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

Doug Hendrie

21/05/2018 10:01:22 AM

A coronial report has recommended urgently phasing out use of the fax machine for communicating medical test results. But how close is the healthcare profession to eliminating this dated technology?

Dr Nathan Pinskier wants to see the fax machine ‘consigned to the scrapheap of history’.
Dr Nathan Pinskier wants to see the fax machine ‘consigned to the scrapheap of history’.

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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Wally Jammal   22/05/2018 8:25:44 AM

Unfortunately, it is constant misinformation from the RACGP like "You can’t send sensitive healthcare information by email" that helps to keep the medical community in the dark age of fax machines. Until such time that point to point inter operable secure message is widely available, with appropriate consent and care, you can email whatever good patient care requires.

RG   23/05/2018 9:07:32 AM

I think the underlying point is being missed.

We're talking about one person (e.g. the one reporting the test result) attempting to convey information to another person (the one responsible for care - ordering a test, following up, etc) to facilitate patient care. If the information is important, then there is a responsibility on both parties to make sure that the information has been conveyed and is understood. While it is extremely important to build in as many fail-safes as possible, this responsibility still exists, regardless of the METHOD of transmission.

Without going so far as to say that retaining fax machines is the answer, surely it would be easier to address the issue of confirming whether a fax has actually been received/read by the person for whom it was intended than trying to build an entirely new, universally-compatible messaging system.

MG   1/06/2018 7:26:33 AM

Wally, I think you misread the comment. One can’t send clinically sensitive information through retail email systems. This is the security issue coming up. Not to mention the specific directions of that Privacy Commissioner not to use regular email systems. The same commissioner actually prefers fax as am more secure system to regular email. Dr Pinskier is not referring to encrypted information systems like Medical Objects or Healthlink. These systems are secure, but one still can’t add attachments to a message.

Roger   18/09/2018 6:02:31 PM

What is the answer? NBN is upon us the fax line cannot exist without ATA an unreliable technology!

Dr P Arndt   2/10/2018 5:58:01 PM

Not the Coroner and not anyone else is able to think through what I do. After I send a fax I ring to ensure it was received by the right person. I then record name of recipient and date and time. Problem solved.

Frank Lee   21/11/2018 9:40:51 PM

A secure email end-to-end encryption system called Pretty Good Privacy (PGP) has existed since 1991 that could be used as the basis for a more secure document delivery method than fax. It's relied on by whistleblowers and for sensitive document delivery in other fields.