Once, I inadvertently worsened a situation. Yes, it really only happened once…
At Centralis Health, we facilitate the movement of healthcare data in various ways. One of those ways is through our messaging platform, hMessage, which includes faxing capabilities. The importance of fax in healthcare is often underestimated until something goes wrong. Last week, a fax issue was brought to my attention that felt like a red alert disaster, and in my efforts to help, I unfortunately caused more chaos.
Here’s a quick recap of the situation: A non-Centralis Health participant was experiencing issues faxing to a Centralis Health participant, with nearly 100 failures and only 38 successes in the past 30 days. Although this issue had been reported multiple times over the last few months, our support team advised the senders to address it with their carrier because the Centralis Health participant was not having issues receiving faxes from anyone else.
Why did we do this? Because, in most cases, the sending carrier controls the call routes a fax takes to its final destination. Think of the sending carrier as a pitcher and the receiving side as a catcher. The catcher can suggest what pitch to throw, but the quality of that pitch is ultimately up to the pitcher. The catcher does their best to catch it, but sometimes it ends up heading for the backstop, missing the catcher altogether.
To the credit of the sending office, they escalated the issue to their electronic medical record (EMR) provider and were informed that they had no control over the transmission of the fax, which is true. They then contacted the company that provides their fax board and were told everything looked good on the board and that they, too, had no control over the transmission, which is also true. However, this company provided the first useful piece of information: they noticed that the calls were taking a least cost route (LCR), likely causing the issue.
A new ticket then appeared in Centralis Health support, questioning why we were using an LCR to receive their faxes and asking if we could fix it. After confirming with my carrier that we weren’t experiencing issues and that the sending carrier was the only entity capable of choosing the route, I jumped in to help.
By this point, tensions were high, and I was now the third person telling her we had no control over how her faxes are sent as we are simply the ‘catcher’ in this equation. The frustration coming from the nursing manager, that’s right, I said nursing manager, was evident. At this point, she had spent countless hours working on this faxing issue, all while maintaining her more important duties of ensuring efficient patient care at her practice.
At last, she placed a ticket with her VoIP carrier, who shall not be named, and was told everything was fine with her lines and there was nothing they could do. Again, she pushed and said she wanted her call routes updated from the current LCR to a more reliable route. She was told the ticket would be escalated to their engineer team. The ticket was closed without notice and with no word from the engineering team, and the faxes kept failing to be sent. At this point, I couldn’t do anything but provide support to this non-Centralis Health organization, so a new ticket was opened, and I was included on the calls with this carrier when she was told, “we cannot update our routes; that just isn’t something we can do.”
Wait, what?! This guy was steamrolling this nursing manager because I KNOW from dealing with our carrier that weird things happen with faxing. One day faxes are successful to a number, and the next, they are failing 100% of the time. When that happens, we place a ticket with our carrier and in no time get a message that call routes are updated and to please try sending the faxes again, and like magic, the faxes are successful again. So, the fact that she was told they couldn’t make these changes blew my mind, and we pushed enough to get the ticket escalated again.
This is when it got worse…
The next day, when the nursing manager arrived at the office, she discovered that something was completely and utterly wrong. In an effort to resolve the failed fax issue, the carrier had updated the hunt group (a mechanism to route calls across multiple lines to mitigate issues with high volume) to give their fax system more lines to handle the volume and reduce failures. In theory, this was a great idea. However, they failed to notify the nursing manager about this change.
As a result, received faxes were printing to paper instead of dropping into their EMR, their credit card machine wasn’t functioning properly, and outbound faxes from their EMR weren’t sending, to name a few issues. All this chaos occurred because the nursing manager placed a ticket, at my encouragement, with her carrier seeking help with what appeared to be an issue sending to a single number. So now, rather than finding a resolution to the faxing issue, the focus was shifted to reestablishing the hunt group configurations and getting the practice back to square one, which at this point still included failures to our carrier.
Once the hunt group configurations were re-established, I was invited to join a call with the nurse manager and the SUPERVISOR of the VoIP phone carrier who told me he had never heard of LCR, and he even asked another engineer who also had never heard of LCR and he has been with the carrier for 20 years.
Once again, my mind was blown as this simply isn’t the way our carrier responds to legitimate concerns.
He did, once again, state that they would escalate the ticket to the ‘carrier-to-carrier’ team who might be able to troubleshoot with our carrier. This is where we left it on Friday evening, so To BE CONTINUED…
However, because even a 20-year veteran in the phone carrier industry wasn’t familiar with LCR, I would imagine most of you aren’t either, so here is a brief description of the concept. LCR stands for Least Cost Route. The idea behind the functionality is in the name. A sending carrier has many options when determining the route a call takes to get to its destination, and to save money, they often choose the one that costs them the least amount of money, or the least cost route. As the saying goes, “Fast, Good, Cheap…pick two,” LCR is the equivalent of fast and cheap. But I wonder if the nursing manager in this story who uses the low-cost VoIP carrier that only transmits over low-cost routes would still find it either fast or cheap after all the time spent on this issue, still without a resolution.