Consensus Cloud Solutions
This week I am talking to John Nebergall, Chief Operating Officer of Consensus Cloud Solutions which we recorded live from HIMSS 21 in Las Vegas. Consensus is a spin off from J2 and eFax and they provide interoperability and streamlined workflows in a simple platform that keeps you connected through each patient’s continuum of care
Taking a contrary view to the general perception on Fax technology Consensus plans on using the infrastructure to create an interoperable solutions. As one commentator put it during the HIMSS interoperability showcase, they were seeing red
https://twitter.com/RasuShrestha/status/1425522323935879170?s=20
And it’s not hard to understand why – we have all had our fill of paper based systems that lock information away and fail to delivering information and knowledge into the care process. But that resistance is based on the old traditional perception of Faxes as a paper *output*. That’s where John and Consensus have focused their efforts in the output component of Fax technology.
As John points out – Faxes are Digital information, albeit in the form of Audio files since the technology was developed in an era when phone lines were the majority share of communications links.
As you can see in the image paper information is scanned encoded into an audio file and train fitted to another machine to be rendered. You can think of it a little like the Transporter in Star Trek
Except with inanimate object and specifically with paper.
But just because the information starts off as paper does not mean it has to end up as a paper render, in fact its the start of the creation of an end-to-end interoperability solution.
Listen in to hear us discuss the new age of faxing who as John describes
is that fax is a very useful, very secure, very reliable, very inexpensive protocol for moving information from point A to point B electronically
You can hear why faxes remain a primary form of communication that is legally accepted thanks to a level of security that other methods do not enjoy. We perceive something to be old and limited usefulness but there are still many examples of technology that have been revamped to continue to deliver value and function to our world and faxes are no different. Faxes can produce HL7, FHIR and discreet data
Don’t write off the fax technology quite yet – this is not your father’s fax anymore
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Thanks for tuning in today, I’m Dr. Nick the incrementalist Join me as I seek out the small incremental changes being applied in other industries that we can learn from, and that can be applied in healthcare. Can these changes bring immediate value, but also add up to the big improvements and revolution we need in healthcare? Come along with me to explore the possibilities. My innovative guests from around the globe have used small incremental improvements to achieve their moonshot. And today I’m delighted to be joined by john Namba goal. He is the CEO of consensus cloud solutions. JOHN, thanks for joining me today. Thank you for having me. I appreciate it. So as I do with all my guests, I think it would be great to get a little bit of background on you. How are you arrived at this point in your career? What were the important sort of inflection points? Tell us your story. Well, I’ve been in healthcare IT REALLY since 2000. I joined all scripts.
John Nebergall
In in 2000, Glenn Tolman and I, the Toulmin family and I go back several years, I spent seven or eight years at all scripts, moved on to zincs, health, clinical decision support, and then spent a few years at Orion health, the makers of Rhapsody, so I’ve seen things from the perspective of the EHR, the HIE and clinical decision support. And having that background made me a perfect candidate to be recruited into a job to run a fax organization. I joined j to global in 2018, to run their cloud facts organization, the primary nameplate, there’s a brand called effects, which everybody’s probably heard of. And, you know, there we started the transformation that’s got us to a point now where we’re kind of a multi protocol platform for delivery of secure information, focused primarily on healthcare.
Nick van Terheyden
So you brought it up, you brought the F word up in healthcare, let’s be clear, I think I’ve probably heard in numerable times, you know, the death of faxes, faxes are going to disappear where you know, we don’t need faxes. And yet here you are talking about faxes, and an organization that is focused on that technology. Tell us a little bit about what it is that you do and why you think maybe faxes aren’t going the way of the dinosaurs
John Nebergall
are coming into this opportunity. I think that like the rest of the healthcare IT professionals that are probably swirling around us here in hims, fax was a four letter word. The reality is, is that fax is a very useful, very secure, very reliable, very inexpensive protocol for moving information from point A to point B electronically. Now, since often you render that through a machine and to a piece of paper, you have this image of faxes, as always being a piece of paper, in, in fact, with our cloud fax solution, it’s entirely paperless can be sent directly out of an EHR or some other system of record and can be consumed on the other end by any EHR or some other system of record without ever having a piece of paper exists. And the security around fax is far superior to anything that you’re going to find in in an email system, for example.
Nick van Terheyden
So I think it’s worth diving into that because not everybody is familiar with it. And, you know, certainly from the perspective of security, and gosh, you know, why is this better than other things. But there are reasons for that. I mean, this whole protocol is actually a confirmation as there’s a whole exchange that takes place. Tell us tell us a little bit about what’s going on behind the scenes because I think it’s important to understand this.
John Nebergall
Well, interestingly, what you’re doing when you send fax is you’re sending a sound file over a telephone line is answered on the other end and decoded. Generally, when people are looking for things to steal cyber criminals, folks who want to steal identities, those kinds of things. They’re not looking for a sound file over a telephone line, because that’s any one of 10 billion pieces of information that’s usually a conversation going across telephone line. So To a great extent ctac facts moves in camouflage. In addition, those faxes are encrypted. So you have the ability to both blend into the background as well as be very secure in terms of of how you do the digital transfer. Ultimately, you want to be able to find a way to take that fax take that that transfer mechanism and be able to use that information. On the other end, I think I’ve generally said that if there’s a argument against fax hits on the receive end of things, where you have what is rendered is an image file, often unstructured data. And that’s exactly the problem that we’re solving.
Nick van Terheyden
So we have a secure mechanism, I wanted to say, when you started talking about it, you know, hides underneath, because as soon as you mentioned it, people start focusing on it. But I’m sure too hard to find needle in a haystack to find the audio that’s taking place. It’s encrypted. So you know, secure and I think confirmation that takes place. But as you rightly say, I mean, I think our sort of general dislike or irritation is that it turns it back into these pieces of paper that we’re awash with that provide, they provide value, but not the same level of value that digital records do. You know, whilst there’s general sort of pushback on electronic medical records, and you know, the value proposition, pretty much 100% of clinicians will say, No, I prefer this. I just don’t like the interactions that we have. When you think about the new innovations that we need to bring to that receiving end. What do we have to do? And what’s what are the possibilities? I mean, this seems like a missed opportunity, where we’ve all been beating up on faxes, but that’s a, I think, a fake idea. I mean, this is something we shouldn’t be focusing on and thinking about the opportunities.
John Nebergall
Well, you know, that there’s been a lot of work in technology generally, around how to encrypt something and then decrypt something. When you think about fax, I draw the parallel there. Essentially, what you want to be able to do on the receive end, is decrypt the fax. And I’m sure my technology friends will, you know, that thumbed their noses at my characterization, but you want to take a fax, and be able to say, Look, I’ve got all the component parts here, how do I take this and, and create a structured data message out of it. And what what you get when you start to apply machine learning, automated intelligence principles, and repetition after repetition, is that the the computer systems can learn to extract data in structured form, from that fax message, and in fact, create an HL seven message of fire message a, a structured, cc, CCD, all of those things, in fact, we’re finding are very possible. And when you apply those kinds of technology, to the issue of how do I render of facts into an EHR system, or into some other system of record, as searchable, and structured data? The problem is very solvable. And in fact, we’re solving it today.
Nick van Terheyden
So I got to say, as I listened to that, it sounds a little bit like almost magic. In some respects, you’re taking something that we all can recognize associate with you know, I, I’m sure most people are listening to this going, they can hear the fact sound we’ve all gotten used to and this spitting out of a piece of paper, but you’re saying you’re taking the output and turning it into all those messes. So that’s digital information. How on earth are you doing that?
John Nebergall
Well, it really is, by teaching a computer system to effectively read the facts, be able to identify what’s an patients name, what’s the physicians name, what’s a problem, what’s a medication, and extract that information and be able to create the structured data right off of a form, say that’s faxed or even, you can teach it how to read handwriting, ultimately, and you’ve probably had the experience of of on your digital device, they’re doing handwriting that turns into text. You know, the principles are the same. The difference is that when you apply this kind of natural language processing technology, it understands those letters in some kind of context. It no longer is looking for, you know, a J and o and H And then what is looking for as a first name, they can say there’s a first name, not just a collection of letters. And by applying this your wind up in a spot where you can take that facts and, and really transform it. And, and learning to transform it and flight so that when the sender sends a fax, the receiver is actually receiving something in a form that they’d rather have it can send a fax, receive a direct secure message, can send a fax, and receive an HL seven message, a fire message. And that’s exactly the kind of technology that’s going to be a very big difference maker. For those of us who still see that in in the clinical workflow, as soon as you have a piece of paper. And we all know the steps that anybody goes through in that workflow, a piece of paper exists, fax immediately becomes the superior workflow. Because you just need to drop it through a machine and it goes on its way. If you can transform that fax, and render it in a way that structured data, you wind up being able to serve both ends.
Nick van Terheyden
So for those of you just joining, I’m here with john navigo. He is the Chief Operating Officer for consensus cloud solutions, we were just talking about the new age of faxes and the innovations around not just the sending, I mean, essentially, faxes are rife throughout the healthcare system, it doesn’t matter how you cut this, they exist everywhere, I, it’s almost hard for me to imagine walking into any clinical setting, and not seeing some fax machine that’s not sitting idle To be clear, it’s in use daily, in some cases in high volume, in fact, and here, you are saying, we’re taking this and we’re going to digitize that information, tell us a little bit about the process that you’ve gone through and some of the examples of what you’ve been able to achieve with that?
John Nebergall
Well, the the process winds up being one by applying the principles of machine learning and most, most specifically, repetition. So the more times a computer can see a form with information on it, the computer learns over and over again, as it gets feedback. The feedback is supplied by people who take the form, once a computer is done, here’s what I think it is. And a human being can make corrections. But imagine doing that day in and day out 10s of 1000s of times, the computer starts to get very good at being able to identify fields in a form, identify words in context in those fields. So we’re fortunate in in having what we believe is the largest cloud fax operation in the world, north of two and a half to 3 billion pages annually. And and those reps those opportunities for that repetition that you send through that machine, give us a real opportunity to start to decode this. And, you know, it’s not like you’re doing anything that’s terribly out of the ordinary because the normal corporate course of business, these faxes are going from point A to point B, what we’re trying to do is apply some intelligence to that and to learn from that. And then ultimately now being able to render these kinds of advances in structured data. And in the interoperability workshop, in fact, we are showing a live demo an actual scenario where we are taking a fax, delivering it as structured data, in fact, into an epic system.
Nick van Terheyden
Hold on, stop right there. You’re telling me that faxing is sitting in the interoperability forum and demonstrating the interoperability of data in the show here today? I mean, that’s just extraordinary when you think about it, and all of the negativity that surrounds this perception, I think one of the things I imagine you have to sort of deal with is that perception that is driven by the paper output that’s existed. So you’ve achieved success, you’re showing it. Tell us a little bit about where you see that going. I mean, to me, this sounds like we’ve suddenly got a massive input stream that we can harness that has not existed before. Well, I mean, it’s existed, but it’s not been useful to us, or at least not in a real sense.
John Nebergall
Yeah, there’s an education process that definitely needs to take place. And I think that there’s a certain reaction that people especially in healthcare IT have when you start to say the F word. The reality of it is though, most of what has been focused on in the interoperability revolution is new methods of digital information transfer new things to invent new new things to buy for the practicing physician. And, you know, what we did is we said, Look, here’s something that works, is trusted, is inexpensive. And in fact, if you just spent a little time improving it, you, you get to the same place that you can with a whole new digital system that can cost into, you know, easily seven, eight figures, if you’re a large institution,
Nick van Terheyden
I gotta say, that sounds like an incremental step, incremental step, but we think in a very important one. So an incremental step that builds on existing technology, an infrastructure, I mean, to me, it feels a little bit like the infrastructure that we have for petrol based engines, they exist, because we have the supporting infrastructure that allows cars to fill up in all of these gas stations, what we don’t have is the electrical grid to support electrical vehicles. And that’s why we’ve got hybrids. And for me, this feels like a, you know, something of a hybrid approach to this from a data standpoint, we’ve got the outbound capabilities, you can take those messages, and you’re applying that learning that is now converting it Have you got some examples of this in use in in any instances?
John Nebergall
Yeah, as a matter of fact, that that is a actual live instance, that we’re using in the interoperability showcase the, the folks at hims, are very good at making sure that you’re not bringing vapor into into play. So you know, the platform that’s been created, allows for us to be able to, essentially, take a message the way you want to send it, and, and deliver a message the way that the receiver wants it delivered. And whether that’s, you know, rendering a fax as a structured data message, or allowing a sender, the option of, of not sending a fax at all, and sending a direct secure message. We we created a platform in order to accommodate that, because I think flexibility is is the item, I don’t think we’re going to place a bet on which technology wins. I think our our job is to be Switzerland in the middle. And whichever workflow, the particular healthcare organization finds is superior for them accommodated.
Nick van Terheyden
And it sounds like the the sender doesn’t have to care at all about send, they just send it the same way that they’ve always sent the information. And it’s all on the receiving end to turn that into useful data. Yeah, the receiver
John Nebergall
in this situation is going to choose how they want that message rendered. And it’s up to us to get it there the sender, the sender chooses to send the easiest way they can and we accept it that way. And and it’s up to us to do the transformation.
Nick van Terheyden
And you’ll do it no matter what that inbound messages the way it comes in. We’ll
John Nebergall
do that no matter what.
Nick van Terheyden
Fantastic. So the organization has gone through a little bit of change over the last recent past you’ve started as one organization, there’s a split. Tell us a little bit about that what’s going on there and why that’s the case.
John Nebergall
Well, when I joined the organization I was known as the the fax business inside inside j two global, which is a publicly held organization. And the fax business was as I mentioned, figurehead or nameplate was effects but my facts Metro facts as facts pesar fact I facts you facts we facts, they facts, all of those brands. Pretty much all of those brands existed under under a main umbrella. And and over the past two years, we’ve focused on the technology and transformed the business into really a secure Document Delivery business. Certainly faxes is a cornerstone and it’s heavily used not only in healthcare, but in other industries. But built upon that and and what has emerged is consensus cloud solutions. And the consensus suite is able to do these kinds of transformations clarity, consensus, clarity, specifically is what I was talking about for for the transformation of structured, unstructured and structured, but we’re going to be spinning off so so we’ve been very successful at what we’ve done. A j two has decided that in order for us to be even more successful and bring more value to the marketplace, they were going to spin us out as a separate publicly traded company. That’ll be expected to be happening sometime in the September ish timeframe. And we’re very excited about that. So we will soon be standing on our own and delivering value to healthcare, IT shops all over all over the US.
Nick van Terheyden
Fantastic. So few minutes left, as you think about the future, I mean, let’s be clear, I, I gotta say, if you’d asked me a year ago, two years, even five years ago, if I was going to be talking about faxes in 2021, post pandemic, wouldn’t have been on my list, I got to be honest, I think I probably sat in the same groupings of folks that just now this is a dead technology, you’ve reinvigorated it with a different way to sort of think about it applied new technology taken the benefits of it, where do you see this going? What are the opportunities? What are you excited about?
John Nebergall
Well, you know, the, the beauty of cloud facts is that you really have a technology that can be introduced into a workplace, it’s a technology people are familiar with feel comfortable with. And he can start immediately bought by introducing an electronic workflow. So if you just think about the advantage that that you would have to approach of physician’s office, who has been using a fax machine for ever, and can say, you know, what, you keep your fax number, you still send and receive faxes, only now they render electronically without having to apply any of the advanced technology. And, and you you introduce a superior workflow, you get rid of the paper, you’re able to easily take documents and file them into a system of record. Not as as structured, but even as unstructured data as a document in innovations file. And, and start the process of eliminating the loss of time and energy and money in having to run the fax machine, the paper, the toner, all of those kinds of things, just as simple as that you start start with that. But then you start to open up their possibilities. After that to say, now we can bring it to the digital age, already got a paperless workflow, what if you were able to send and receive structured messages so that they would immediately file into your system of record, you no longer have to worry about it rendering as a document, even electronic document. And you start to build upon that. So we’re incremental is really the key word here, you just start with small changes that build on each other, and can bring somebody really into the mainstream in terms of a digital health record, step by step, having each step be comfortable with the kinds of technologies that they are used to using without needing to make a big investment.
Nick van Terheyden
So I gotta say, I’m feeling a little bit inadequate. Now, because I got rid of my landline, I don’t have a fax machine. And I feel like I can’t play in this new world that exists. But that’s not the case, right? We can all get access to this, it’s essentially a cloud based solution, you got to have some scanning capability, I assume to be able to incorporate
John Nebergall
Well, if you’re starting with a piece of paper, sure. But if you’re outputting, a document a PDF or Word document, some kind of output from an EHR, that you take that output and you send it The, the the fax numbers still exists, but you can think of it just like a unique email address, there’s a dunja digit number that identifies you as you at your computer. And you send it to another 10 digit number that identifies the receiver and and you don’t need a phone line at all.
Nick van Terheyden
So it’s it’s a new age of innovation, that starts to bring digital information through faxes that we’ve always associated with paper. And, you know, the old way of doing things, but entirely rethinking that building on existing infrastructure, I think very exciting, you know, using innovation around natural language processing, artificial intelligence that has sort of applied all of that learning to the billions of messages that you’ve been able to train the system on. I think this is an exciting time for all of us. closing thoughts?
John Nebergall
Well, I think that as I’ve said before, one of the things that has happened in our sort of approach to interoperability, especially at the regulatory level, is the sort of this forward look that leaves people behind in the dust. Not everybody can keep up with the pace of technical innovation and, and you need to look back when you look ahead, make sure you’re backwardly compatible that you can still use use other methods effectively to be able to reach the same end goals. And I think more than anything that that’s the, the, the one finishing thought I’d want. I’d want to leave with everybody who’s listening. Don’t be so fast just to show up to shuffle off the old ways, think about how you can incorporate them in the way forward and move incrementally.
Nick van Terheyden
I gotta say he’s singing my song. So thank you for that. Unfortunately, as usual, we’ve run out of time. So it just remains for me to thank you, john, for joining me on the show today. Thanks very much.
John Nebergall
I really appreciate you having me.
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