The Perverse Persistence Of Fax Machines In American Medicine

A coworker recently remarked to me, “I can’t believe it’s almost 2023 and we’re still using fax machines!” I nodded in agreement, and I also began to wonder why that was.

According to Telnik’s Brian Segal, one important reason is clumsy government incentives under the Obama administration to force hospitals and doctors to use electronic medical records. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the government offered billions of dollars to encourage medical systems to switch from paper-based to electronic systems.

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Segal also notes, “Many electronic health record (EHR) systems were hastily developed to be implemented before incentive funding 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.”

Furthermore, the government incentives did not include provisions for compatibility with other EHR systems. So if a patient has all of their health records in one hospital system and then needs to transfer them to another hospital system across town (or in another city), the data formats may not necessarily be compatible. So the only way to transfer the records would be to print hard copies and fax them.

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(In contrast, in my field of radiology, there is a standard data format called DICOM for distributing images from X-ray, CT, MRI, and ultrasound studies. So, if you get an MRI at one hospital and have a CD copy of your scan, then another doctor at any which other hospital can view the study on their computer without difficulty.)

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Many EHRs are also painfully inefficient for physicians. As Dr. Lloyd Minor of Stanford University noted in 2018 The Wall Street Journal piece, “[N]the top half of physicians said they often engage in activities such as taking paper notes and scanning medical documents in an attempt to avoid EHRs. The question is clear – until the electronic tools we create make healthcare more efficient, pencils, paper and faxes will retain their privileged place.”

Health journalist Sarah Cliff also notes that many large hospital systems have perverse financial incentives not to share internal data more easily: “A shared medical record… makes it easier to visit another doctor.” A walled garden—where documents are traded only within a single hospital system—may encourage patients to stick with those providers.”

(Cliff calls fax machines “the cockroach of American medicine: hated by doctors and medical professionals, but able to survive—even thrive—in a hostile environment.”)

Finally, Alex Hogan of STAT News notes, “In many states, health care providers are required by law to keep paper copies of patient records. Sometimes it’s more convenient to just fax something than to have to download a file and print it from an email.”

The federal government has specifically told doctors and hospitals that fax machines meet HIPPA privacy standards for sharing sensitive medical records.

So while fax machines may seem archaic, images are often blurry and hard to read, and managing hundreds of sheets of paper a day may seem absurdly inefficient, fax machines in healthcare will be here in 2023. And probably for many years to come.


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