Since the 1990s, dosage healthcare has been hooked on fax technology to move information. And though far better alternatives now exist, we still have a healthcare fax fixation.
Consider some choice anecdotes:
• Rules for lab requisitions demand that a rubber signature stamp applied to a hard copy be authenticated by initials and date in pen; if faxed, there is no requirement to authenticate.
• Pharmacies accept faxed prescriptions that are created with a digital image of a physician signature; if they receive a hard copy of the same document they want the doctor to re-sign in ink next to the signature image.
• A patient who carries a printed and signed mammogram requisition to a local hospital’s x-ray department is told that all incoming requests must be faxed – hand delivery isn’t permitted.
Of course, none of these policies make any sense. But they each reveal the mistaken belief that healthcare fax solutions are superior to other document handling and transmission options. Recognizing that they demonstrate wrong impressions, let’s look at our continuing healthcare fax confusion with the goal of creating policies that can make patient information more accurate, comprehensive and secure.
Faxes provide clear advantages compared to hard copy moved by courier or postal mail. They arrive faster, provide a delivery confirmation to the sender and there’s no postage expense.
Fax servers, which send information by fax protocol directly from a computer, provide even greater benefit. There is no need to print a hard copy, which saves on consumables, one can fax from any computer location and there’s no paper to shred. Fax servers thereby increase efficiency and enhance healthcare information privacy.
No wonder that parties sending out large volumes of reports – acute care hospitals, labs and diagnostic imaging facilities – were quick to migrate from hard copy reports to fax. But how do we explain the fact that the healthcare industry considers faxes superior to both paper originals and electronic substitutes?
The simple answer is ignorance.
Take the concerns of a pharmacist who receives a hard copy of a prescription with a digital image of the doctor’s signature. Pharmacists express concern that they cannot sufficiently assure the prescription’s authenticity because:
1) Anyone could have pasted a photocopy of a signature onto a fake prescription and then copied it to make it look like a legitimate physician order
2) There is no fax header line that shows the origin of the document
Neither of these arguments is well-founded.
First, laser printers and photocopiers have 10 times the resolution of a fax. That means that a hard copy will more easily reveal a counterfeit attempt than will a fax printout; in fact, faxing is a great way to conceal a paste-up job.
Second, contrary to what many believe, the originating number on the top line of an incoming fax isn’t produced by the phone network (like call display). Instead, it’s simply the number programmed into the sending machine by the user, who can choose whichever number they like. Wanna disguise yourself as a doctor’s office? Just buy a cheap fax machine, program the doctor’s fax number into it and start faxing.
The myths about a healthcare fax being secure don’t end there.
If a fax machine isn’t placed in a safe area, the fact that the document got to the right device doesn’t mean that it’s privacy-protected. And though using a fax server with a programmed directory of destinations reduces “wrong numbers”, a single data entry error can send a torrent of faxes to a local convenience store. Finally, a fax server is a computer device and is no less vulnerable to hacking than any other server.
It’s reasonable to respond that other electronic data transmission suffers from the same problems. That’s true, though a purpose-built network for electronic healthcare information exchange would do better at protecting documents from falling into the wrong hands; there’s no readable hard copy lying around and no chance of the document getting sent outside the closed circle of healthcare.
But there are two advantages to overcoming our healthcare fax fixation that are more important.
The first is speed. While faxing is way faster than moving hard copy, it’s also much slower than electronic messaging technologies. That’s why everyone who faxes has a limit on the number of pages they are willing to send as a faxed document.
Less recognized, but most important, is the fact that the standard fax protocol strips away significant portions of information when it turns documents into data sent by phone line or internet. If the information starts out fully digitized in a computer – meaning that textual data can be searched and that numeric data can be graphed – then it is reduced to a simple two-dimensional image of the information, just as if one took a low-resolution photograph of the page.
That means that when the faxed document arrives at the recipient’s machine, even if it was sent from outgoing fax server to incoming fax server, it will not be able to be searched for content without applying optical character recognition (OCR), which works quite well on text but is less reliable when trying to re-digitize numeric data. Knowing this, would you want a clinician to make a decision about your health based on lab results that were sent by fax and then scanned and read by computer?
The same low-resolution characteristic of fax also significantly limits its ability to handle still images (of course, it can’t handle any type of moving image).
In other words, fax technology is an ongoing and substantial contributor to data loss at a time when we are trying to improve healthcare delivery through information gathering and management. Yes, fax is easy and widely available. But so are lots of other archaic technologies, including paper records.
While some might assert that this is a technology issue, it’s not; the networks and processes that would be the logical replacements are affordable and have established track records in other industries. That means that fixing the healthcare fax fixation will fall to policymakers who understand the value of electronic healthcare information and how faxes impair needed advances in a digital age.