Saturday, June 9, 2018


I’m on a mission!

Whenever I get an opportunity to take a shot at the health care system for their use of fax machines I make sure to climb upon my soapbox and share my utter disdain for the use of this device that should have been purged in the 1990’s

In my office, we have one of these fancy pants network printing workstations.  The thing probably costs a fortune.  It does colour…it scans…it also faxes.  In the past 10 years I believe I have used the fax function a total of three times.  Who did I fax?  A government office, an insurance company, and of course a Doctor’s office.  Both the government office and the insurance office that I faxed, are now using email.

How has my new mission to purge health care of fax machines gone?  Not well.  I have discovered that health care loves their fax machines.  They actually get quite defensive when you cast aspersions on their archaic devices.

On a recent visit to our pediatrician even my wife got in on my fax shaming mission, when our pediatrician, asked us to fax her an insurance form.  My wife literally laughed at the prospect.  This laughter was met with a 10 minute diatribe on how our Doctor couldn’t function without her beloved fax machine.  In fact, she now has software that takes incoming faxes and her office admin can take an electronic version of the fax (called a scan in the rest of the world) and can automatically file it electronically in our chart.  It doesn’t even need to be printed.

When my wife explained to me how this worked; I was flabbergasted.  Exactly how is that different from an email?  The health care system has actually developed software that facilitates and expands the use of fax machines.  Unbelievable.  

As an avid health care conspiracy theorist I hypothesize that the use of fax machines is an intentional way of keeping patients at arm’s length and away from their data.  What patient has a fax machine at home?  No one.  If we do have a fax machine  (at home)we probably should be getting counselling for being a hoarder.  By using a fax machine it makes it impossible to send documents to patients because they don’t have fax machines.  Conveniently most health care organizations have privacy policies that forbid the email of patient information via email due to privacy concerns.  Within our Health Region, by policy, if patient information is transferred via email it must be encrypted.  Who is going to do that?  This makes it very easy for health care organizations to make policy that disallows any transfer of information via email.  It's easier for them but not for you!  Just another example of provider-centric policy.

The fax saga gets worse.  I read an interesting report a few years ago.  Our quality team at one of the hospitals, where I sit on a Quality committee, did a study of how many faxes were being sent unnecessarily within the hospital.  As an example, when a patient is admitted to the hospital it starts a chain of events that are driven by policy and process.  These processes include sending documentation to various recipients by fax.  This is done automatically and without thought.  One document may be faxed to 5 different offices by policy.  What the study attempted to do was determine how many of these documents were sent and never looked at.  They were picked up from the fax machine, put in someone’s “Inbox."  A week later, when the “Inbox” was full the recipient may glance through the stack of faxes and throw the majority of them in the trash.  The fax equivalent of Spam.  The study found hundreds of documents were being sent weekly without any reason or purpose.  They were simply being put in the trash.  How is this the safe handling of patient data?

For those who think I am making far too big a deal out of this I have a few comments.  For me the fax machine is symbolic of a lot of problems in health care.  Fax machines are archaic and outdated.  The problem with getting rid of them is that it would create a storm of change in the basic operations of health care.  Policies would have to change and equipment would have to be upgraded.  Herein lies the problem.  Most administrators would rather develop band aid solutions to using a fax machine rather than go through the pure torture of drafting new policies on how to safely transmit data via modern means.  Policies that might take years to develop.  Administrators have nightmares about this kind of change as it is arduous and painful.

With change being this difficult within the health care environment one has to question how difficult it is to make other changes that effect clinical practice.  That is also depressing.  I have read that in some instances it can take up to 17 years for proven research to be fully implemented in the clinical environment.  17 YEARS!  That is an abysmal number.

The fax machine causes problems in health care!  It is a barrier for patients to access information.  It is not secure.  It is also a symbol of how difficult it is to change anything in health care.  Something we need to get much better at, if we are to change health care for the better.

Yes…I’m coming for your Fax Machine!

*Credit to Isabel Jordan @seastarbatita who posted the first #AxetheFax hashtag I came across, to which I have un-apologetically ripped off.

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