Just the Fax: Health Care in Canada Still Stuck in the 1980s
It’s a dark, rainy Thursday night towards the end of 2021, but for Steven Marji, it could just as easily be 1991.
He’s just returned from a repair job, fixing a critical piece of technology his customer simply can’t do without: the fax machine.
This time the boss was an 85-year-old semi-retired real estate agent. But, although printers and copiers make up the bulk of his business, Marji finds that there is an industry, aside from retirees, where he can still find them.
“I’m a little surprised by the medical field that they still rely on him,” he told The Star on his way home from his last job.
“It keeps us going. “
While most offices have long thrown away their fax machines – the provincial government plans to phase out traditional fax machines across the public service by the end of the year – they remain a lingering feature in hospitals , pharmacies and doctors across the country.
Many doctors have newer digital models that embed faxing into a printer or scanner, but frustrations remain, amid calls to bring the industry into the 21st century and move beyond an archaic system whose pandemic has exposed the worse.
During the early days of COVID-19 in Toronto, test results had to be faxed from labs, causing “significant delays” in processing and notification, according to a Toronto public health report from May 2020.
Because of these pitfalls, the agency implemented a new case and contact management system, which reduced the need for faxing.
There were other high-profile examples from around the world, the BBC reported that in Austin, Texas, the testing system was quickly overwhelmed in June 2021, in part due to the need to fax the results. Health officials in the Netherlands have faced a similar problem.
But despite some improvements made during the pandemic, faxing remains a critical step in transferring patient information to healthcare.
In an October report, the Ontario Medical Association, which represents physicians in the province, reported that nine in ten physicians rely on faxes to share patient information. Thirty percent of physicians surveyed said that linking medical record systems to reduce fax use would save them about one to five hours per week.
“Do you know that dial-up modem sound?” It’s really what’s going on in my mind as we go ahead and click, ”said Dr Miriam Hanna, a Burlington-based pediatric allergist consultant.
All of her patients need a referral to come see her, and about “99%” of them come by fax, she said. They are part of “every day, and every encounter is in some way tied to using a fax machine.”
This means that information can be “easily lost”. Sometimes the fax does not go through or is sent to the wrong number. They can also be blurry, or staff just get a blank page.
“It’s archaic, that’s what we do though,” she said.
“Doctors have always used faxes, for better or for worse. “
Dr Rashaad Bhyat, a family doctor in Brampton who works part-time with Canada Health Infoway, a federally-funded not-for-profit organization that promotes digital health solutions, said stories of confusion over faxed , like those from the pandemic, are just the “tip of the iceberg.” In his office, he uses electronic medical records, but the system always ends with faxes, as they have to fax documents to other offices, hospitals and pharmacies.
“Fax is very unreliable, very insecure as a technology and it is very difficult to eliminate,” Bhyat said.
“We frequently have what we call a fax label, going back and forth between our office and specialist offices, or our office and hospitals. “
The information “ends up in a barrage of round-trip faxes, which ends up taking a day or two to sort through.” He likens the fax to “throw something in the ether, it’s a black box.” This often results in a “significant delay” which can impact who receives their medication and “causes a lot of inconvenience for the patients and a lot of stress for everyone involved”.
Of course, the fax machine has not always been a symbol of outdated technology. It took them decades to figure out – Scottish scientist Alexander Bain is credited with inventing the first fax machine in the 1840s – but at the turn of the 20th century, “What’s your fax number?” Was the question asked at every business meeting.
“The machine converts text or images into a pattern of dots and sends signals. Somewhere on the other end of a phone line, another fax machine receives the signals and transcribes them in the correct dot pattern, Star reporter Alison Cunliffe wrote in a July 1988 article.
She thought that they were becoming so popular that they might one day be in every living room, next to “the computer and the VCR.”
What if your friends needed directions to get to your house? No problem, “just fax a card to your guests”.
Needless to say, the fax didn’t live up to the hype.
So why are they still so ubiquitous in health care?
“It’s inertia,” said Sachin Aggarwal, CEO of healthcare technology company Think Research.
“It’s something that everyone has to take on, it has to come from the top down, there has to be mandates, but the technology is already there. “
Michael Green, president and CEO of Canada Health Infoway, said there needs to be a “concerted effort” between health authorities, health departments and health professionals to effect the change.
“The thing with health care is a pretty conservative area and I think it takes time to change the practices,” he said.
Some of this can be done through laws or a combination of carrots and sticks. But it’s complicated by the fact that in Ontario, most physicians are independent contractors, who bill the government for services, rather than receiving salaries.
The approximately 1,300 traditional fax lines of the Ontario Public Service are spread “across all ministries,” said Kyle Richardson, Manager of Questions, Media and Correspondence, Treasury Board of Ontario Secretariat , in an email. “Of these, more than 90% will be eliminated or migrated to digital alternatives. “
The health sector includes other agencies and organizations that are not targeted by this modernization project, he added.
One extreme idea is to simply ban faxing, making it illegal to send health information by fax, Green said. Incentives could also be offered to doctors to invest to replace them.
“There is still a long way to go, unfortunately,” he said.
In the meantime, back in his car, Marji, an occasional fax repairer, is a philosopher. Over the course of a decades-long career, he has seen different technologies fall into fashion and go out of fashion.
But somehow they have a way of never really going away. In addition to faxes, he still does some repairs on his hobby, typewriters.
“They said typewriters were going to be obsolete, but that never really happened,” he said.
“Twenty to thirty years from now you will still see people using the fax machine… it will still be there.
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