It’s time to plan the funeral for fax in healthcare

It’s 2023 and the fax machine has been on life support for far too long — it’s time we pull the plug and place the final nail in the coffin. Despite all the technological advances we have made over the years, I was flabbergasted to discover faxes maintain their position as the primary method of communication in the health

industry. In the days of instant communication, I find it barbaric that 75% of healthcare depends so heavily on an archaic form of communication for something as important as our health.¹

The fax machine was invented in 1954 by Xerox.² Its simple form and immediate delivery of crucial information made it an ideal mode of communication in the healthcare industry. With the enactment of HIPAA in 1996 and the subsequent 2002 Privacy Rule instating guidelines on the sharing of medical records, secure communication became increasingly crucial.³ Fax machines were deemed to be secure and easy enough to operate within the HIPAA guidelines. These guidelines could be easily summed up in two words: “reasonable safeguards.”⁴ This simplicity fostered the widespread adoption of only needing a max of 10 numbers to share information — e.g., referrals, progress notes, prescriptions, lab results — faster than the days it would take to send via the U.S. Postal Service.

The HITECH Act of 2009 invested $27 billion in shifting the country from hard-copy medical records to the adoption of EHRs.⁵ Adoption was widespread, with a 2021 CDC survey showing 88.2% of office-based physicians using an EHR and 77.8% a certified EHR.⁶ An unfortunate oversight was the failure to promote interoperability outside a health system. The focus in creating these EHRs was in intercommunication from offices within a health system and other health systems using the same EHR system, but there were no guidelines ensuring successful communication across different EHRs.⁷ This sometimes results in providers relying on faxes for communication outside their health ecosystem on top of payers’ insistence on fax communication.

The current state can be seen as incentivizing the continued use of faxes. By being unable to effectively communicate outside the EHR, EHR vendors can create monopolies in communities by guiding surrounding organizations into their ecosystem. When it comes to selecting an EHR many organizations will opt to choose the same system as their neighbors to easily share information without the headache of transcribing the entire record for a referral. On the provider side, it can be viewed as a method to keep their current patients from leaving and seeking care elsewhere, due to the difficulty with transitioning care and ease of staying within the organization. Health systems would like their patients to stay in their network and view the challenges of switching providers as a barrier to secure their patient pool.

In a time where physician burnout is on the rise and we anticipate a greater physician shortage, solutions are necessary. A 2021 physician compensation report by Medscape found that less time is being spent with patients and more time on administrative/documentation tasks with a reported average of 15.6 hours per week.⁸ Physicians prefer to spend their time interacting with patients, but the incessant need of transcribing medical records is taking up a significant amount of their time. This can be viewed as a substantial contributor to the ever-growing physician burnout. When records are faxed, they are prone to numerous complications: Images and text can be distorted or rotated, pages can be missing, the information cannot be automatically transcribed and they can be sent to the wrong number. This poses serious HIPAA risks and, if it occurs, it isn’t always discovered quickly, resulting in delays of data transmission that can be life or death in dire circumstances.

Providers are habitually reprimanded by hospitals as a result of the unabating reliance on fax. Many hospitals require pre-op information and H&P to be faxed prior to an operation, but surgeries are still delayed on the common occurrence of those records being misplaced or fax transmissions failing to go through.

A significant amount of effort and resources has been put into digitizing medical records, and the lack of interoperability is creating more mundane tasks. Anytime a record must be faxed, the receiver must transcribe the information into their EHR, which takes time and is human error prone. Last year when I moved across the country, I changed health providers for the first time in my life. My medical record was more than 300 pages long, resulting in me filling out my medical history two times by hand and verbally to my provider in addition to the 300-plus pages I gave them. All this despite my entire record since birth already being digitized by my previous provider.

If I get a new phone, I can connect it with my old phone and all my contacts will be moved from one to the other; why can’t my medical history be done in a similar fashion? Then there is the financial imperative to achieve such ease of use: Communication deficiencies can cost a 500-bed hospital more than $4 million a year.⁹ 

There will always be risks associated with securely sharing information over the internet, but we have come a long way, and I refuse to believe faxing is the best way to maintain HIPAA compliance. Fax machines are prone to security breaches just like all technology, either through human error or exploited vulnerabilities in the fax hardware itself.¹⁰ Healthcare providers need to push for a better way for transmission of data where it can easily sync with other EHRs, even if that requires the intervention of new legislation.

Forcing EHRs to conform to the same guidelines of interoperability, we can improve communication as records can quickly and securely be sent between systems with a clearer look at a patient’s medical history. This transition will inevitably improve patient care and reduce many of the frustrations in the daily life of being a provider.

By not doing anything, the negative impacts brought from relying on faxing as a main form of communication will persist throughout healthcare. Avoidable medical errors will continue to disrupt the industry, and physician burnout will continue to increase. The current EHRs will only grow in complexity within their ecosystems making it harder in the long run to promote interoperability with outside organizations.

There has been talk circulating for many years on the need for action. It has been nearly five years since then-CMS Administrator Seema Verma announced that steps were being taken to remove barriers to sharing data between patients, providers and payers, with the goal of making “doctors’ offices a fax-free zone by 2020.”¹¹ That obviously didn’t happen. More needs to be done to achieve the change we so desperately need. It is time to set a date and plan the funeral for fax machines, so we can deliver the care we are capable of and that our patients deserve.

Notes:

1. Clements J. “Fax Technology Still Popular in Healthcare Settings- an EHR Shift is Vital.” MOS Medical Record Reviews. Nov. 13, 2017. Available from: https://bit.ly/3MuOKdy.
2. Lynn J. “Saying We Shouldn’t Use Fax Because It’s Old is Like Saying Email Is Old and We Shouldn’t Use It.” Healthcare IT Today, Feb. 10, 2022. Available from: https://bit.ly/3Ocq1fl
3. “Why is HIPAA-Compliant Fax Crucial for the Healthcare Industry?”  mFax by documo. Available from: https://bit.ly/3IiLCiu
4. Segal B. “Here’s why hospitals still use fax.” Telnyx, May 26, 2021. Available from: https://bit.ly/41CFMPz
5. Ibid.
6. “Electronic Medical Records/Electronic Health Records (EMRs/EHRs).” Centers for Disease Control and Prevention. Jan. 26, 2023. Available from: https://bit.ly/3MxN7fd.
7. Hendrie D. “Why is it so hard to wean healthcare off the fax machine?” News GP, May 21, 2018. Available from: https://bit.ly/3W7Qooy.
8. Kane L. “Medscape Physician Compensation Report 2021: The Recovery Begins.” Medscape, April 16, 2021. Available from: https://bit.ly/3Ih9SS9.
9. “Report: A Survey of Healthcare Leaders and Patients” Tiger Connect. Available from: https://bit.ly/3M2uWNa.
10. Davis J. “90% Healthcare Providers Still Rely on Fax Machines, Posing Privacy Risk.” Health IT Security, Nov. 14, 2019. Available from: https://bit.ly/3Mx9Qb5. 
11. Morse S. “CMS Administrator Seema Verma calls for an end to physician fax machines by 2020.” Healthcare IT News. Aug. 6, 2018. Av