Axe the fax

From the Globe and Mail December 2018 Health reporter Andre Picard:
https://www.theglobeandmail.com/canada/article-the-british-are-axing-the-fax-will-canada-follow-suit/

It’s not often that a seemingly mundane ministerial announcement reduces one to jealous tears, but this one fits the bill.

On Sunday, Matt Hancock, the British health and social care secretary, banned the purchase of facsimile machines by the National Health Service effective Jan. 1, 2019. He also ordered that faxes be phased out completely in hospitals and physicians’ offices by April, 2020.

Oh, but how Canada – a country even more in the poisonous grip of the fax than Britain – could use this common sense initiative.

“We don’t underestimate the enormity of the challenge to remove all our machines in such a short time, but we cannot afford to continue living in the dark ages,” Mr. Hancock said in the release.

Amen.

In July, the Royal College of Surgeons released a report that revealed the NHS, the country’s publicly-funded national healthcare system, had more than 8,000 fax machines in service. A group of hospitals in Newcastle Upon Tyne had a mind-boggling 603 facsimile machines in use.

To cap it all off, the NHS had the dubious distinction of being the largest purchaser of fax machines in the world.

Richard Kerr, chair of the committee that prepared the report called the situation “farcical” and called on government to invest in 21st century technology.

The government actually listened.

In addition to the fax ban, there are two other important aspects of Sunday’s announcement. Come 2020, communication will be by secure e-mail or apps and, just as importantly, all communication technologies will have to meet a standard that ensure that they can talk to each other across organizational boundaries. 

There will also be some additional money for hospitals and physicians to replace their fax machines – £200-million (about $340-million) – in addition to what the NHS is already spending on IT. 

But we do know that the fax machine is still ubiquitous. A 2017 survey found that two-thirds of Canadian physicians use the fax as their primary means of communication with other health care professionals, such as doctors, pharmacists, and hospitals.

So why do we continue to use technology that is almost universally acknowledged to be absurdly outdated?

Some claim that the fax is more secure than alternatives like e-mail. Our privacy rules also consider the fax the safest form of communication. That’s simply not true, especially with readily available encryption. The continued use of fax machines is bad for privacy and bad for patient safety.

A principal reason the fax endures is habit. Change is always slow in the ultra-conservative health system, especially when it costs money.

But the single biggest impediment to banning the fax is that the computer systems and electronic health records that we have are rarely able to communicate with each other. Interoperability has not been a priority and that has left us beholden to largely paper-based technology.

Many will look at what is going on in Britain with envy. But, in true Canadian fashion, we will find countless excuses for not doing the same.

Expect to hear that, because Britain has a centralized national health-care system, ministerial directives are a lot easier to issue and implement. There is some truth to that; Canada’s 14 ministers of health can barely agree on the time of day, so an initiative to ban fax machines may be a stretch.

But we shouldn’t forget that Britain’s “axe the fax” campaign was a grassroots initiative. The College of Surgeons gave the initial push by providing data that generated a lot of media coverage and made it easy for government to act.

There were also hospitals that showed impressive initiative. For example, the Leeds Teaching Hospitals NHS Trust committed to eliminating its 340 fax machines within three months, sending a message to others that it was doable.

There is no doubt that fax machines can be eliminated, and they must be, sooner rather than later. The only question is who is going to show leadership? What health care organization, hospital, or politician is going to make axing the fax their legacy and drag Canada out of the dark ages?

Carlo Domeniconi-Koyunbaba