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.
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.
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 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.
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.
EDI as well
And just try to get regular people to use email encryption. Yes, it could be signed to show that it hasn’t been altered, but then most users can’t even figure out where a file has been saved.
So they use faxes.
Here (not US) they’ve tried implementing a dedicated “secure email platform” for medical professionals so that they can exchange patient data. It’s both progress and kind of idiotic, but it’s not very widely used (because now, they have yet another email address to manage, on top of the six they already have to use).
Secure email is nearly always implemented as a portal-based system in practice. It’s also typically only used for one-off exchanges. It’s not our first-line method of communication, but it gets used within the facility literally every day.
HIE portals are more commonly used for provider-to-provider exchange that doesn’t justify full data integration.
At any rate, the fundamental point stands: regulatory compliance has absolutely nothing to do with why faxes are still in use in the industry.
We need to try and bankrupt any company that produces fax machines.
The industry will need to adapt once fax machines aren’t produced anymore.
Unfortunately, supply and demand dictates that new manufacturers will pop up in place
You’re both right.
Faxes in the eyes of the law are secure, for any privileged or confidential info. So are secured emails, last I checked.
To be clear, this is specifically what I was calling incorrect:
Faxes are one compliant means of electronic communication. They’re just not the only one. Secure email is fine.