Why are we still using fax machines in 2020?
*This post was originally published on November 24, 2020.
This week, I was catching up on some news, and what did I see happen in my city? This headline... "Fax Problem Closes Local Coronavirus Testing Site"... *Audible Sigh* The testing site closed because of "technical issues" with the fax. The police had to be deployed to control traffic, people who were already in line had to be redirected to other sites, people coming to the site that day were proactively redirected - it was a whole to do. You can't tell from the article what exactly the issue with the fax machine was, but I can take a pretty educated guess based on what happened in Texas.
What I imagine happened in Arlington is that, like in Houston, testing sites were sending lab results over to the local public health department via fax, and potentially the broken fax derailed that process. Again that's all hearsay from me but what I assume happened.
Regardless of what exactly happened, the heart of all this is that the fax is ubiquitous, maybe not in other industries, but in healthcare it's wildly prevalent. According to Cerner, an electronic health record (EHR) company, faxes "are still being used by 89% of health care organizations and an estimated 75% of all health care communications are still processed by fax."
What are faxes and why are they still used? A fax machine is a telephonic communication device that was more widely used in the 90s a variety of industries. In the fax system, a document is scanned through the fax machine, converted into an image and the bits and bytes of that image are sent through audio-frequency tones over phone lines to another fax machine that interprets it all and prints the information on the other end through another fax machine.
Besides what happened in Arlington, faxes are clunky and have caused numerous problems, for instance, Ask the student in this CNBC article, the man who sent a confidential medical fax to NASA, and this OBGYN in my city about faxes and they'll tell you that they are not.
They're still around for a few reasons:
HIPAA and "security": HIPAA governs the way that medical practices can send patient information to ensure privacy. Faxes are assumed to be a safe and private method of sharing information, but for some it doesn't feel like that and for good reason. For instance, this student who had to use a fax machine for the first time recently at 22 years old. "But after he sent the [fax confirmation] request, unlike with email or SMS messages, he had no idea whether the right person had received it. 'I had zero context for how to make it work,' said Utrankar." Faxes may get to the right place but not necessarily to the right person - that is a HIPAA violation.
The financial incentive for poor interaction design between EHRs: There's a notion in healthcare called interoperability. As a designer, I call it a friction. For instance, Epic EHR's software doesn't play nice with Cerner's forcing an interaction via fax. And there's a reason they don't play nice and have the ability to quickly and easily share information between the two EHRs. I remember switching over from Tricare/Humana to Kaiser and subsequently needing to write up a form that gave my doctor the OK to fax all of my records to Kaiser, in 2017. When the Obama administration injected billions of dollars to incentivize the healthcare industry to go digital, it mandated that systems could share information. Unfortunately it didn't write into law an incentive for health systems to talk easily with each other, hence the fax.
Comfort in the status quo: The HIPAA site reads that "The Privacy Rule allows covered health care providers to share protected health information for treatment purposes without patient authorization, as long as they use reasonable safeguards when doing so. These treatment communications may occur orally or in writing, by phone, fax, e-mail, or otherwise." Despite this, fax machines are still widely used to get and receive patient information. Some say that it's easier to set up a fax machine than it is to set up encrypted email. Others say that older doctors are just more used to the technology and decidedly refuse to switch to an email product.
At this point in time there's no silver bullet to kill the fax and no one blog post that will solve all of its problems. But moving forward, here are some hopeful signs to the fall of the fax, for instance, legislation like the 21st Century Cures Act, which requires EHRs to exchange information without "special effort."Alphabet and Apple Health teams are working on technology to empower patients to access and move their EHRs between doctors. Companies like Doximity are making products like direct messaging and DocFax, an online, HIPAA-secure fax services for doctors.
Have you ever had to get your medical records from one provider or another?
I'm Sarah Coloma, an Interaction Designer based in Arlington, VA working in mediums from Arduino to Figma. I write every Sunday and sometimes on Wednesdays about the intersection of design and fields ranging from healthcare to civic organizations to social media.