One of the major service issues within Medical Imaging is delivering reports quickly to referring physicians. As an effort to improve service, Mount Sinai Hospital's Department of Medical Imaging implemented Auto-Fax to distribute imaging reports to physicians instead of the postal service. When a report is transcribed and then verified by the dictating radiologist, the radiology information system will automatically fax the result report to the referring physicians if subscribed to the Auto-Fax service. If not, the report will be printed and mailed out manually. A transmission log is kept recording the requisition number, time, date, fax number, number of pages, and transmission status of all reports faxed. The system will try three times to fax the report. If unsuccessful at all attempts, the report will be printed and sent out by mail. Referring physicians are required to sign an agreement that the receiving parties are responsible to ensure transmitted reports are kept confidential. Over 150 referring physicians have signed on for the service. Initial problems with missing cover pages, missing report pages, and reports not being received by physicians have been resolved. A recent survey of physicians receiving reports by Auto-Fax indicate that the service is very popular and has increased the speed with which transcribed report are received. Suggestions for improvement included faxing reports in batches, at specific times of the day, and directly to personal computers. Challenges reported included photocopying thermal paper faxes and sorting reports (for those offices with shared fax machines).