I’ll admit, I’m pretty frustrated right now lol. me and my doctor have been trying to submit a referral to a specialist but for the last several weeks, when i call them, they still haven’t gotten it yet. they told me it’s because they only have one fax machine so it refuses any incoming faxes if it’s in the middle of printing a different one.
my problem is, why haven’t we come up with a more modern and secure way of sending medical files?!?! am i crazy for thinking this is a super unprofessional and unnecessary barrier to care?
luckily I’m mobile enough to drive a physical copy to their location, but not everybody who needs to see this type of doctor can do that, nor should they have to.
Speaking as someone who works directly in the field: this is just plain factually incorrect. Encrypted email is compliant with patient privacy regulations in the US.
The issue is entirely cultural. Faxes are embedded in many workflows across the industry and people are resistant to change in general. They use faxes because it’s what they’re used to. Faxes are worse in nearly every way than other regulatory-compliant means of communication outside of “this is what we’re used to and already setup to do.”
I am actively working on projects that involve taking fax machines away from clinicians and backend administrators. There are literally zero technical or regulatory hurdles; the difficulty is entirely political.
I work with healthcare software so I can echo most of what you’re saying.
The thing is the lowest common denominator is a fax (usually a fax server that creates a PDF or TIFF of what comes over the wire), so that’s what people go with. It’s the interoperability between different systems that’s the problem. There’s no one standard…except for faxes.
HL7 and FHIR have been around for decades. Exchanging data is actually the easy part.
The problem is typically more on the business logic side of things. Good example is the fact that matching a patient to a particular record between facilities is a much harder problem than people realize because there are so many ways to implement patient identifiers differently and for whoever inputs a record to screw up entry. Another is the fact that sex/gender codes can be implemented wildly differently between facilities. Matching data between systems is the really hard part.
(I used to do HL7 integration, but have since moved more to the systems side of things).
I feel this - I’m often on the other end working with data from clinicians in the field for massive studies. The forms that come in can have an infinite number of possibilities just for noting sex. Enough so that our semantic layer needs a human reviewer because we keep finding new ways field clinicians have of noting this. Now imagine that over the whole gamut of identifiers.
tl:dr - Humans are almost always the problem in data harmonization.
I work in a particularly niche area (home infusion/home medical equipment) and while HL7 and FHIR are indeed things, practically no software that was built for those lines of business had any sort of module for that. We have a FHIR interface now and…no one uses it. They prefer faxes.
That’s likely a peculiarity of the niche you’re in. HL7/FIHR are the norm for enterprise-level systems. Hospitals couldn’t function without it and at any given time we typically have multiple HL7 integration projects rolling just as a mid-size regional.
Definitely less defined in the small-practice and patient-side space. Though, like I said, the big problem there ends up being data normalization anyway.
EDI as well
“embedded in many workflows”
Key statement right there.
And once people see what that really means, and what it would take to move past it (including time, cost, and risk), they may start to understand. You’re dealing with it first hand, so you know what’s involved.
It became the de facto way to send stuff with high confidence it went to the right place. Then tech addressed the paper-to-paper over one phone line issue with modem banks into a fax server. So all the same fundamental comm tech (so fully backwards-compatible), but a better solution for the company with that infrastructure. Such a company has little motivation to completely change to something new, since they’d have to retain this for anyone that hasn’t switched. Chicken-and-egg problem, that’s slowly moving forward.
It’ll be a long time before it’s gone completely. Perhaps in 20 years, but I suspect fax will still be around as a fallback/compatibility.
They’ve had motivation since the HITECH Act passed in 2009. Medicare/Medicaid compensation is increasingly directly tied to real adoption of modern electronic records, availability, and interoperability. Most healthcare orgs rely heavily on Medicare/Medicaid revenue, so that’s a big, big deal.
I do. Which is why I’m actively and aggressively removing fax machines from our environment. Efaxing (e.g., fax-to-email gateways) will stick around for back-compatibility purposes with outside organizations, but the overall industry trend is to do everything you can to minimize the footprint of fax machines because they’ve traditionally been used in ways that will cost the company serious revenue if they cause you to miss CMS measures.