Healthcare sends an estimated nine billion faxes a year because every organization built its own private line to every other one — "a different dirt road for every car to everywhere else." A neutral hub says: connect once, reach everyone. Watch the difference.
Each dot is a hospital. First, the world we have: everyone wiring to everyone, a private connection for every pair. Hit Pave the road and the tangle collapses to a single hub — the same reach, a fraction of the wiring. The counters underneath are the whole argument.
The math: wiring every org to every other is N×(N−1)/2 private lines — 45 hospitals need 990. One neutral hub is N — just 45. Same reach; 20× less to build, break, and secure.
TEFCA — the federal "connect once, reach everyone" agreement — went live in late 2023. The 2024 ONC/AHA hospital survey captures an early rollout: a substantial group is live, and an even larger group is only planning. Look at the gap between the road that's paved and the road that's only planned:
Share of 2,253 surveyed hospitals, 2024 wave. Nearly half are "planning" — a roadmap, not a road.
The hub only wins because it's neutral — the one thing no single vendor can credibly be, since every vendor's incentive is to own the pipe, not share it. That's the opening.
mimi_ws_1.healthit.hospital_tefca_participation; source vintage mimi_src_file_date=2025-08-01; 2024 extract. MimiLabs report + SQL (query 6a58823653c953cfacc6047e) returns 2,253 hospitals across 51 jurisdictions: 461 live, 1,106 planning, and 1,988 in a health-information organization. These are self-reported survey indicators of awareness and intent, not measured live-exchange volume. "Nine billion faxes" is an industry estimate cited in the paired newsletter.