Bob Rice founded SecureCare Technologies Inc, Austin, Tex, in 1999 with the flagship product eClickMD—a portal allowing home health agencies to send documents to physicians for online signing. The company introduced Sfax, a secure fax-management system for health care, in October 2007. In mid February, it introduced the only secure, electronic fax record (EFR) with digital signature that is 100% dedicated to the health care industry. CLP spoke with Dennis Nasto, the company’s CEO and president, about these products and about how they can help accelerate EMR adoption.

Q: What was the guiding premise of eClickMD?

A: Physicians are inundated with paperwork that needs to be signed and returned, and Bob’s agencies had a problem getting paperwork back from them. If you don’t get it back in time, you can’t bill for the services. He put into an electric scenario documents you could sign, which was a benefit for doctors—we were tracing billing codes they often missed. A lot of doctors were missing $15,000 to $20,000 a year. Today, we have about 1,200 doctors using the system, and it continues to grow.

Q: Was there a guiding philosophy?

A: To create a community of health care providers to collaborate and exchange documents online. It was kind of an early MySpace for doctors.

Q: You joined the company in 2003 as an executive in sales and marketing and became CEO in November 2006. After 20 years building your resume in the industry, why did you align yourself with the company?

A: It’s really a passion for me. I truly believe we can have a positive impact on health care, especially as it pertains to the document exchange between providers, and I want to be one of the leaders of that change.

Q: Tell us about your background.

A: I graduated with a bachelor’s in science from Western Michigan University in 1980, and started my health care career in 1983 with Kimberly-Clark health care division—I spent 8 years there primarily in a sales management role. In 1991 I joined a start-up medical device company—STERIS Corp. They had a new liquid chemical sterilization system for heat-sensitive devices. I spent 7 years there. We started out with almost no sales, and when I left they were up to $600 million annually. I was VP of sales for the Americas, VP of the national accounts, and I started a new division, sterilization services. STERIS is where I really got the bug for being an entrepreneur. When I joined the company we had just over 40 associates, and we went public about a year after I joined. I left in 1998, and we had over 4,000 associates. This was a great learning experience for me in management of hyper growth.

Q: What is the company’s primary product?

A: Sfax, the only electronic fax record with digital signature that is 100% health care.

Q: What is an EFR, and how does Sfax conserve resources?

A: EFR replaces manual fax processes that are the dominant choice for health care document exchange today. Sfax saves users about 95% of their time and up to 80% of costs. Once you use it, you will never want to go back to manual faxing. Think about what you would do if I took away your e-mail and you had to go back to regular mail. It’s that kind of technology we see that really changes things. Remember typewriters? Carbon paper before copy machines? Technology is changing the way businesses are run.

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Q: What is the biggest issue in transmitting patient health information (PHI)?

A: You can’t use e-mail to route PHI in health care. Normal e-mail is not secure and does not pass the HIPAA test. Plus, many documents need to be signed or initialed, and digital signature technology does not exist as a standard feature in e-mail accounts. Doctors don’t have IT departments to support the security requirements needed, and they don’t want to pay extra for it. Electronic fax services and fax servers are better solutions—but those are primarily fax via e-mail. When you send a fax, you have to attach a document to the e-mail, and you have to first create a document to put into the electronic format. Same problem.

Q: How do the digital signature and annotation features work, and how do they compare to electronic signatures?

A: An electronic signature is nothing more than an image of a signature placed in a document. There is no audit trail or anything that can tie the signer to the document. Plus, they can be easily forged. For example, I can take a piece of paper with your signature on it, scan it, put it on my computer, and sign documents with your signature. On the other hand, a digital signature is a higher form of electronic signature. With Sfax, we issue our users their own unique digital certificate, kind of like your fingerprint; it’s unique to you. It has a cryptonic hash—or computer code—associated with each user and the document. The digital certificate is stored on our servers. The benefit is that you can log in and sign from anywhere you have an Internet connection. After logging and being authenticated on the system, you can view the documents and place your signature where you want it before locking it into place. This creates a time and date stamp that ties your signature to the document. It cannot be forged. Physicians want to sign documents from different locations, and this system gives them that flexibility. It allows users not to have to worry about where the digital certificate is stored renewing it, or paying extra for it. And you don’t need a special VPN connection. Annotation tools allow users to add text, check boxes, rubber stamps, and more. This means you never have to print a document that you get in Sfax. You can complete it, sign it, and send it back. No paper.

Q: What is the value of creating a log and audit trail for fax transactions?

A: It’s really important. Accurate records must be kept of those transactions per HIPAA. Most health care providers have to manually log fax records. With Sfax, all of that’s done automatically. It makes it easy for someone to be compliant with HIPAA. It’s automated and secure. If users have an interruption in their service—say, if the Internet goes down—you can’t work; or if a computer crashes, you can lose all of your documents. With our service, you don’t have to install anything locally and documents are stored on our remote servers. All you need is an Internet connection. You’re not paying up-front costs for software, hardware, and maintenance. It’s software as a service.

Q: How can users access faxes from the Internet, and route, store, and search fax records?

A: A lot of times, labs will send lab results to a doctor—they will fax results, and what happens is doctors are getting so many faxes they lose them or can’t find them. They will call the lab back, and the lab has to go back through the paper file and/or reprint the document to refax. In this case, the lab that uses Sfax can search for the sent fax and click resend. It’s a huge time-saver.

Q: Is the HIPAA-ready platform one size fits all?

A: It’s scalable. Whether you are a single user or 5,000 users, you don’t have to do or purchase anything extra.

Q: What products are planned for the future?

A: We have several new features to Sfax that will be released on a monthly basis. Stay tuned.

Q: What’s the biggest challenge you face in the marketplace today?

A: Getting the word out. Health care is so ingrained in manual fax process they don’t know there is a solution.

Q: How are you tackling the challenge?

A: We go to software vendors who have relationships with large groups of end users. We tell them, ‘You’re trying to automate customers, but you don’t have last mile, the document-delivery module.’ We partner with them, we integrate our application in theirs, and we enable their customers to be Sfax-enabled. Software vendors resell the product to their customers. Customers can ask the current software vendor for Sfax, but they can buy it and benefit without integration.

Q: Describe some industry trends.

A: The biggest trend is about moving our health care system to an electronic medical record (EMR) to share patient health information among providers. Full EMR adoption in physician practices represents less than 10% of doctors out there, and it’s not growing dramatically. There’s a reason for that. It’s a big investment and a big disruption in their practice. I think of Sfax as a bridge technology, or a big baby step toward EMRs. Widespread adoption of EFRs will lead to wider adoption of the EMR.

Q: What special qualities does your company have that make it stand out from others in the industry?

A: We’re 100% focused on the health care industry with this product. Fax servers and fax services are more broad-based. You have to understand health care—talk the talk—to be successful in this market.

Q: What’s the most outstanding thing the company has done?

A: Launching an EFR with a digital signature and an annotation feature.

Q: What would you like the company to be known for?

A: Eliminating manual fax machines in health care—kind of like what e-mail did to regular mail, we want to do this with faxes.

Q: Look into your crystal ball. What does the future hold for the company?

A: We’re expecting explosive growth because our relationships with software vendors are expanding. We expect to be the standard for all fax transmissions in health care. We’re the Blu-ray, not the HD DVD. We expect to come out on top.

Q: What is the future of the industry?

A: It’s about nonstop change. The future can be affected in a positive way by greater adoption of EMRs. Banks communicate all across the world with your private financial data, but we can’t communicate our private health records. We have to get into the electronic format first. Sfax will get us 80% there. It will help accelerate EMR adoption.

Judy O’Rourke is associate editor of CLP.