Why is it so hard to wean healthcare off the fax machine?

The emails started flying soon after the news broke. A coronial inquiry in Melbourne into the death of civil engineer Mettalaloka Halwala had just found that a critical medical test result had been sent to the wrong fax number.
 
The test showed that Mr Halwala had signs of potentially fatal lung toxicity linked to his chemotherapy treatments.
 
But the vital information never reached the specialist for whom it was intended.
 
Coroner Rosemary Carlin stated in her findings that it was, ‘difficult to understand why such an antiquated and unreliable means of communication [the fax] persists at all in the medical profession …  it seems to me that it should be phased out as a means of communicating test results as a matter of priority’.
 
She called for the development of national standards around communicating medical test results.
 
In flurries of emails, doctors have been discussing what can be done, and why it is so hard to wean healthcare off the fax machine, a technology of the 1990s that is now a relic in almost every other industry.
 
Why, in short, hasn’t healthcare gone fully digital, given what often amounts to life-and-death importance of communication between healthcare professionals?
 
GP and Chair of the RACGP Expert Committee – eHealth and Practice Systems (REC–eHPS) Dr Nathan Pinskier believe he knows precisely why it has been such a challenge.
 
‘The fax has had longevity because it’s reliable. Everyone traditionally had a fax machine, and fax numbers were widely available in directories, so it was easy to know where to send it,’ he told newsGP.
 
‘This tragic event shows why we shouldn’t rely on faxes as a primary method to alert people in high risk situations.’
 
Dr Pinskier has been at the forefront of efforts to replace the fax with a digital solution, working closely with the Australian Digital Health Agency (ADHA).
 
‘We want to see the fax machine consigned to the scrapheap of history. We want a secure messaging service that works,’ he said.
 
However, Dr Pinskier is under no illusion that replacement will be simple. For one, he said, faxes are also surprisingly secure, with the information harder to intercept than when sent in digital form.
‘Digital has had a convoluted journey over the last 15–20 years. Email has become pervasive but, in health, it’s problematic because ordinary email is not secure. You can’t send sensitive healthcare information by email,’ he explained.
 
Spotting an opportunity, IT companies built secure messaging services for general practices and hospitals. Some offer the ability to show whether the recipient has read the message, essentially making certain that the right person has seen the right information.
 
‘People assume if you fax it to a number, it gets looked at. But that’s not always the case,’ Dr Pinskier said. ‘It might go to the wrong number, or slip off the end of the fax machine.
 
‘That’s one of the big advantages of secure messaging – you can show people the messages that weren’t received or weren’t read.’
 
Problem solved? Not so fast, according to Dr Pinskier. 
 
The issue now is that the different software platforms are not interoperable – they cannot talk to each other – and even if they can, a PDF on one proprietary system may not render at all in another.
 
Add to that the fact there is no single directory of electronic contact details for healthcare providers, and the true challenge becomes apparent.
 
The ADHA is currently running two trials with HealthLink and Telstra, testing solutions that allow secure messaging between different clinical information systems. HealthLink is leading a consortium focused on secure messaging between GPs and other specialists, while Telstra is focusing on the ability to send discharge summaries to GPs and other healthcare providers.
 
Dr Pinskier feels one potential challenge is the possibility of the expected expansion of the My Health Record program sucking oxygen away from the secure messaging initiative.
 
‘Clinical information is point to point, provider to provider. This is our core business. And if we can make it work reliably and electronically, you can build up a whole database of information that can be used for My Health Record,’ he said. ‘But My Health Record is a harder sell if it’s not linked to messaging for healthcare.’
 
Dr Pinskier is confident that the ADHA trials will lead to a national secure messaging service by the end of 2018.
 
‘I’m hopeful we’ll have a scalable outcome later in the year, one able to be rolled out across the whole healthcare sector,’ he said. ‘And if we get to that point, we should be able to see the end of the fax machine.’

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