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.
In the eyes of the law, a fax is a secure way to send personal information. An email, even an encrypted one, is not. We need to fix the law, but lawmakers as a rule do not understand technology.
I mean, from a technological perspective email, even encrypted, really isn’t that secure. That being said neither is fax but…
Encryption would protect an email in flight and prevent interception. Faxes have no such capability and are entirely susceptible to being tapped.
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.
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
this makes no sense to me when patient portals exist. why isn’t there a provider portal that can handle sending medical info back and forth? I can see all my medical details online already.
because the referring physicians refuse to log into multiple systems and the providers refuse to log into multiple systems and theres no universal trusted system.
m 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.
Thats the thing. Most if not all insurance companies HAVE provider portals. They cannot get rid of fax until every mom and pop clinic, dentist office, and hospital use these portals.
Example of a Provider Portal: https://www.floridablue.com/providers https://healthy.kaiserpermanente.org/northern-california/community-providers/claims
See, you’re thinking 21st century, but this is both a healthcare management technology and a government regulation issue, so you’re 2 centuries too new. We need to go back to 1843 with the electric printing telegraph, which used pendulums and electric signals to scan images and send them over telegraph wires. That’s where healthcare technology regulations stopped.
That is patently false. Encrypted email and patient portals are absolutely allowed under regulation.
What you have here is a practice that has probably been in operation since the 80s or before, and they refuse to change their ways.
I never claimed that email or patient portals weren’t allowed.
Providers have a market incentive to provide the most convenient experience to their patients. The market incentive does not exist for sending information to other providers so they will take the path of least resistance to be compliant with regulation
read my post again. this is a provider that is probably losing business because people can’t get their referral in to see them unless they walk it through the door themselves. how is that convenient?
I have never seen a specialist without a giant wait-list. These providers tend to have too many patients so they have a negative incentive for trying to make it easier to reach them.
Shit, they could just get a better fucking FAX machine that can put new incoming faxes into a queue. The last fax machine I used (like well over a decade ago) could at least do that.
You can even have multiple fax machines on the same phone number if you really need it.
no kidding! i have enough to deal with, without having to babysit a doctor’s office that won’t update their equipment.
Referrals are electronic for those running a modern EMR, like Epic. The systems exist, it’s up to both sides to implement them.
thank you, this is exactly the type of answers i was hoping for!
I have to fax docs a lot. Couple of years ago we started using stonefax so it’s like an email. I wish the faxing was the worst part - most take 1-3 calls to the doc to get them sent back.
Unfolding a Xerox copy faxed over a phone line wont infect your entire network.
Opening an email, tho…
Boy do I have bad news for you https://threatpost.com/def-con-2018-critical-bug-opens-millions-of-hp-officejet-printers-to-attack/134972/
Its not the fax over phone line that was compromised, its the internet connected printer. In fact, HP even has services where you email to your own printer in order to print.
Can you pick it up and deliver it to the new office in person?
HIPAA.
i understand HIPAA. i don’t understand why we are still using the technology we started using in the 60s. my question is why haven’t we found a better way since then?
You can’t even stop junk snail mail or end daylight savings time. Good luck.
Plenty of people still use landlines. That tech is much older than faxes. Internal combustion engines have been around for about as long. There have been improvements, of course, but the basic idea of spark plugs igniting fuel, which pushes down a piston is quite old.
Like many things the 1960s tech is “good enough” and the government hasn’t mandated a specific standard.
The “modern” fax machine using telephone was invented in 1964 by Xerox, but technically the fax machine goes back to 1843. Bain patented the electric printing telegraph, which used pendulums and electric signals to scan images and send them over telegraph wires.
it’s generally harder to fax to a wrong number, have that actually hit a fax machine, and have it print than to accidentally email the wrong person or something. There are things that could be implemented into certain systems to only send to certain addresses, etc., but that information also exists in multiple places that can be accessed as well. For a fax, the message exists on the sender’s side (physical if any, machine memory possibly), receiver’s side (same), and briefly on the wire. This is opposed to hard drive, cloud, etc. where it is always vulnerable.
