The Perverse Obsession of Fax Machines in American Medicine

A colleague of mine recently remarked, “I can’t believe it’s almost 2023, and we’re still using fax machines!” I nodded and also began to wonder why this happened.

According to Telnyx’s Brian Segal, one major reason is clumsy government incentives under the Obama administration to push hospitals and doctors to use electronic medical records. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the government offered billions of dollars to incentivize medical systems to switch from paper-based to electronic systems.

Segal also notes, “Many electronic health record (EHR) systems were developed in a rush to be implemented before stimulus funds ran out. As a result, most medical record systems are based on spreadsheet technology, similar to Microsoft Excel. The systems have a steep learning curve and are difficult to use.”

Furthermore, the government incentives did not include provisions for compatibility with other EHR systems. So, if a patient has all of their health records in one hospital system and then needs to transfer them to a second hospital system across town (or another city), the data formats may not necessarily be compatible. So the only way to transfer records would be to print hard copies and fax them.

(In contrast, in my 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’re doing an MRI at a hospital and you have a CD copy of it scanned and, then another doctor at any other hospital can view the study on his own computer without difficulty.)

Many EHRs are also painfully ineffective for physicians. As Dr. Lloyd Minor of Stanford University noted in a 2018 Wall Street Journal piece, “[N]The top half of physicians said they often engage in activities such as taking paper notes and scanning medical documents in an effort to avoid EHRs in the first place. The issue is clear — until the electronic tools we create make healthcare more efficient, pens, paper and faxes will retain their privileged position.”

Health journalist Sarah Kliff also notes that many large hospital systems have a perverse financial incentive not to make it easier to share internal data: “A shared medical record…makes it easier to see a different doctor. A walled garden—where records are shared only within a hospital system—may encourage patients to stay with those providers.”

(Kliff calls fax machines, “the cockroach of American medicine: hated by doctors and health professionals, but able to survive—even thrive—in a hostile environment.”)

Finally, Alex Hogan of STAT News notes, “In many states, medical providers are required by law to keep paper copies of patient records. Sometimes it’s more convenient to just fax something than to have to download a file and print it from an email.”

The federal government has specifically told doctors and hospitals that fax machines meet HIPPA privacy standards for sharing sensitive medical records.

So while fax machines may seem archaic, images are often blurry and hard to read, and handling hundreds of incoming sheets of paper a day may seem absurdly inefficient, fax machines in healthcare will be here in 2023. And likely for many years to come.

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