The medical industry underwent a huge transition from paper to digital medical record keeping in 2009. But hospitals still use fax for most external communication. In fact, most of the medical industry relies on fax for sending medical records between institutions.
There are several reasons why hospitals still use fax. Some of them are legitimate. Some of them are unfortunate. You have to understand the challenges and incentives of medical communication to see why hospitals still use fax.
The Push for Electronic Health Records
In 2009, the Obama administration rolled out the Health Information Technology for Economic and Clinical Health (HITECH) Act. The legislation invested $27 billion dollars into incentivizing medical businesses to digitize their record keeping.
The HITECH Act was successful, by some measures. Hospitals and clinics did indeed transition to digital record keeping, in accordance with standards set forth by the National Coordinator for Health Information Technology (ONC).
In some cases, the move to digital records improved operational efficiency. But, over a decade later, hospitals are still using fax. All the records are digitized. And hospitals definitely have email.
What happened? And, more importantly, should hospitals use fax, when there are digital alternatives that seem much more efficient?
Why Didn’t Digital Record Sharing Take?
Although the HITECH Act successfully incentivized hospitals to move their record keeping to computers, it did not incentivize medical institutions to share their patient data. Additionally, there were no provisions for information sharing in the requirements to receive HITECH incentives.
Also, as it turns out, there are some fairly strong incentives not to share patient information between medical organizations.
Doctors and hospitals don’t want their patients going to other doctors and hospitals. Lost patients mean lost revenue.
So medical information technology companies developed their own digital record keeping systems without making any effort to ensure that they could share data with other medical record keeping systems. Hospitals ended up with medical record keeping systems that, along with other issues, couldn’t share information with outside organizations that used different record keeping systems.
But the phone lines still connected any two hospitals with a phone… Or a fax machine.
Why Hospitals Still Use Fax
Hospitals still use fax because it works, no matter what digital medical record keeping software each hospital uses. Medical record keeping software is often proprietary and won’t communicate with software from other hospitals. Fax represents a simple workaround that’s secure enough to meet patient privacy standards.
Some government legislators have considered simply banning the use of fax in medical communication. However, the incompatibility of medical record management software isn’t the only reason hospitals still use fax.
It may not even be the primary reason.
Fax is also secure enough to meet HIPAA privacy standards. And it’s easier to secure than any digital communication method.
Fax is Recognized as More Secure
Fax is more secure than email and cloud file sharing because it’s less exposed. Email addresses and passwords are leaked and scraped from the internet every day. Data breaches happen on even the most secure cloud platforms.
But fax machines are difficult to breach, because it requires sending malicious code in the form of an image or printable text file. And fax machines are relatively simple to isolate from other devices to mitigate the impact of a breached fax machine.
Additionally, it’s relatively easy to meet HIPAA data protection requirements for faxing medical records. The HIPAA rules for faxing require “reasonable safeguards” for faxing medical records.
Most modern fax machines send information over IP networks using an internet connection. But security focused telecom carriers offer end-to-end encryption that meets the HIPAA standard for fax.
Ultimately, hospitals also use fax because it’s the most secure way to transmit patient data.
Electronic Health Records are a Mess
As we mentioned earlier, communication between hospital record keeping systems isn’t the only issue.
The government incentives were supplied by limited funds, even though the budget was large. Many electronic health record (EHR) systems were hastily developed to be implemented before the incentive funds ran out.
As a result, most medical record systems are based on spreadsheet technology, similar to Microsoft Excel. The systems have a steep learning curve and are difficult to use. Many medical professionals spend an hour or more doing data entry for every hour they spend with patients.
That’s not to say that EHR systems don’t work. They can. But it requires a significant time and effort investment from doctors and others in the medical industry.
So, when they needed to solve the problem of sending medical records to other medical institutions, most doctors turned to a familiar technology that they already had on hand: fax.
Doctors Still Like Fax
Doctors were faxing medical records before the move to electronic health records. Most doctors already have a fax machine and they know how to use it. And modern fax machines work more like printers. They don’t even require someone to stand at the machine to send a fax.
Given the struggles with using the current EHR systems, most medical professionals didn’t have the time or energy to learn or develop a way to transmit medical records digitally. It made the most sense to just fax them, since they were already doing that.
It’s not that fax machines became part of the healthcare information infrastructure as a result of medical records going online. The fax machines were already there.
The new communication methods weren’t doing what people needed. So they just turned their fax machines back on and used them, because they got the job done.
Will Fax Ever be Replaced in Healthcare?
It’s unlikely that fax will be replaced in healthcare any time soon. The previous administration opposed outright banning fax in the medical industry, favoring a focus on requiring all EHR systems to be compatible with each other.
And sending faxes isn’t the problem, anyway. The problem is that medical businesses have made it hard to share patient information as an underhanded way to keep patients from going to other medical practices. It’s not that fax machines are forcing people to send faxes.
So fax is here to stay in the healthcare industry.
If you need to fax documents securely, you need to fax documents over a private IP network using a Fax API. That way your carrier can keep patient data on their network and encrypt patient data until it reaches its destination, which ensures your organization meets the HIPAA requirements for faxing medical documents.
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