Beware simple icons and enemies when navigating digital transformation. Getting rid of your fax too quickly might cause more problems than it solves
“Fax machine, rest-in-peace”, said Dr Frank Jones recently in a call from the RACGP for GP surgeries to switch entirely to digitally secure communications within the next three years (no less).
Tim Kelsey, the new head of the Australian Digital Health Agency, got a head start on Dr Jones a few weeks earlier with a call for a “bonfire of the faxes” in healthcare, in the manner similar to that which has occurred already in the financial services and travel sectors.
Dr Jones says it’s bizarre that faxes are still the most important communication device in this day and age in healthcare. It certainly seems a little bizarre. But rarely are things so simple when it comes to digital transformation.
Despite what some people would have us think, the idea that doctors are digital laggards is a myth. There are no statistics that say doctors do their banking, book travel, find a date online, use their mobiles, talk to friends on Facebook or use Instagram in any different proportion to their demographic in any other profession.
So what gives on the fax machine? Why does our largest medical database provider, The Australian Medical Publishing Company (AMPco) say to us that you can reach 70,000 Australian doctors 10 times more effectively using this alleged dinosaur of analogue written communication, than electronic mail? Why do more than 15,000 medical practices and other healthcare facilities steadfastly hold on to and use their fax machine like hipsters with their vinyl record collections and turntables?
Here’s a few thoughts on the matter that the regulators and digital evangelists should perhaps chew on a bit harder before they light up the bonfires.
1. Faxes are the universal adaptor
Patient management systems, especially the deskbound ones that currently dominate the medical landscape, such as MedicalDirector and Best Practice, can talk electronically and securely to only a very low percentage of whom they need to. Although there are secure communications standards and three certified providers (Argus, Healthlink and Medical Objects), the standards aren’t adhered to, and are even ignored by some of the major service suppliers (mainly the pathology providers) which have developed their own messaging services. Allegedly some won’t even accept messaging, in some instances, from the certified providers. This makes things extraordinarily messy and complicated in medical communications.
The fax isn’t efficient, for sure. And Dr Jones’ aim to get rid of it isn’t such a bad goal. It’s just that it’s the only device that can actually talk to nearly all points of this complex maze. And things aren’t likely to change quickly, so you’d be brave to throw your fax out today and expect your office to keep running smoothly.
Another myth promulgated throughout medicine is that the fax is insecure. Compared with what? Unfortunately, even HEPA compliant security, which we have on some medical communications systems, and which are many times more electronically secure than most banking systems, carries higher risk than the current, distributed fax system. The reason is simple. Faxes are point to point. One transaction. All that can be lost in one transaction is one record.
And not to rub it in, but when did we last here of a mass security breach caused by “the fax”. We haven’t, because there just can’t be one. Whereas, once you’re in the world of electronic data security you’re in the world of “lots of data” being stored and moved and people love to get hold of “lots of data” in one go.
If the US National Security Agency and the whole US government couldn’t keep Edward Snowden down, you’re always going to have issues with masses of data being transported and stored in a single place. Security isn’t the problem here anyway, it’s efficiency. Digital electronic communications, if you can standardise them well enough, are massively efficient. Faxes are not.
There will need to be a trade-off somewhere in the future.
3. The Cloud
If you could standardise communications between all the systems and the suppliers, and have them run through a simple set of standard protocols, the efficiencies would go a long way to solving a lot of the dilemmas faced by governments in terms of burgeoning health costs. It is the holy grail of most modern healthcare systems. That’s the reason we’ve already wasted $1.2 billion on the MyHealthRecord.
But you aren’t going to achieve the efficiencies and communications needed if you are “off the cloud”. It isn’t ever going to be easy with cloud networks, but permission-based communications via the cloud will make it feasible. Until then, the fax talks to anyone point to point. It even talks between computer and fax.
It’s seriously inefficient in that it’s linear, usually paper-based and can’t handle a lot of volume. But it does talk to every type of provider: pathology, allied health, hospitals, peers, even your friends. Until you have a decent cloud infrastructure and networking starts up between various medical supplier hubs, we should be careful to rid ourselves of this noisy beast.
David Kelly, director of marketing and CPD at AMPco, says that if anyone mandated the abolition of the fax within a short period of time it would almost certainly isolate and cause severe anxiety and stress to quite a few doctors who still are using the fax.
Some doctors don’t use medical software but remain very effective with the fax at the centre of their communications. Single-doctor surgeries would likely be severely affected. No matter how networked cloud infrastructure might make us in the long run, some people can’t, or won’t, change. This long tail needs to be considered. They won’t be as efficient, but likely they will remain important contributors to their communities, and they will need to be accounted for
as change comes.
5. Digital isn’t everything
The world is now replete with examples of digital evangelists and companies pushing their technology as being inevitable, and a 100% solution, when that clearly isn’t the case. Facebook and Google currently take nearly 75% of all new media bookings across the Western world, in part because of hype about how effective and cheap these new channels are for marketers.
But the reality isn’t all it seems. Facebook recently had to admit that its video offering, which was taking money hand over fist from old TV networks on the promise of massive reach and efficiency, is up to 80% less effective than many marketers were led to believe.
A week ago, the marketing director of Telstra told a major marketing conference in Sydney that YouTube was the most effective medium in shifting its brand identity in the last year. In fact, TV (free to air and cable), was 10 times more effective and cheaper. How did that happen? Was it that YouTube represents a customer that creates nearly $1.3 billion of streaming revenue for Telstra’s broadband business? “Buyer beware” is critical in the digital world because perception isn’t everything.
6. Back up
Let’s imagine we get nearly all doctors on cloud-based medical software next week, and we manage to get some reasonably standardised permission-based protocols in place for the big databases that would then be a regular part of normal communications. And then the internet goes down – in your office, in your street, in your suburb. It happens a lot.
What then? Use your fax. It’s likely that it is still working if it’s on the twisted copper wire phone system, which most of them are. So possibly, you should never get rid of them, just in case. At least not in our working lifetime.
Medicine isn’t travel or finance. You aren’t going to die if you don’t get that Airbnb booking or miss a deposit or two. You can die in medicine.
The fax is surely a thing of beauty. Whirring away in the background, rolling out reams of actual paper, with writing on it, that you can instantly transport. The complexity of medical communications is the main reason the fax persists in a sort of “land that time forgot” way in healthcare.
The fax is simple, secure and universal. Its simplicity is part of its beauty. Sure, it doesn’t play beautiful music like an old amplifier and turntable, and it doesn’t really look that great as a piece of office furniture. But anything that persists as long as it has in medicine because it’s the only tool that can get such a complex job done, is worth some admiration, and, in the long term, preservation – even if just for the sake of posterity.