1
Running Head: SILO Process
SILO PROCESS
CARLA GINART
LIBERTY UNIVERSITY
BMIS510_B01_202520
JANUARY 31ST, 2025
SILO Process 2
Data Silos/ Faxing
Scenario
I am choosing to do this assignment based off of a work process. The silo process that I will be
looking at will be faxing. The owners of the eye care facility want to improve operation and
decrease down time between receiving a faxed request and the time a patient is scheduled or has
the information from the fax put into the chart. With the decreased downtime, this could
potentially lead to increased profits and the ability to see more patients. The current system is
running on a VOIP fax line that still comes to an actual fax machine, so there is room for
improvement. I am doing this to help show the current business process for faxing.
Initial Assessment
My first course of action is to visit one of the locations and observe who all is involved in the
process of faxing from beginning to end, until all information is either entered the patients’ chart,
or the patient has been scheduled for an appointment.
Stakeholders
During your visit, you find the following stakeholders:
• Office Managers
• Employees (Receptionist, Techs, Drs., IT personnel, Retina staff, General Staff, On
Call Staff)
• Outside Practices
• Patients
Distinct Business Activities
You also observe the following business activities:
Greeting guests
Prepping patients’ charts
Seeing patients
On standby for any IT issues
Calling pre-op patients for surgeries
Fax machine
Answering calls
AS-IS Business Process
After your visit, you compile the following notes regarding what you observe to be their current
business process.
Referring Provider Initiates Referral
oReferral is submitted via website or fax. www.vistareye.com/referrals, fax: 540
777-2719
At the beginning of each week, management reviews the shift schedule for the week and
notifies each IT of the schedule for the week. IT then post the schedule to the intranet for
all employees to access. This is often done through emails.
SILO Process 3
At the beginning of each shift receptionists, techs, Drs., IT personnel all login to the
system and also have to login to EHR system, so that they have the appointment book
open and ready for the day.
When patient enters the facility, the receptionist greets them and asks them to verify all of
their information in the systems.
If needed the receptionist will get a new copy of the patient’s insurance card.
The receptionist will then check the patient in and then send them to the waiting area.
In between patients the receptionist will answer any incoming calls, faxes, and emails.
oTeam reviews the referral for urgency.
oCheck if the patient is a new or established patient.
oConfirm patient’s demographic information and insurance details.
oCreate a task in NextGen and route it to the appropriate team based on the referral
type.
oRoute Task to One of the Following Teams:
Referrals – General
Referrals – Retina
Referrals – Southside – Retina
On-Call Team (if the referral is urgent/general)
oFor On-Call Team Referrals: Receptionist holds
the task until the appointment is scheduled.
oAfter Scheduling: Receptionist sends the
appointment notification letter back to the referring
provider via NextGen fax.
oThe task is completed, and the referral loop is
closed.
o***For patients who cannot be contacted, after 48 business
hours, an Unable to Contact letter will be sent to the
referring provider and the task is marked as complete.
Each team above will do the following:
oIn between patients the tech will check their messages in the EHR system to see if
any incoming faxes have been assigned to them.
oTask Assigned to Appropriate Team The assigned team reviews
the task.
oTeam schedules the patient for the necessary appointment.
oIf the fax was sent to the wrong dept it is then tasked to the correct team to
handle.
oIf any qualifying questions need to be asked, they will reach out to the patient or
the referring practice, and they will make sure to notate the account.
oIf instruction is needed from the doctor, the tech will reach out to the provider,
usually in person, or over the phone to gather instruction.
oAfter Scheduling: Receptionist sends the appointment notification
letter back to the referring provider via NextGen fax.
oThe task is completed, and the referral loop is
closed.
SILO Process 4
o***For patients who cannot be contacted, after 48 business
hours, an Unable to Contact letter will be sent to the
referring provider and the task is marked as complete.
The tech comes to grab the patient and takes them to the exam room.
The tech then goes over patient history and anything else that needs to be done before the
doctor comes in.
The doctor will come in and exam the patient.
oIn between patients the Dr. will answer any questions that come in from patients,
or techs, and will provide feedback on the next steps that need to be taken.
oIf the Dr. feels it would be better for the patient to see a different provider, they
will have the tech task the message to another provider with detailed instructions
on why the Dr. felt the change was required.
The tech will come back into the room after the exam and hand the patient their fee
tickets.
The patient takes their fee ticket to the receptionist at the front desk.
The receptionist will go through the process of checking out the patient.
If the patient has a co-pay or anything else due and they pay in cash, the receptionist will
collect the money and returns the change.
If the patient has a co-pay or anything else due, and they pay by credit card, the
receptionist enters the card data into the system and awaits verification of sale. If the card
is accepted, they then return the charge receipt to the customer for signature. If the card is
declined, the receptionist returns to the customer, requesting another form of payment.
SILO Process 5
Gap Analysis
The eye care facility that is being looked at currently uses an EHR system. A patient's entire
medical history, including diagnoses, prescriptions, lab results, clinical notes, and imaging data,
is stored and managed digitally by an Electronic Health Record (EHR) system. This platform
enables healthcare providers to access and update this information electronically across various
healthcare settings, giving them a comprehensive picture of a patient's health journey over time.
“One of the key features of an EHR is that health information can be created and managed by
authorized providers in a digital format capable of being shared with other providers across more
than one healthcare organization, including laboratories, specialists, medical imaging facilities,
pharmacies, emergency facilities, and school and workplace clinics. “(Stair, 2017) The silo issue
currently being looked at has to do with how the eye care facility currently handles referral faxes.
They previously updated from a traditional fax line to a VOIP fax line, however they are still
having issues with the VOIP fax line, that they also experienced with the traditional copper fax
line. “Before the advent of “big data” and “cloud-based” technologies, faxes were a standard
method for securely sharing data between the data provider and the public health agency.”
(Elliot, 2024) The process of referring patients to specialized care is ineffective and prone to
mistakes. Using a standard fax machine can be time consuming and cause delay in the patients
getting the care that they require. It can take up to a minute or more per page when doing faxes,
which if you are sending a fax that has multiple pages, this can take quite a while to complete.
“The poor data quality from faxed documents and underdeveloped use of eReferrals within and
between different healthcare systems are cited as sources of continued inefficiencies in the
referral process” (Odisho, 2020) Referral process flaws result in lower health outcomes, longer
SILO Process 6
wait times for patients to receive care, worse patient experiences, and higher operating expenses.
Many referrals to tertiary and quaternary care facilities are still made via fax, even though the
use of standards-based electronic referral solutions can help reduce some of these inefficiencies.
By further organizing and simplifying the patient referral process, referral automation will
improve the referrals process. “The shared electronic medical record with ‘in-network’ or
collaborating facilities has facilitated the sharing of essential patient information without
compromising patient security.” (Park,2022) But only when the collaborating health systems
integrate their electronic health record (EHR) systems do external eReferrals function. As a
result, faxed documents still account for a significant share of external referrals. “Electronic
referral systems with integrated patient imaging have been proposed to improve the current
referral process. Patients referred through the electronic platform had less testing before
treatment; we hypothesize that this finding is due to the superior quality of images sent via this
system.” (Nanji, 2024) The solution that is being looked at for the TO-Be business process is to
set up and use EHR faxing. EHR faxing is a way to send and receive faxes through the EHR
system itself, instead of using a physical fax machine. The benefits of doing this includes,
improved communication time, leaves less of a environmental impact, it helps maintain
compliance and security because those features are already built into the EHR system. This also
allows for information to be entered into a patient’s chart quicker. “All faxes transmitted
securely and directly through the cloud, offer more scalability, higher service level, and
eliminating the need for costly, local based faxing infrastructure in your data centers.” (Harraka,
2025) Which is why I feel it would be better for the organization to go ahead and make the
switch from our current faxing practices to a new cloud practice. This would be done by
integrating with a third party that would allow us to send and receive faxes through our EHR
SILO Process 7
system but also still maintain the ability to send a “fax” from a physical machine if needed, by
routing the fax to our server using an email address tied to the server. “One of the reasons cloud
faxing works so well to provide interoperability between different EHR systems is that it enables
healthcare providers to embed the cloud faxing system directly into their EHRs. Specific
application programming interfaces (APIs) exist to integrate data from faxes automatically into
the EHR.” Several healthcare facilities can send, receive, and store faxes with ease within their
systems and communicate data to others while maintaining file security when cloud faxing is
integrated into their EHRs. Instead, than requiring physicians to print paper papers or send them
over unprotected lines, they can deliver documents such as lab results and clinical summaries.
The irregular structure of traditional communications is one of its drawbacks. Effective
information transmission may be hampered by incompatible digital or physical infrastructure
components. Paper and digital communication and storage systems might not work together, or
one facility might not have the technology needed to connect with another. A variety of facilities
can access and utilize the same data thanks to the continually compatible structures of cloud
faxing systems.
To-Be Business Process
The new To-Be Business Process would be as followed:
Referring Provider Initiates Referral
oReferral is submitted via website or fax. www.vistareye.com/referrals, fax: 540
777-2719
At the beginning of each week, management reviews the shift schedule for the week and
notifies each IT of the schedule for the week. IT then post the schedule to the intranet for
all employees to access. This is often done through emails.
At the beginning of each shift receptionists, techs, Drs., IT personnel all login to the
system and also have to login to EHR system, so that they have the appointment book
open and ready for the day.
Fax is automatically tasked to a “task group” based on key words in the fax
oIt automatically routes Task to One of the Following Teams:
Referrals – General
Referrals – Retina
Referrals – Southside – Retina
SILO Process 8
On-Call Team (if the referral is urgent/general)
oFor On-Call Team Referrals: Receptionist holds
the task until the appointment is scheduled.
oAfter Scheduling: group sends the appointment
notification letter back to the referring provider via
NextGen fax.
oThe task is completed, and the referral loop is
closed.
o***For patients who cannot be contacted, after 48 business
hours, an Unable to Contact letter will be sent to the
referring provider and the task is marked as complete.
Each team above will do the following:
oIn between patients the techs and receptionists will check their messages in the
EHR system to see if any new incoming faxes have been assigned to them.
oTask Assigned to Appropriate Team The assigned team reviews
the task.
oTeam schedules the patient for the necessary appointment.
oIf the fax was sent to the wrong dept it is then tasked to the correct team to
handle.
oIf any qualifying questions need to be asked, they will reach out to the patient or
the referring practice, and they will make sure to notate the account.
oIf instruction is needed from the doctor, the tech will reach out to the provider,
usually in person, or over the phone to gather instruction.
oAfter Scheduling: Receptionist or Tech sends the appointment
notification letter back to the referring provider via NextGen fax.
oThe task is completed, and the referral loop is
closed.
o***For patients who cannot be contacted, after 48 business
hours, an Unable to Contact letter will be sent to the
referring provider and the task is marked as complete.
In between patients the Dr. will answer any questions that come in from patients, or
techs, and will provide feedback on the next steps that need to be taken.
oIf the Dr. feels it would be better for the patient to see a different provider, they
will have the tech task the message to another provider with detailed instructions
on why the Dr. felt the change was required.
When sending a fax the following steps would be used.
oOpen a patient’s chart
oOpen the document or image that needs to be faxed
oSelect the fax option
oEnter in the recipient’s fax number
oThe fax is put into a queue to be sent out
oCertain documents and images can even be scheduled to be sent out later in the
day as needed.
SILO Process 9
SILO Process 10
References
Elliot, A. J., Hughes, H. E., Harcourt, S. E., Smith, S., Loveridge, P., Morbey, R. A., Bains, A.,
Edeghere, O., Jones, N. R., Todkill, D., & Smith, G. E. (2024). From Fax to Secure File
Transfer Protocol: The 25-Year Evolution of Real-Time Syndromic Surveillance in
England.JJournal of medical Internet research,J26, e58704. https://doi.org/10.2196/58704
Harraka, K. (2025, January 31). Leverage your fax environment with epic. Instant InfoSystems.
https://instantinfosystems.com/leverage-your-fax-environment-with-epic/
Nanji, K., Fung, M., Qian, J., Khan, M., Barbosa, J., & Chaudhary, V. (2024). Comparing an
electronic clinical information transfer system to traditional fax referrals for patients with
suspected neovascular age-related macular degeneration or diabetic macular edema.
Canadian Journal of Ophthalmology., 59(5), e614–e615.
https://doi.org/10.1016/j.jcjo.2024.03.020
Odisho, A. Y., Lui, H., Yerramsetty, R., Bautista, F., Gleason, N., Martin, E., Young, J. J., Blum,
M., & Neinstein, A. B. (2020). Design and development of referrals automation, a
SMART on FHIR solution to improve patient access to specialty care.JJAMIA open,J3(3),
405–412. https://doi.org/10.1093/jamiaopen/ooaa036
Park, C., Cho, Y., Harvey, J., Arnoldo, B., & Levi, B. (2022). Telehealth and Burn Care: From
Faxes to Augmented Reality.JBioengineering (Basel, Switzerland),J9(5), 211.
https://doi.org/10.3390/bioengineering9050211
Softlinx. (2025, February 6). 8 ways cloud fax boosts interoperability in healthcare.
https://softlinx.com/2020/11/cloud-fax-boosts-interoperability-in-healthcare/
Stair, R., & Reynolds, G. (2017). Fundamentals of Information Systems (9th ed.). Cengage
Learning US. https://mbsdirect.vitalsource.com/books/9798214344249
