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Just the fax: Canadian health-care is still stuck in the ’80s

December 31, 2021 by Jackson

It’s a dark and rainy Thursday night towards the end of 2021, but for Steven Marji it might as well be 1991.

He’s on his way back from a repair job, fixing a vital piece of technology his customer simply can’t live without: the fax machine.

This time, the patron was an 85-year-old half-retired real estate agent. But even though printers and copiers make up the bulk of his business, Marji discovers that there’s one industry, aside from retirees, where he can always find them.

“I’m a little surprised the medical field they still rely on it,” he told the Star as he drove home from his most recent job.

“It keeps us going.”

While most offices ditched their fax machines long ago — the provincial government plans to phase out traditional public service fax machines by the end of the year — they remain a persistent fixture in hospitals, pharmacies and doctors across the country. .

Many doctors have newer digital models that integrate faxes into a printer or scanner, but the frustrations persist amid calls to usher the industry into the 21st century, and move beyond an archaic system that exposed the pandemic’s worst.

During the early days of COVID-19 in Toronto, test results had to be faxed from labs, which a Toronto Public Health Report of May 2020.

As a result of these pitfalls, the agency has implemented a new case and contact management system, reducing its reliance on faxes.

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 because of the need to fax the results. Health officials in the Netherlands faced a similar problem.

But despite some improvements made during the pandemic, the fax remains a critical step in the transfer of patient information in healthcare.

in a October Report, The Ontario Medical Association, which represents doctors in the province, reported that nine out of 10 doctors have to rely on faxes to share patient information. Thirty percent of the doctors they surveyed said linking healthcare record systems to reduce reliance on faxes would save them about one to five hours a week.

‘You know that sound of a dial-up modem? That’s really what’s going on in the back of my mind as we go through and click through,” said Dr Miriam Hanna, a pediatric allergist in Burlington.

All of her patients require a referral to get to her, and about “99 percent” of them come by fax, she said. They are part of “every day, and every encounter is linked in some way to using a fax machine.”

This means that information “can be easily lost”. Sometimes the fax does not come through or goes to the wrong number. They can also be blurry, or employees just get a blank page.

“It’s archaic, but that’s what we do,” she said.

“Doctors use faxing forever, for better or for worse.”

dr. Rashaad Bhyat, a primary care physician in Brampton who works part-time at Canada Health Infoway, a federally funded nonprofit that promotes digital health solutions, said stories of fax confusion, like that of the pandemic, are just the “tip of the iceberg.” In his office, he uses electronic health records, but the system still ends up in 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 eradicate,” Bhyat said.

“We often have what we call fax tags, going back and forth between our office and specialist offices, or our office and hospitals.”

Information “ends up in a barrage of back and forth faxing, which ends up taking a day or two to sort out.” He likens faxing to “throwing something in the airwaves, it’s a black box.” This often results in “significant delay” that can affect people receiving their medications and “causes a lot of discomfort for patients and a lot of stress for everyone involved.”

Of course, the fax was not always a symbol of outdated technology. It took decades for them to figure it out — Scottish scientist Alexander Bain is credited with inventing the first early fax machine in the 1840s — but by the late 20th century, “what’s your fax number?” was the question at every business meeting.

“The machine converts the text or images into a dotted pattern and sends out signals. Somewhere on the other side of a phone line, another fax machine receives the signals and translates them back into the correct dot pattern, star journalist Alison Cunliffe wrote in a July 1988 article.

“Science fiction.”

She mused that they became so popular that they could one day be in every living room, next to the ‘computer and video cassette recorder’.

And if your friends needed directions to your house? No problem, “just fax your guests a map”.

Needless to say, the fax didn’t live up to the hype.

So why are they still so ubiquitous in healthcare?

“It’s inertia,” said Sachin Aggarwal, the CEO of healthcare technology company Think Research.

“This is something for everyone to tackle. It has to come from the top down, there has to be some mandates, but the technology already exists.”

Michael Green, the president and CEO of Canada Health Infoway, said there needs to be a “joint effort” between health authorities, ministries of health and health professionals to make the change.

“The thing with health care, it’s a pretty conservative field and I think it takes a while to change 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 doctors are independent contractors, billing the government for services rather than receiving salaries.

The approximately 1,300 traditional fax lines in the Ontario Public Service are spread “across all ministries,” Kyle Richardson, manager of issues, media and correspondence for the Ontario Treasury Board Secretariat, said in an email. “More than 90 percent of that will be eliminated or migrated to digital alternatives.”

The healthcare sector includes other agencies and organizations that are not eligible for this modernization project, he added.

An extreme idea is simply to ban faxing, making it illegal to fax health information, Green said. Incentives can also be given to doctors to make investments to replace them.

“There is still a way to go, unfortunately,” he said.

Meanwhile, the occasional fax repairman Marji sits back in his car philosophically. Over a decades-long career, he has seen various technologies come in and out of fashion.

But somehow they have a way of never really disappearing. In addition to faxing, he also does some repairs to his passion, typewriters.

“They said the typewriters would be outdated, but it never really happened,” he said.

“Twenty to thirty years from now you will still see people using the fax… it will always be there.”