Why Your Doctor's Office Still Depends on a Fax Machine

This piece appeared in The Wall Street Journal on September 19, 2019.


Early in my medical career, fax machines were all the rage: state-of-the-art technology, swift and simple to use, predicted to be in every home in America. But the much-hyped machines eventually fizzled out like floppy disks. Except in health care. And now, nearly 40 years later, faxes are still coming off the rollers in hospitals and clinics across the country.

Here’s a typical scenario: A specialist asks a primary-care physician for a patient’s electronic health record (EHR). But because the two providers don’t use the same EHR software, the record must be faxed. When it finally arrives on the other end, perhaps the handwriting is illegible, or the page with the relevant information is missing. Even if all goes well, the specialist will still have to fax back a report of the patient visit, risking further information breakdowns. It’s not just physicians who get caught in the fax trap either  patients themselves sometimes become the go-between, receiving their own records via fax so they can pass them along in person or through yet another fax. 

These inefficiencies drive up costs, frustrate clinicians, inconvenience patients and create gaps in patient care. How, then, have fax machines endured in medicine? In a world where the Apple Watch is being deployed in medical studies, why do we still rely on a clunky beige box that peaked in popularity around the same time as the Walkman? 

Lots of reasons, it turns out, and chief among them is the inadequacy of electronic health records. Though they’ve done plenty of good and are leaps and bounds ahead of where they were a decade ago, EHRs still fall short in many ways. One of the biggest shortcomings is the lack of interoperability among different EHR systems. Siloed information prevents hospitals, medical offices and others from sharing information electronically, creating an overreliance on faxes, snail mail and patients who hand-carry their medical information from one provider to another.

Fax machines cover for the shortfalls of EHRs in other ways, as well. They are easier to use with less cumbersome interfaces, and they provide targeted information rather than information overload. In a 2018 poll, nearly half of doctors said that they often engage in activities like taking paper notes and scanning medical documents in an attempt to avoid EHRs in the first place. The issue is clear — as long as the electronic tools we create don’t make health care more efficient, pens, paper and faxes will retain their privileged place.

It’s going to take forward strides in the standardization and interface of EHR systems before the fax finally fades away. Once various health-care providers are all on the same page, we can improve the coordination and efficiency of care. When physicians are able to collaborate and share their findings, any one provider can reference all of the health-care data on a specific patient to predict, prevent and cure disease more effectively, providing each patient with seamless, individualized care.

The promise of this more proactive and powerful future is one where technology helps patients manage their own health and well-being. If we’re ever going to get to that future, we’ll have to break our fax habit.