It’s time for us to move beyond fax machines, which are still in wide use in healthcare. If you’re an American who has been prescribed a drug in the past several years, it’s extremely likely your doctor sent that prescription to the pharmacy via fax “technology.”
This was sparked from a story in this week’s column:
21st Century Problem
Some in Canada are having trouble getting tested for Covid-19 thanks to overburdened fax machines. Faxing is so slow there’s a huge backlog of testing referrals because the faxes can’t get through to already-busy machines. Then New Brunswick’s fax network crashed completely, grinding their testing to a standstill. Horizon Health Network officials have announced a new system to catch up again: they switched to secure email, which “has eliminated the potential for bottlenecks,” said Tim Calvert, Horizon’s regional director of I.T. Security. Faxes are still widely used in healthcare because of its perceived security. In Ontario, meanwhile, Finance Minister Peter Bethlenfalvy has ordered that province’s public services, including the healthcare system, to phase out fax machines entirely by the end of the year. “Nothing says ‘The Flintstones’ like a fax machine,” he said. (RC/CBC) …Old problem: busy signals. New problem: spam filters.
There Are Better Alternatives
In the early 1990s, when I started This is True, I had a fax machine. It was handy when signing up newspapers to carry the column, which was the first leg in my business plan for income. Sure, I got some business thanks to the fax, but very quickly the number-one user of my fax machine, after (yep!) spam, was credit applications from a car dealer.
No, I wasn’t in the business of auto loans: the car dealer had programmed their fax machine incorrectly, putting my number in rather than some lender.
I called the car dealer. I called them again. And again and again. I still got the loan applications (and who knows how many buyers wondered why they never got their car loans!?)
The faxes kept coming.
Until one day I got a great idea: I wrote a letter to the car dealership that said that for any further loan applications were sent to me, I was going to call each customer to tell them that the car dealer had sent their confidential financial information to a complete stranger, and suggest they take their business to a more professional dealer.
There were several pages after that: the first page of several loan application forms showing the customers’ names, addresses, social security numbers, income levels, etc. I did, of course, fax it to them.
The dealer never replied to my letter …but I never got any other faxes from them. I’m sure someone at the company was read the riot act by an irate boss who realized the faxes were putting them at huge risk of lawsuits.
Faxes are Secure?
Healthcare systems think faxes represent a “secure” communications channel.
No, really: “The health care system has long used faxes as a secure method of transferring confidential or sensitive documents, particularly in cases where agility, cost, and also any limitations posed by legacy systems are a factor,” said Tim Calvert, the Horizon Healthcare regional director of I.T. Security, who was quoted in the story above. “With faxing, the information is transferred directly from one fax to a receiving fax with a confirmation that the transmission was received, thus limiting the risk of unauthorized access.”
Which assumes two things that are really important to security: 1) that the number they’re sending the information to is correct (or, as the case may be, still correct!), and 2) that the receiving fax machine is physically secure, and the person pulling the maybe semi-legible sheets of paper from it is trustworthy enough to receive such sensitive information and will route it appropriately and securely.
Of course, the sender has no way to know about the receiving end’s security procedures.
Hopefully, the transmission doesn’t actually use paper at all: the images can be rendered into computer files (e.g., PDF documents) and then be routed on an internal network as needed. And that’s another issue with them: they’re images, not text that can (say) be lifted out of the document and plopped into just the right place in a patient’s medical chart. While optical character recognition can convert it to text, I’m sure you’ve seen examples of the results of OCR: sometimes horribly distorted “information” that makes little or no sense.
Of course, the sender may also be faxing from a computer. So why use such old technology in the first place, when encrypted communications is the norm for data transmission online?
Healthcare is bound by regulations like no other industry.
Isn’t There Already Something Better?
Sure: EMR — Electronic Medical Records — are now the gold standard, but when I was on the board of our local health clinic, the nightmare was that EMR systems were not compatible with each other. We had to subscribe to a “network” at great cost that would translate one medical provider’s EMR to our EMR (and back). It got worse: there were two such EMR networks in our state alone that (you guessed it!) were not compatible with each other — unless you paid another fee for translation between the two.
And everyone in that chain wanted to make a “good” profit.
Which is, of course, the problem: I’d love to know what percentage of healthcare spending is skimmed off as profit in the United States. It would be interesting to compare that to the same number from Canada and other countries.
Let’s take faxes off life support and turn to much-more-modern encrypted communications channels …just like Canada is working on.
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