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It seems most would rather continue with tried-and-true methods -- especially older providers -- rather than incur the expense of electronically communicating with patients or one another. Between HIPAA concerns and widely publicized issues with the interoperability of electronic health records software systems, it's somewhat less of a surprise that a majority of communications at many offices still takes place via fax.
Are your clients younger, or just more tech-savvy? I assume they're at a small practice, and not hospitalists?