What exactly is Consensus? What specifically are the key communication roadblocks in the healthcare industry and how does Consensus solve them? Why don’t EHR’s develop their own tech to do what Consensus does? As Healthcare interoperability solutions are core to your development, what is your product roadmap timeline?  What makes your value proposition to the healthcare sector unique? What is the nature of your recently announced contract with the VA? Is there an advantage to being FedRAMP certified? The FCC has set a sunset date for POTS. (Plain Old telephone Service) Copper lines will not be supported anymore. How does this impact your business? What is the risk that there could be changes in healthcare information communication protocols that negatively impact your business? Who are key competitors and how does Consensus compare? What is your total TAM? What’s the mix of your Corporate customers based on size and type? How big is the market for Corporate Fax? Why is this market growing? If the Corporate Fax market has such an attractive growth profile, how much risk is there for new entrants?  As the SOHO segment makes up about half of your revenue, how should investors think about this side of the business?  How is it different from your Corporate segment and are there any growth opportunities in the SOHO market? What are the drivers of the Corporate channel overtaking the SOHO channel? How are Clarity, Unite, Signal and jSign integrated with existing eFax? What’s the revenue contribution from them? What does management expect as revenue contribution from new products such as jSign, Clarity, Harmony etc. over the next few years? Do any of these products cannibalize existing corporate fax revenue or is the opportunity incremental? Glossary

What exactly is Consensus?

Consensus focuses on providing secure cloud document and data transmission services throughout the healthcare ecosystem through a simple secure API connection that integrates easily into health record and patient management systems. We have been a leader in the digital fax space for over 20 years and have focused this service to address the needs of the healthcare industry in the past five years. The healthcare industry is the single largest user of fax services. We purposefully built a team focused on the healthcare industry needs, and have invested more than $100 MM to solidly position Consensus. The Company leverages its technology heritage to provide solutions that transform unstructured digital documents into secure, advanced healthcare standard HL7/FHIR structured data.

back to top

What specifically are the key communication roadblocks in the healthcare industry and how does Consensus solve them?

Healthcare industry communication and workflow challenges occur because that ecosystem consists of multiple devices, systems, and vendors that must communicate with multiple protocols spanning a wide variety of endpoints. Think about hospitals, labs, insurance, clinics, etc. – each with their own chosen system of sending and receiving that are, most often, unique.  It is a highly fragmented environment that forces participants to communicate in multiple protocols that are not compatible with each other.  This adds significant complexity, cost, effort and capital outlay with no guarantee that messages will actually reach their destination.

Many of these care settings have different communication systems, platforms, workflows. devices, systems and protocols spanning a wide variety of endpoints. Think about the information flow from hospitals, labs, insurance, clinics, etc. using communication platforms that are unique to their segment. It is a highly fragmented environment that forces participants to communicate in multiple protocols that are not compatible with each other.  This adds significant complexity, cost, effort and capital outlay with no guarantee that messages will actually reach their destination.

The central problem arises from the multiple message protocols (HL7, FHIR, Direct Trust messages, ScriptStandard), and the lack of a standard routing framework (in banking you have SWIFT codes and routing numbers, in healthcare no such equivalent exists), that have not been adopted, and difficulty finding patient records since we don’t have one medical number (in banking we use the social security number) There are also many different EHR systems with many different software versions, and the list goes on.  If you send a message, you have no assurance that it got there, and if you receive a message, you have to go through many steps to attach it to the right platform and patient. On the receiving side, that same message may be in a format their system may not be able to recognize. Across that messy environment, fax is the embedded common denominator that verifies delivery, is highly secure, includes complete originating information and is HIPAA compliant.  Our position as the leading provider of digital cloud fax technology offers an important advantage in establishing relationships in the sector, proving the reliability of our service, demonstrating the security of our system and our commitment to high service levels.

The healthcare industry is also a highly regulated industry that has strict communication rules regarding treating patients and interoperability. While the industry today uses point solutions, new rules recently passed into law (The 21st Century Cures Act) are requiring new protocols to prevent the blockage of information. That is putting additional pressure on the industry to establish a routing framework that effectively forces participants, creating point to point connections, to ensure security and authenticity and encourage the use of standards such as HL7 and FHIR. HL7 messages, as an example, need an HL7 vendor, then they need a direct connection to their target; and finally - need to have a message translator (interface) to take incoming messages over that connection and structure them to be consumed by their system (e.g. the receiving system is Epic 12.2.4 and the message came from Cerner 10.8.0). That would let one hospital speak with one other hospital. Repeat that for every hospital, lab, pharmacy, nursing home, clinic etc. that a single hospital shares information with.  A large hospital can easily have hundreds of interfaces, each running different software, and requiring software maintenance expense, sitting in a data center that costs money running on servers that consume capital dollars and managed by an expensive IT staff.  Complicating things further, when that Cerner system that communicates with the Epic system upgrades to v11.0.0, the interface breaks.  Worse, when our example hospital upgrades to Epic 12.4 they ALL break.  Finally, now that they have their HL7 interfaces, they need to go and select their DirectTrust secure messaging vendor (think of a healthcare specific secure email system), a vendor that supports FHIR, and they need to build new interfaces etc.  The cost and complexity are staggering.

Consensus, as a result of our established Digital Cloud Fax network, has many established connections with hospitals, labs, pharmacies, health plans etc. and is a natural hub.  Second, our secure, scalable cloud architecture eliminates the need for installed software and associated costs.  Third, the Consensus product suite can deliver across the spectrum of protocols, allowing healthcare stakeholders to have a single vendor to manage.  One single connection Consensus, with our wide range of verified endpoints offering every major healthcare communication protocol, eliminates the need for all those interfaces.  No other company is addressing the interoperability opportunity with this approach.  We are unique in capabilities, well penetrated because of our position in fax and a known quantity in terms of service, security, and reliability.  Scale gives us a large cost advantage, our modern architecture allows fast product deployment as new technologies emerge and, as a public company, Consensus eliminates the risk associated with so many small private single-point vendors in the space.  With single-point vendors slugging it out to displace each other in a one-protocol paradigm, administrative costs in healthcare continue to skyrocket.  We solve that simply, elegantly, reliably, securely and at a fair price.

EXAMPLE: Demo of Consensus Clarity: Consensus Clarity - How it Works in 30 Seconds 

back to top

Why don’t EHR’s develop their own tech to do what Consensus does?

Most EHR solutions do a wonderful job communicating to other “like” systems (i.e., Epic to Epic, Cerner to Cerner etc.). Challenges arise when communicating from one EHR  to another, and this is an area in which we excel. In addition, communication outside of a network has security implications that EHR vendors would generally want to avoid but the Consensus system is hardened to ensure safe and secure delivery across networks. There are also complexities around protocol acceptance. For example, if a customer sends an HL7 message, can the counterparty receive it? We know from our own customers (many of whom are EHR systems where we often white-label our technology) that this is an area of technology EHRs are happy to outsource to a third-party expert.

back to top

As Healthcare interoperability solutions are core to your development, what is your product roadmap timeline? 

In 2020 we launched Unite, a product that combines secure direct messaging – the recognized standard for healthcare specific secure email – cloud fax, patient record query via Kno2’s Carequality interface, workflow tools and the ability to switch mode of transport based on the sender’s preference.  In 2021 we launched jSign, a secure digital signature product built on block-chain technology for incredibly reliable authentication, and in March 2022 we released Clarity, an advanced technology product that uses natural language processing technology to extract unstructured data and arrange it in a structured format.  This is a powerful automated intelligence tool that can eliminate the need for humans to manually enter data into systems.  It streamlines workflows that save time and money while improving accuracy of the ingested data.  Later this year we are planning the release of Harmony, a communication network that we believe will greatly simplify the ability for connected communities to share information with a minimum of transactional friction.

back to top

What makes your value proposition to the healthcare sector unique?

The healthcare sector is an important market for the company, comprising over half of our SMBE revenue and roughly two thirds of new sales for that stream of revenue.  Our success in healthcare grows from two distinct and differentiated value propositions. First, our integrated product set offers the ability to access every widely used and HIPAA compliant communication protocol from a single platform.  The full suite of capabilities we offer is unique in the industry, and we are the only interoperability vendor that includes cloud fax in their solution set along with HL7, FHIR, Direct Secure Messaging, medical record query and electronic digital signature.   Second, since we are a cloud solution, our communication package eliminates the need for costs associated with hardware, data center space, IT staff, and expense software maintenance costs. The Consensus solution is singular in our comprehensive approach to communication, security, process automation and transformation tools.

back to top

What is the nature of your recently announced contract with the VA?

The VA is working on a large-scale digital modernization initiative, and we’re very happy to be partnered with Cognosante to deliver the ECFax platform. The idea of modernization here is very important because it characterizes the position of digital cloud fax – a modern solution for secure, reliable, verifiable and scalable secure document communication. It also highlights a key advantage that our fax products in particular have in this marketplace – a native cloud model that replaces physical servers to do the work.

When the solution is meaningfully deployed across their more than 1,200 locations, we expect revenue of approximately $10 MM per year. While we expect this to occur sometime in 2024, we do not control the timing of the rollout. In our arrangement, Cognosante provides the professional services/first line support and Consensus provides the cloud fax backbone.

back to top

Is there an advantage to being FedRAMP certified?

FedRAMP security is the gold-standard for cloud offerings used by federal government agencies, and we will be the only FedRAMP certified cloud fax offering in the market. The advantage from this deployment is the VA’s plan to make ECFax a facility open for use by the rest of the federal government – a federal service bureau. As a result, revenues could be in excess of our estimate.

back to top

The FCC has set a sunset date for POTS. (Plain Old telephone Service) Copper lines will not be supported anymore. How does this impact your business?

Most telecommunications technology now runs on fiber using VoIP (Voice over Internet Protocol), and copper lines are disappearing. Telcos have moved away from copper to fiber, but one place it has persisted is fax due largely to the difficulties in delivering fax over VOIP. Our network has been almost completely VOIP for 3 years and we have been successful in eliminating the issues of fax over VOIP. Many of our competitors continue to rely on copper. We see this cut away from copper as a potential benefit. Because we have developed deep telco relationships over the past 20+ years, as the telcos either add new customers or have existing customers adopt VOIP, we are already prepared to offer them the digital fax solution.

back to top

What is the risk that there could be changes in healthcare information communication protocols that negatively impact your business?

While we would certainly anticipate advances in technology, the risk of those changes negatively impacting Consensus is low. Changes in healthcare communication are very slow to market. Any change that could be (eventually) widely adopted will require many years of testing and certification (including HIPAA) before it would become generally available. Since Consensus is committed to offering a full set of capabilities in our platform, we have the goal to incorporate any proven, utilized and approved technology in our tool set.

back to top

Who are key competitors and how does Consensus compare?

Our unique differentiator is that Consensus promotes a variety of HIPAA compliant protocols for the transmission of documents and data under one common platform. Whether a customer uses fax, HL7, FHIR, Direct Secure Messaging, or a customer needs to use a digital signature as a vessel for delivering documents, Consensus will supply all of those technologies and the capability to transform it in route. Easy choices.

We have competitors for individual technologies; cloud fax (OpenText, Concord Technologies, BisCom), Direct Messaging (HISPs - MedAllies, Secure Exchange Solutions etc.) HL7/FHIR (InterSystems, Lyniate) and each competes with us in their own sector.

The Consensus difference lies in our ability to deliver a full-service multi-protocol secure cloud platform.  This platform eliminates the need for an entity to manage multiple communication applications, delivering a single robust cloud solution that is reliable, secure and affordable. It enables the sender to use the technology that fits with their workflow, and similarly affords the receiver the ability to choose the inbound protocol that best suits their needs. There’s no longer a need to compromise on how an information flow is optimized.

With Consensus, not only can our technology accept the protocol that the customer frequently uses, our transformation engine will allow delivery in exactly the way the receiver would like to have it. For example, a sender sends a fax, but the receiving party gets an HL7 message, by their choice.

back to top

What is your total TAM?

Research indicates it is in excess of $10 B and growing.

back to top

What’s the mix of your Corporate customers based on size and type?

Our healthcare customers are across a full spectrum from small offices to large EHRs across all disciplines. Healthcare comprises [33]% of all customers, [52]% of our corporate customers and about two thirds of new sales in our corporate channel. Along with healthcare, our corporate customers range include financial services, legal, manufacturing and government agencies.

back to top

How big is the market for Corporate Fax? Why is this market growing?

The most research we have seen on the revenue size of the small, medium business and enterprise (SMBE) market at roughly $2.3 billion and expected to grow at about an 11% CAGR over the next 5 years (Arizton Fax Services Market Global Outlook 2022 - 2027.) There are multiple factors that keep fax a relevant and growing communication technology.  We’ve done our own industry surveys and the top reason for faxing is that the recipient requires it – that’s the power of workflow.  Other reasons are convenience, strong security, the ability to confirm receipt, reliability and legal compliance. People are just trying to get their job done in the most convenient way possible, and fax is often part of that solution.  We’re a consumer of market research on the subject of cloud fax and there’s certainly consistency in the reports we see that forecast the on-line fax market to grow in the high single digits for the foreseeable future.

back to top

If the Corporate Fax market has such an attractive growth profile, how much risk is there for new entrants? 

There are a number of barriers to entry to this market that afford advantages for Consensus.  First, is the continued misconception that the demand for digital cloud fax is diminishing, discouraging potential entrepreneurs and suppliers of seed capital from considering entry.  Past that, building an enterprise grade cloud fax system is technically challenging and capital intensive. Over the past 25 years Consensus has amassed 125 patents in the area of fax technology, pioneered the ability to integrate fax with email systems, built applications for corporate administration of their fax environments, invented fax-integrated workflow systems and pioneered auto scaling for on demand capacity management. Finally, the expertise required for integration of fax systems into central systems of record like EHRs, ERP and SFAs is a specific technological capability that is not easily replicated.

back to top

As the SOHO segment makes up about half of your revenue, how should investors think about this side of the business? 

It’s a solid business that throws off cash and gives us a reasonable return. Access to the SOHO market is advantageous for selling products of interest (jSign) as a companion to fax. It allows us to leverage the brand recognition that SOHO affords us by offering complimentary technologies as cart options for new subscribers.

back to top

How is it different from your Corporate segment and are there any growth opportunities in the SOHO market?

The sales approaches are very different, with SOHO being virtually exclusively an eCommerce channel that’s marketed and sold in a self-service environment with pre-packaged subscriptions. The Corporate segment is always sales-assisted and offers a host of options for configuration, customization, integration and bespoke solutions.

SOHO certainly has growth opportunities – we can see usage levels in the subscriber base continuing to grow triggering usage charges for customers who exceed their plan limits, we also have the ability to position a product like jSign to market as both a bundle with one of the fax solutions as well as a stand-alone subscription. There is generally an incorrect view that the number of subscription accounts is the measurement of growth in SOHO. This is a larger story than that.  We would not characterize the SOHO as the company’s growth engine; however, it provides a steady source of revenue.

back to top

What are the drivers of the Corporate channel overtaking the SOHO channel?

Our investment and concentration in growing the Corporate market is the primary driver. Since 2017, our shift to building a secure, scalable enterprise grade platform to meet the market’ needs have resulted in impressive growth in the Corporate space. While SOHO remains a steady performer, the driver behind this shift is our decision to aggressively pursue larger commercial customers with an emphasis on healthcare.

back to top

How are Clarity, Unite, Signal and jSign integrated with existing eFax? What’s the revenue contribution from them?

Unite and Signal incorporate Cloud Fax as a key delivery method alongside the other digital protocols. We view jSign as a fax companion specifically for signature workflows across several industries. Our revenues primarily come from our cloud fax business with a modest amount from our additional interoperability products (as they are new to the market) and there is still a large transition opportunity Cloud Fax to replace on-premise fax solutions.

back to top

What does management expect as revenue contribution from new products such as jSign, Clarity, Harmony etc. over the next few years? Do any of these products cannibalize existing corporate fax revenue or is the opportunity incremental?

Our current product roadmap is disclosed through the end of 2022. In early 2023, we will release the product roadmap for the next two years.  Our first set of milestones is hitting the release date for these services and we have thus far. Most of these will map to the corporate channel.

From a data standpoint, it’s important to look at the metrics that we report, the total number of customers, most notably the ARPU, the average revenue these accounts produced per month and the retention rate.

The advance of these products is not expected to cannibalize existing revenue streams as new products which are being developed represent a complimentary product suite to stand together with fax. We have commercialized eFax and jSign for our SOHO and Corporate customers.

back to top

Glossary

HL7- is a Standards Developing Organization accredited by the American National Standards Institute (ANSI) to author consensus-based standards representing a board view from healthcare system stakeholders. HL7 has compiled a collection of message formats and related clinical standards that define an ideal presentation of clinical information, and together the standards provide a framework in which data may be exchanged.


FHIR- stands for Fast Healthcare Interoperable Resource. This emerging standard combines the best features of HL7 V2, HL7 V3, and CDA, while leveraging the latest web service technologies. The design of FHIR is based on RESTful web services. With RESTful web services, the basic HTTP operations are incorporated including Create, Read, Update and Delete. FHIR is based on modular components called “resources,” and these resources can -be combined together to solve clinical and administrative problems in a practical way. The resources can be extended and adapted to provide a more manageable solution to the healthcare demand for optionality and customization. Systems can easily read the extensions using the same framework as other resources.


Direct Trust- The DirectTrust organization is dedicated to build and strengthen the security and trust framework for the exchange of health data using the Direct Project protocol. DirectTrust members agree to participate in work groups dedicated to security, trust, and growth of the use of the Direct Project; attend monthly educational sessions; become involved with the Direct community; and support the membership growth of DirectTrust.


Direct Project- stands for Fast Healthcare Interoperable Resource. This emerging standard combines the best features of HL7 V2, HL7 V3, and CDA, while leveraging the latest web service technologies. The design of FHIR is based on RESTful web services. With RESTful web services, the basic HTTP operations are incorporated including Create, Read, Update and Delete. FHIR is based on modular components called “resources,” and these resources can be combined together to solve clinical and administrative problems in a practical way. The resources can be extended and adapted to provide a more manageable solution to the healthcare demand for optionality and customization. Systems can easily read the extensions using the same framework as other resources.


ScriptStandard- is the electronic prescribing (e-prescribing) standard created to facilitate the transfer of prescription data between pharmacies, prescribers, intermediaries, facilities, and payers.


EHR- An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.


The 21st Century Cures Act- On April 5, 2021, federal rules implemented the bipartisan 21st Century Cures Act specifying that 8 types of clinical notes are among electronic information that must not be blocked and must be made available free of charge to patients.


Kno2’s Carequality interface- Carequality brings together a diverse group of representatives, including electronic health record (EHR) vendors, record locator service (RLS) providers and other types of existing networks from the private sector and government, to determine technical and policy agreements to enable data to flow between and among networks, platforms, and geographies.

back to top