Why providers just can't hang up on the fax machine

While the fax machine has become a relic in most industries, it continues to play a dominant role in health care—despite federal efforts to digitize medical records, Sarah Kliff writes for Vox.

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Why fax machines lead to so many headaches

Fax machines are far from ideal for sending data—they often experience busy signals, are difficult to read, and are prone to errors that can result in records being lost, misplaced, or sent to the wrong location. Kliff cites one medical worker who recalled accidentally sending medical records to the wrong place: "The FBI called about a half-hour later and asked how I got the number," the worker said. "I told them that I was faxing Minnesota. They told me I had faxed NASA."

Faxed documents also add administrative burdens on providers, who may need to print or transcribe medical records before sending them via fax, and who must input any patient data received via fax into their own EHR systems.

Despite those errors, "the fax is as dominant as ever" in the medical industry, Kliff writes, citing one estimate that faxes account for about 75% of all medical communication.

A gap in federal incentives

According to Kliff, the fax machine has endured in the medical industry in part because of the government's approach to incentivizing the digitization of health records. When the Obama administration created the meaningful use program to encourage health care providers to transition from paper to ERHs, it didn't provide incentives to make EHRs easily shareable between providers. As a result, the fax machine persists as the only universally compatible way to share records.

David Blumenthal, president of the Commonwealth Fund who from 2009 to 2011 served as the National Coordinator for Health Information Technology and oversaw the development and implementation of the meaningful use program, said, "Our philosophy was, you've got to have the information in bits and bytes before you can start sending those down the internet to someplace else." But, he added, "We should never have expected it to occur naturally, that these organizations would readily adopt information exchange."

An economic incentive for incompatibility

In fact, Kliff writes there's actually economic incentive for hospitals and doctor's offices not to share patient information with external providers: When they share a patient's EHR with another doctor or hospital, it makes it easier for the patient to seek care elsewhere.

"When you want competing entities to share information, you have to realize that they're sharing things that could help their competitors," Blumenthal said.

A similarly perverse incentive applies to EHR vendors: "If (electronic record vendors) expended all that time and effort to make it so anyone could plug into any other system, it's reducing the advantage of staying on your particular network," Farzad Mostashari, the former National Coordinator for Health IT who succeeded Blumenthal in 2013, said.

How to get rid of fax machines

Mostashari said fax machines are unlikely to lose their place in the medical office without an explicit push from the federal government. "I think if we want to kill the fax, we need to schedule a funeral," he said. "I think you need a pull and you also need a push."

However, the Trump administration is taking a different approach, Kliff writes. Donald Rucker, the current National Coordinator for Health IT, has said increased federal regulation is not the answer. Instead, he said better-designed EHRs could help interoperability, and fewer federal regulations will better enable individuals to control their own data.

Whether Rucker's approach or a more heavy-handed government approach holds the key to interoperability remains unclear, Kliff writes. But until fax machines make their way out of the medical office, providers and patients will continue to feel the burden, she concludes (Kliff, Vox, 10/30).

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