Two-thirds of Canadian doctors say their primary means of communication with other physicians is by fax.
Medical clinics in this country, on average, send and receive a mind-boggling 24,000 pages of faxed information annually. Only about one-third of family physicians and specialists e-mail their colleagues for clinical purposes, never mind patients.
These data, from a 2017 survey of clinicians by Telus Health, remind us that, in the digital age, health care continues to cling desperately to the facsimile machine, a clunky technology that most industries have long ago relegated to the scrap heap.
Health care is slow to change. Medicine has an intrinsic (verging on pathological) aversion to risk. If a bank introduces a new technology and it flops, that’s an inconvenience for customers; if a hospital does so, it can be deadly. The stakes are higher.
There is also an obsession with privacy, one that, time and time again, trumps convenience and even common sense.
The notion that paper-based records are somehow safer and more secure than electronic records beggars belief. Yet, rules and regulations still hold that a fax is a secure means of communication while e-mail is often not considered secure.
Then, there are the practical technological impediments to abandoning the fax.
The majority of primary care physicians – 77 per cent, according to Canada Health Infoway – uses electronic medical records to maintain clinical notes. But the systems they use come from a wide variety of vendors and are often unable to communicate with each other.
That means GPs often can’t send files to specialists, share imaging such as MRIs, or e-prescribe. (Almost half of prescriptions are still written by hand.) Sometimes, two departments within the same hospital can’t even communicate electronically.
Because of this lack of interoperability, most everyone falls back to the tried and true (and flawed) method, the fax. When you send a fax, it can lie around in the machine, which is a privacy issue; fax machines run out of paper, and don’t have much memory. To receive information, it has to be fed manually into a machine.
A new movie, Falling Through The Cracks: Greg’s Story, underscores some of these issues.
Greg Price was an Alberta man who was diagnosed with testicular cancer at age 30 and died of a blood clot a year later in May, 2012, after much bureaucratic bungling, including faxed referrals to specialists being lost and ignored.
In the movie, which is designed to teach medical students and practitioners about avoiding medical errors, the camera often zooms in ominously on the fax machine.
It should indeed be looked upon as an object of dread.
One study conducted in Hamilton, Ont., found that one in five faxed requests for consultations – notes sent from doctor to doctor – do not even get a response.
What makes Mr. Price’s story chilling is that it is not at all uncommon. Studies have shown, time and time again, that about half of all medical errors are the result of communication problems.
We owe it to ourselves to use state-of-the-art communication tools if we want to keep patients safe – if we want to avoid having them fall through the cracks.
It is all the more important in an age when many patients have multiple chronic illnesses and a variety of health care providers. Consider that the average frail elderly patient sees two GPs and five specialists in four different clinical settings, and their records are often still paper-based. The fact that their medical files are scattered about like seeds in the wind rather than in one central electronic medical record is unconscionable.
In this country, you can be rushed to the ER, and your family doctor will have no idea you have been there; if the ER wants records from your specialist, they will likely have to get them by fax, during daytime business hours; and, if they want to know your medication history, they likely will have no idea how to contact your pharmacist.
Billions and billions of dollars have been spent creating massive health information systems, but we still don’t have the basics down, such as a single electronic medical record (EMR) with a patient’s medical history, accessible to all appropriate health providers.
The technology exists. It’s affordable, and it’s essential. But to make way for the new, we have to usher out the old. Fax machines belong in a museum, not in 21st century medical practice.