Some doctors are using sophisticated techniques to triage faxes — and AI is taking inbox management up a notch
Published in the June 2025 issue of The Medical Post. Used with permission.
Author: Norm Tollinsky
If you’re a fan of the Iron Man and Avengers films, you’ll be familiar with Tony Stark and his AI assistant JARVIS, short for Just a Rather Very Intelligent System. Looking to the future, Dr. Leah Feldman, a sci-fi fan and family doctor at the Atkinson Medical Clinic in Thornhill, Ont., thinks there’s a good chance that family doctors in the not-too-distant future will have their own personal JARVIS to help manage their practice.
Dr. Feldman, a panelist at OntarioMD’s Digital Health Virtual Symposium 2025 in April, was one of three family doctors participating in a session on, “Conquering the Chaos: How to Tame Your EMR Inbox.”
“I’m very hopeful that one day we’ll be able to walk into our office and have our own personal JARVIS like Tony Stark does,” she said. “We’ll have our own personal assistant who will learn from us and over time will become our clone. That’s how I see AI being able to help us in the future.
“Artificial intelligence can already manage our inbox. It can read PDFs. It can tell us you have a rheumatology consult from Dr. X for patient Y and put it in the chart, and it will just get better and better as long as we have the right checks and balances.”
Dr. Feldman may have been referring to companies like two Ontario-based med-tech startups—Phelix.ai and WaiveTheWait—that have developed AI-powered agents that crawl through unstructured faxes. The agent classifies them, identifies the sending physician, the intended recipient and other pertinent details. It can also flag a fax as urgent.
In the absence of an AI-powered inbox agent, every fax that comes into a clinic has to be tagged and classified manually by staff. “For our first implementations, we had staff review the agent’s results so all they had to do was click to approve. Now, we’re removing administration altogether,” said Phelix.ai CEO Hasaan Ahmed.
One Phelix.ai customer, the Doctors Office Toronto, has 13 family physicians collectively receiving about 5,500 faxes per month. “The issue was particularly pronounced on Monday mornings when staff would return to find 350 to 400 faxes from over the weekend. Each fax took five to eight minutes to process, making it a time-consuming workflow,” said clinic admin Melissa Gallippi.
“Due to multitasking responsibilities—including answering phone calls and assisting doctors—admin staff frequently misfiled documents, assigned them to the wrong physician or categorized them incorrectly, leading to a high error rate,” she added. “With backlog issues, physicians often received important test results and consultation notes late, causing delayed patient follow-ups.”
Phelix.ai also has an Outreach Agent that automates key workflows and a Phone Agent that uses AI to answer clinic phone calls. A clinician who needs to see a patient about a lab result would normally assign the task to a staff person. “Now, using the Outreach Agent, it’s assigned to Phelix and we reach out to the patient by SMS, email or phone,” said Ahmed.
The Phone Agent greets the patient conversationally and is able to respond intelligently to a request for an appointment or a lab result, for example, using natural language processing. It can also retrieve information from the EMR.
The Phelix.ai solution is compatible with the Accuro and Oscar EMRs, and a partnership with Telus is in the works.
Sudbury, Ontario-based WaiveTheWait developed what it calls a document triage solution at the request of a clinic the med-tech startup was working with in Vancouver. “They loved what we were building for them, but told us, ‘We have a problem. We’re receiving hundreds of faxes, and our staff are getting burned out. Can you help us?’ We decided to take on the challenge, and it really worked out well for us,” said CEO Shrey Anand.
The administrative burden is particularly acute in specialist clinics receiving referrals because staff have to create a new patient record in the clinic’s EMR. In some cases, said Anand, “We’ve seen referrals that are over a month old that still haven’t been processed.”
The WaiveTheWait solution is compatible with the Oscar and Accuro EMRs.
Neither company currently offers a solution for managing EMR inboxes. Phelix.ai’s Ahmed says the EMR inbox is on the company’s roadmap. WaiveTheWait CEO Anand, while “interested in exploring ways we can help,” points out that the EMR inbox is less accessible to third-party vendors and that, “Hospital and labs already do some sort of triage . . . it’s not nearly anywhere close to what we do. But it’s enough that doctors are OK with it generally. The biggest issue is all the unstructured medical documents coming in through fax.”
No fan of fax technology, Matt Leduc, executive director, products, integrations and service management for OntarioMD, said: “There’s a depressing reality that our medical system still relies a lot on faxes.” He added, “With any luck, anything that has to do with faxing in healthcare will be obsolete in fewer years than I can count on one hand . . . so let’s not invest time to make faxing better. Let’s invest time to make faxing obsolete.”
HEALTH REPORT MANAGER
Leduc sits on an advisory committee responsible for advancing the recommendations from an OntarioMD task force on Health Report Manager (HRM), an Ontario digital health solution that enables clinicians to securely receive patient reports electronically from hospitals and specialty clinics. HRM is a major contributor to the deluge of reports clogging EMR inboxes, distributing approximately 3.5 million reports per month to some 15,000 clinicians, many of which are duplicates and not actionable.
Exacerbating the deluge of reports, hospitals often send the same documents both through HRM as well as by fax, forcing someone in the clinic to go through them line by line to determine if they’re the same or an update.
“We’re asking hospitals to make sure that if they’re sending something via HRM to not also send it via fax,” said Leduc. Clinicians can ask the hospitals in their region to stop faxing reports, but in some cases, there are either system-based or programmatic restrictions that make it difficult for hospitals to comply, forcing them to enlist the help of their health information system (HIS) vendor.
Hospitals are also being asked to cease sending clinically irrelevant spiritual care and dietician reports and to reduce the number of duplicate reports and near matches sent to care providers.
“We found through our analysis of HRM data that in the first six hours of a report being produced there are a number of updates as a result of normal workflow,” said Leduc. “The first six hours accounts for a disproportionate number of duplicates and near matches, so we’re asking hospitals to delay sending a report for six hours and only send the most up-to-date version. This will massively reduce the number of reports doctors receive.”
OntarioMD initiated a pilot with three hospitals—Queensway Carleton Hospital, Sunnybrook Health Sciences Centre and Lakeridge Health—in early 2024 to advance the task force recommendations. It is now working with a larger group of 30 hospitals to reduce the volume of reports landing in EMR inboxes. While some changes can be easily made, others must await a government funding decision to cover the cost of HIS vendor fixes, noted Leduc.
Also filling up EMR inboxes are e-notifications, automated messages limited to informing clinicians that a patient has been admitted or discharged. In July 2024, OntarioMD launched a pilot with 200 clinicians to assess the impact of suppressing e-notifications, and as of December, allows clinicians across the province to turn them off by filling out a form on the OntarioMD website.
“Some clinicians love e-notifications. Others claim it distracts them from more important work,” said Leduc. So far, more than 500 clinicians have opted out of receiving them. They still get HRM reports with more clinically relevant information about their patients’ ER visits or hospital stays.
OntarioMD is also working with Infosys Public Services Canada to make it easier for clinicians to search through and work with HRM reports sent as PDFs. “We’re working with Infosys on an initiative to identify the key content of a PDF report and populate a metadata field that is searchable by an EMR,” said Leduc. “The idea is to extract key data from a report and provide a summary on page zero that allows for searching. We’re also asking Infosys to report if a document is an exact duplicate or a near match and flag any changes, so the clinicians know at a glance what they have to pay attention to.”
The initial plan was to go live with this functionality at the end of March, but it was postponed to ensure there is no risk of error. The anticipated go-live date is now later this summer.
While document triage solutions for fax inboxes and HRM changes will contribute to an easing of the administrative burden clinicians have to cope with, family doctors who participated in OntarioMD’s Digital Health Virtual Symposium in April shared many other ideas to streamline workflow and free up more time for both patient encounters and work-life balance.
Dr. Rebecca Lubitz, a family physician in Kitchener, Ont., shared statistics revealing up to 40% of administrative tasks confronting clinicians can be either delegated or ignored. “In the airline industry, the terms ‘overloading’ and ‘task saturation’ describe situations when multiple alarms go off at the same time, creating a huge cognitive burden that distracts a pilot from flying the plane,” said Dr. Lubitz. “This can happen in medicine too when there’s too much to do and too much incoming data.”
In medicine, the EMR inbox is like the cockpit. “You’re the pilot, managing all this data that’s flying at you, and you have to decide what to do, what can wait and what doesn’t matter.”
Dr. Lubitz says she was spending two full days on paperwork in a practice of 1,200 patients before a CPSO auditor complimented her on the thoroughness of her work—but advised her she could be a little less thorough and spend more time with her family.
“I realized that it wasn’t valuable for me or my patients to spend tons of time charting and not have time to see patients clinically. The value was in the clinical encounter, the script, the referral, the imaging, the counselling and the conversation. It wasn’t in the beautiful note. As long as the note was correct, that was enough.”
Resolved to change how she managed her practice, Dr. Lubitz planted a SEED to reduce administrative burden. The acronym stands for Stop viewing unnecessary data, Eliminate duplicates and partial test results, Educate your staff, and Delegate.
In addition to taking advantage of the HRM and e-notification changes noted above, Dr. Lubitz advises clinicians to tell commercial labs to stop sending partial test results and to ask hospitals to stop sending lab reports because in most cases they are also communicated as part of admit notes and discharge summaries.
The advice was echoed by Dr. Kevin Samson of Guelph, Ont., in another session at OntarioMD’s Digital Health Virtual Symposium. “For one set of blood tests we can get three reports—one every time something is added until the final comes in,” he complained. “We can call Lifelabs and Dynacare and say, ‘Hold the partial reports. I don’t want to see them until the final.’”
Dr. Lubitz also educates her staff and employs a part-time nurse to help her with her EMR inbox, providing them with protocols and pre-signed templates for prescriptions and requisitions that don’t require her attention. Staff are authorized, for example, to process insurance notes for massage therapy and creatinine tests for pending CT scans.
She delegates staff to send MedsCheck and vaccination notifications directly to the patient chart and asks her nurse to review and summarize consult reports, flagging anything she needs to do or know. Detailed protocols to delegate the processing of other inbox items reporting abnormal eGFR and lipid results, for example, save time, while the flagging of urgent results relieves her anxiety about items of urgency lurking in her inbox.
Prescription refill requests, another source of inbox congestion, can be onerous to deal with when a patient is on eight different medications that need to be refilled at different times. To avoid getting a refill request every few weeks for a different medication, Dr. Samson suggests co-ordinating prescription refill timing, “so there’s one message once a year instead of who knows how many messages I would otherwise get.”
He educates patients to have their pharmacy request refills because “when the pharmacy requests it, it’s a complete request with the dose.” Also, “sometimes, if pharmacies don’t get a response the next day, they send me another message. I tell them not to do that.”
All three doctors on the Virtual Symposium’s “How to Tame your EMR Inbox panel”—Dr. Samson, Dr. Feldman and Dr. Vineet Nair of London, Ont.—offered advice on managing their inbox while on vacation. “I do tend to find myself still checking my inbox when I’m away because it’s easier for me in the long run than coming back and having a week’s worth of messages to read,” said Dr. Nair.
“If you don’t want to manage your inbox while you’re away, you can hire someone to do that for you and take that off your plate,” added Dr. Feldman. “It depends a lot on your practice style, how long you’re away, and the team you’re working with, so everyone will have a different strategy.”
“What was life-changing for me,” shared Dr. Samson, “was a decision I made a few years ago to book my first half-day back to go through my inbox.”
Efforts underway to reduce the volume of hospital and lab result reports will make a significant contribution to reducing the volume of reports and notifications in EMR inboxes, but Dr. Feldman’s wishful thinking about her own personal JARVIS, an AI-powered clone, doesn’t seem so unrealistic given the introduction of AI scribes as well as document triage solutions and outreach agents by companies like Phelix.ai and WaiveTheWait.
We are still in the very early stages of introducing artificial intelligence into family medicine practice, but the future looks promising given what we already know about the impact it can have on relieving the administrative burden that can lead to physician burnout.