A colleague recently said to me, “I can’t believe it’s almost 2023 and we’re still using fax machines!” I nodded in agreement and started to wonder why.
A big reason, according to Telnyx’s Brian Segal, is the Obama administration’s clumsy government incentives for hospitals and doctors to use electronic medical records. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the government provided billions of dollars to incentivize the healthcare system to move from paper-based to electronic systems.
Segal also noted that “many electronic health record (EHR) systems were developed hastily to implement before incentive funds ran out. As a result, most medical record systems are based on spreadsheet technology, similar to Microsoft Excel. The learning curve for these systems It’s steep and difficult to use.”
Additionally, government incentives do not include provisions for compatibility with other EHR systems. So if all of a patient’s health records are in one hospital system and then need to be transferred to a second hospital system across town (or another city), the data formats may not necessarily be compatible. Therefore, the only method of transmitting records is to print a hard copy and fax it.
(By contrast, in my own field of radiology, there is a standard data format called DICOM for distributing images from X-ray, CT, MRI, and ultrasound studies. So if you do MRI at a hospital and Have a copy of your CD scanned, and then another doctor at any other hospital can view the study on their own computer without trouble.)
Many EHRs are painfully ineffective for physicians.As noted in a 2018 study by Dr. Lloyd Minor of Stanford University wall street journal piece, “[N]Half of physicians said they routinely engage in activities such as taking paper notes and scanning medical documents in order to avoid EHRs in the first place. The problem is clear — as long as the electronic tools we create don’t improve the efficiency of healthcare, pen, paper, and fax will retain their privileged status. “
Health reporter Sarah Kliff also points out that many large hospital systems have perverse financial incentives no Make internal data easier to share: “Sharing medical records…makes it easier to see different doctors. A walled garden—where records can only be traded within one hospital system—could encourage patients to stick with those providers.”
(Cliffe called the fax machine “the cockroach of American medicine: hated by doctors and medical professionals, but able to survive—and even thrive—in hostile environments.”)
Finally, STAT News’ Alex Hogan noted, “In many states, medical providers are required by law to keep paper copies of patients’ medical records. Sometimes it’s more convenient to just fax something than download a file and print it from email.”
The federal government has explicitly told doctors and hospitals that fax machines comply with HIPPA’s privacy standards for sharing sensitive medical records.
So while fax machines may look archaic, images are often blurry and hard to read, and managing hundreds of incoming sheets of paper each day seems ridiculously inefficient, fax machines in healthcare will be around in 2023. And likely many years from now.