Optimizing Enterprise Referral Processing through Automated Fax Triage

Health systems face a paradoxical translational gap: Despite operational and domain expertise and real-world implementation environments, they continue to face challenges in innovating with emerging technologies to improve care delivery. This gap often stems from a fundamental tension between the large-scale, centralized approach required for foundational information technology infrastructure and the nimble, decentralized methods essential for rapid, user-driven innovation, highlighting a critical need to reconcile these divergent mindsets within health systems. This case study describes how Stanford Health Care, a quaternary academic medical center, addressed this gap through a bottom-up grassroots innovation approach enabling rapid identification, iterative prototyping, and enterprise scaling of an artificial intelligence (AI)-enabled intervention that was sourced and developed internally by the frontline staff and resulted in operational impact at scale. FastFax is an automated triage system that assists the enterprise referral management team in the triage of urgent, externally faxed referrals, a previously manual process that required sorting through individual fax cover sheets. By leveraging an agile, user-centered approach, frontline staff on the referrals team identified key leverage points in their workflow that could be addressed by AI, resulting in the codevelopment of a targeted solution that shortened processing times for urgent faxed referrals from about 33 hours to about 1 hour, enabling the organization to reach its goal of same-day processing of urgent referrals. FastFax was initially piloted for 6 months from January through June 2023 and has continued post pilot as an interim enterprise-wide solution for triaging faxed referrals. FastFax has also informed the procurement of broader vendor solutions, demonstrating the value of health systems being active developers rather than passive consumers of technology. Indeed, based on the learnings and insights from the experience, FastFax - initially envisioned as a stopgap solution - is now being refined internally into FastFax 2.0 to address all faxed referrals, rather than pursuing an external vendor solution.