Facing the Fax: The U.S. Healthcare System Is in a State of Emergency

Recently, Britain’s National Health Service (NHS) banned the purchase of new fax machines for its facilities. It also announced that it wants fax completely phased out by the spring of 2020. Roughly 8,000 fax machines are still being used in the country’s healthcare system, a figure that its Royal College of Surgeons has called “absurd.”

But do you want to know what’s really absurd? According to Vox, fax machines still comprise as much as 75% of all communication for U.S. healthcare.

It has left our system and our data in disarray. And drastic measures need to be taken before it collapses under its own weight.

Why Our Health Sector Is Stuck on Paper

Fax machines are a precarious way to transmit data. Even if you manage to get past the busy signals and blurry printouts, your message could still end up at the wrong destination. So it makes sense that the majority of industries abandoned this outdated technology two decades ago.

But in U.S. healthcare, the fax machine has found a second life. How did we get here? The short answer is economics and politics. Let’s elaborate.

In February 2009, President Barack Obama signed a new stimulus package into law that included the HITECH Act (Health Information Technology for Economic and Clinical Health). $30 billion of this stimulus bill was dedicated to incentivizing healthcare providers to switch from paper to digital records.

And for the most part, it worked. By 2015, 83% of hospitals were using electronic medical records (EMR)—a steep increase from just 9% in 2008. But by focusing on this endeavor, the Obama administration failed to account for one crucial aspect: sharing.

Obama’s officials were optimistic that health systems across the U.S. would take to sharing patient data naturally. In retrospect, they now realize this was naive to assume. David Blumenthal helped the Obama administration with health policy from 2011 to 2013. Here’s how he puts it:

“We don’t expect Amazon and Walmart to share background on their customers, but we do expect competing hospital systems to do so. Those institutions consider that data proprietary and an important business asset. We should never have expected it to occur naturally, that these organizations would readily adopt information exchange.”

As a result of this oversight, most healthcare facilities remain unable to transmit and share data conveniently. $30 billion later, they’re still left with one option: print out the documents and fax them.

Unhealthy Economics

Unfortunately, healthcare facilities are also economically incentivized to keep their patient data to themselves. Obviously, patients would prefer that hospitals can easily exchange information with one another. But from a business perspective, that could result in a competitor siphoning their patients.

Blumenthal says, “When you want competing entities to share information, you have to realize that they’re sharing things that could help their competitors.” The HITECH Act required hospitals to have the ability to share patient data. But it didn’t require them to do so. As a result, these facilities saw the situation as a win-win—they could avoid investing in some newer technologies and make it harder for patients to leave them for competitors.

The same motivations apply to EMR makers. From a business standpoint, why should they work on connecting with other EMRs when they could instead work on converting hospitals to their platform? Mostashari says, “If [electronic record vendors] expended all that time and effort to make it so anyone could plug into any other system, it’s reducing the advantage of staying on your particular network.”

Dire Situations Call for Drastic Measures

By now, it’s apparent that fax machines are still around because they’re advantageous for the business side of healthcare. But business should never become a priority over a person’s health. Yet, here we are.

The status quo has led to a convoluted system that is beyond inefficient and time-wasting for physicians as well as potentially dangerous for patients. And let’s be honest—nobody wants any of those adjectives associated with their healthcare.

In Mostashari’s opinion, more government intervention is needed to address this issue. He believes the government should take a similar approach to Britain and mandate an expiration date for the fax machine: “I think if we want to kill the fax, we need to schedule a funeral.”

The Trump administration sees things differently, however. Donald Rucker is in charge of Trump’s Office of the National Coordinator for Health Information Technology. He thinks more regulations aren’t the answer: “All of the thousands of regulations that have piled on have the net effect of preventing us as individuals from controlling our data, from shopping for care, or having vaguely cost-effective care to shop for.”

Instead, Rucker believes the solution lies in better-designed EMRs that allow for easier information sharing. He says this should already be in the making due to a new provision in the 21st Century Cures Act which requires EMRs to have the ability to exchange data with other EMRs in a way that needs “no special effort.”

Whether a proper solution will come from policymakers or MedTech developers remains unclear. But one thing is certain: Something must be done soon. As long as fax machines keep playing a vital role in the U.S. healthcare system, doctors and patients from San Francisco to New York City will continue to suffer the consequences.