Are fax machines and mailed letters ‘no longer best practice’?

At a time of heightened attention on the risks that come with paper-based health records, are they still relevant, and safe, in an increasingly digital world?
 
One expert says faxes, letters and other non-digital correspondence just aren’t meeting the standards of modern healthcare today, and GPs could benefit from exploring where improvements can be made.
 
The focus on outdated record keeping comes as media reports reveal up to 150 patients at Mildura Base Public Hospital (MBPH) had been left waiting for care for more than a year after boxes of paper referrals were forgotten.
 
It is believed one affected patient had since died after a GP’s referral wasn’t actioned.
 
Victorian Shadow Health Minister Georgie Crozier told newsGP these patients had been ‘left waiting while their health deteriorated’.
 
‘These 150 referrals sitting in a box are forgotten Victorians,’ she said.
 
‘They are patients who have not been triaged, have not been diagnosed and have not received the timely healthcare they deserve and need. There have been tragic consequences as a result.’
 
System-wide challenges
It’s a sad situation that has prompted discussion within the health sector about how best to ensure health facilities, including general practices, have modern systems in place for handling health information.
 
Two years ago, Federal Health and Ageing Minister Mark Butler spoke of his frustration that medical correspondence was still occurring over fax machine despite such major technological advances.
 
‘A technology first invented in 1964, 20 years before Medicare, is still frustratingly, maddeningly, all too common in Australian healthcare settings,’ he said.
 
While strides have been made towards healthcare digitisation, there is still much work to be done. And there are risks in failing to keep pace with change, as has been seen this past week at the Mildura hospital.
 
MBPH Interim Chief Executive Matthew Jukes confirmed to newsGP that the hospital is taking steps to address the cause of the problem and is ‘committed to modernising the way patient information is received and managed’.
 
This includes continuing work with the Department of Health and regional network to expand capability through the Electronic Medical Record program.
 
‘What happened should not have occurred, and we apologise and have empathy for the families affected,’ Mr Jukes said.
 
‘The hospital has taken actions to strengthen processes for receiving, tracking and managing referrals.’
 
Faxes and mailed letters
Dr Steven Kaye, Deputy Chair of the RACGP Expert Committee – Practice Technology and Management, said while tech advances are occurring rapidly, such as the growth of AI, paper-based communication is still an ongoing issue.
 
And the MBPH is a reminder of the need to ensure systems are digitised where possible.
 
‘Paper, faxes and other non-digital, unencrypted communication is simply no longer best practice and does not meet contemporary standards,’ Dr Kaye told newsGP.
 
‘Most practices will have an image-based system, so whether it is snail-mail letters that are still coming in, or whether it’s faxes, there’ll still be an element of essentially, image-based, non-digital communication that’s going on.
 
‘A physical letter will get scanned and put into the record, so while it looks digital, it is in fact just a scanned document, which is unusable.’
 
The same goes for faxes, even digital faxes, he said, which are still essentially a scanned document that arrives as a PDF but is ‘as equally non-usable as a scanned document in-house’.
 
This means doctors are limited in how they can used that data, Dr Kaye explains.
 
‘The ability to interrogate databases, either by questioning or AI, is severely limited by non-digital information,’ he said.
 
‘Digital documents can be receipted, logged, tracked and responded to. They allow data analytics and extraction to occur in a safe environment.’
 
For practices to move forward, Dr Kaye said governments must ‘delegitimise and remove the use of the fax’.
 
‘They need to remove the fax as a communication mechanism first up and remove paper communication, snail mail, secondly, because they’re just not the current standard. They’re not at the contemporary levels that we’re expecting.
 
‘It’s not going to happen by a goodwill. It actually needs to be legislated.’
 
Patient safety is a key driver and is ‘always front of mind’, he said.
 
‘Certainly, for everybody in the RACGP, patient safety is the key, with clinical outcomes as the positive reward. And digital mechanisms are the way to make that happen.’
 
In the MBPH situation, referrals to the hospital were understood to be paper based, exposing them to risk, whereas many new and larger hospitals now have digital referral processes, Dr Kaye explained, so that the digital data can be tracked and doesn’t get lost.
 
‘For example, Monash Health only accepts referrals into the hospital in their particular digital format, which is fantastic. It’s a wonderful change,’ he said.
 
‘It took a long time, and they had to be very strong and say, “we’re not accepting letters, we’re not accepting faxes, we’re not accepting any other form except for the one that we want to have”, and they made it well known.’
 
However, he points to some challenges that brings.
 
‘The problem is that they accept the referrals only one way, digitally, which is perfect, modern and effective, but when they send letters back to us, more often than not, it’s by fax, which is unbelievable.’
 
Moving forwards with a digital health strategy
The ability to have the advanced digital systems within the health sector talk to each other has been an ongoing problem, and one the Australian Digital Health Agency is working to address.
 
A spokesperson for the Agency told newsGP that My Health Record is available to clinicians and consumers to safely and securely share clinical information.
 
The Agency also continues to work with governments, software vendors and the health sector to improve interoperability and make digital health systems easier to use, better connected and more consistently embedded in everyday clinical care.
 
This includes practical education and support for healthcare providers, as well as work to improve the way clinical systems connect with national digital health infrastructure.
 
In the longer term, the Agency is working on Health Connect Australia ‘which will create a health information exchange between systems in the health ecosystem using agreed standards’
 
And while these are broader projects in the works, there are also steps individual practices can take to ensure their systems are efficient and effective in a modern digital healthcare age.
 
‘For general practices looking to modernise, the focus should be on practical changes that improve workflow and patient care, the Agency spokesperson said.
 
‘This includes reviewing how information is sent and received, using secure digital communication channels where available, checking whether practice software is on the latest version and configured to connect with My Health Record, ensuring staff understand privacy and access requirements, and using Agency education resources to build confidence across the practice team.’
 
Dr Kaye said the work of the Australian Digital Health Agency is positive.
 
‘The projects are great, and from an interoperability point of view, they’re trying to roll out connectivity across the health system, which is fantastic,’ he said.
 
‘What the government through Minister Butler, and the Digital Health Agency have been very proactive about over quite a number of years now is to progressively, relentlessly digitise health across this country.
 
‘But the rest of the system needs to follow suit. The smaller hospitals, the government departments, the outpatient departments, the private hospitals – they all need to follow suit, do the right thing and communicate digitally in encrypted fashion.’
 
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clinical governance medical records medical software patient safety referrals technology