is only natural. With a little effort, you can change to Direct Messaging. Once you make the change you will be very happy that you did.

James E. Grue, OD, is a health-care reform speaker and consultant. To contact him:




Ronald P. Snyder, OD, FAAO, is the president and CEO of HealthCare Registries, LLC. To contact him:



Michael J. Lipson, OD, FAAO, is the chairman of the OrthoK Advisory Panel of HealthCare Registries, LLC.


To Top
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.