The Royal College of Surgeons of England balked at the 8,000+ fax machines used by the National Health Service for clinical communication and coordination. The surgeons pointed to advancements in artificial intelligence, robotic surgery and other digital technologies while communication within the health system relied on the fax.
“Alongside all of this innovation, NHS hospital trusts remain stubbornly attached to using archaic fax machines for a significant proportion of their communications. This is ludicrous,” said Richard Kerr, RCS council member and chair of the Commission on the Future of Surgery (RCS, 2018).
#AxtheFax sentiment expressed in U.S., Canada and beyond
Enter #AxtheFax, or #AxeTheFax for those preferring the alternate spelling. Either way, it’s a sentiment voiced worldwide to eliminate antiquated fax machines and bring clinical communication and coordination into the digital age (Kirby, 2020). A recent State of Healthcare Communications report estimates that 90% of United States health care organizations still rely on fax machines, with another 39% still using pagers (Davis, 2019), when communicating HIPAA-protected and other information.
The U.S. entered the forget-the-fax fray when Seema Verma, then administrator of the Centers for Medicare and Medicaid Services, called for the elimination of all fax machines (CMS, 2018). Some progress has been made with proposed rules introduced in January 2021 for improved clinical communication and coordination that meet U.S. HIPAA requirements (Federal Register, 2021). Canada is taking steps to ax the fax, too (Singh & Aggarwal, 2021).
Five reasons why #AxtheFax strikes a chord
Consider these real-time challenges that regularly happen with faxed patient health data:
Privacy and security risks. Even with digitized information exchange, a digital or online fax often travels to personal email addresses or telephone numbers that are not secure, creating the risk of identity theft, phishing and other security breaches that compromise the privacy and security of patient data.
Delivery confirmation not personalized. The generic confirmation of a delivered fax tells only that: the fax reached its destination fax number or email but does not identify if it reached the intended person or department.
Misdirected information. The receipt of faxed information depends on one vital factor – the correct fax number for the intended recipient. Without it, medical errors can happen, and people may die. Reducing medical errors includes improving communication (Rodziewicz, et al., 2021) with data sent to the right person as quickly possible. Confirmation of the correct fax number before sending helps avoid a HIPAA violation if the fax reaches the wrong destination.
Insufficient information. COVID-19 brought patients to hospital emergency rooms and intensive care units across the globe. Doctors often waited days for patient health data transmitted via fax, with the length of the delay determined by the time required for staff to sort and identify often hundreds of faxed pages of patient data and log the information for public health reporting. (Kliff & Sanger-Katz, 2020).
Inconsistent reporting platforms. Reporting COVID-19 and other epidemiologic data to public health databases requires digital transmission of that information. Hospitals, health care providers and labs did not always report public health data due to lack of digital reporting methods and often transmitted data that did not meet infectious disease reporting guidelines (Arvisais-Anhalt, et al., 2021).
Alternatives to faxing provide secure and immediate exchange of patient data
For some, paper may be contagious (Lynn, 2021). Using paper requires no training; it’s a flexible and adaptable option for communication. Yet, health care discourse thrives on digital platforms with secure, information-sharing applications.
Michael Garron Hospital, a division of the East Toronto Health Network, has served 400,000 people in 22 diverse neighborhoods for more than 90 years. A case study on the Hypercare website explains how the hospital relies on a smartphone app for easy and efficient digital communication among clinicians.
Dr. Carmine Simone, the hospital’s chief of surgery, uses the app for reviews of patient data and group discussions with colleagues. “Hypercare has made communication between the members of the surgery team so much easier,” he stated. “Not only does it offer a secure platform to communicate about patient issues, but it is also a user-friendly platform for group conversations or group announcements.”
For doctors, nurses and other health care professionals, the Hypercare solution simplifies communication via a smartphone app. Rather than hurriedly leaving an exam room to fax or retrieve important data, a clinician can send or check for the information on their smartphone. It’s easy, with an interface designed for health care.
Similar to instant messaging, the HIPAA-compliant platform provides an interface designed specifically for health care. Pricing meets the needs of users, whether a small team or an enterprise staff.
Arvisais-Anhalt S, et al. What the coronavirus disease 2019 (COVID-19) pandemic has reinforced: the need for accurate data, Clinical Infectious Diseases, March 15, 2021;72(6):920–923.
CMS.gov. Speech: Remarks by Administrator Seema Verma at the ONC Interoperability Forum in Washington, D.C. Aug. 6, 2018.
Davis J. 90% of healthcare providers still reply on fax machines, posing privacy risk. Health IT Security, Nov. 14, 2019.
Federal Register. Proposed Modifications to the HIPAA Privacy Rule to Support, and Remove Barriers to, Coordinated Care and Individual Engagement. Jan. 21, 2021.
Kirby D. NHS hospitals have only a few weeks left to get rid of their fax machines and are in ‘desperate need of new systems.’ inews.co.uk. Feb. 14, 2020; updated July 10, 2020.
Kliff S. and Sanger-Katz M. Bottleneck for U.S. coronavirus response: the fax machine. New York Times. July 13, 2020.
Lynn J. Paper is contagious. Healthcare IT Today. Feb. 2, 2021.
Rodziewicz TL, Houseman B, Hipskind JE. Medical Error Reduction and Prevention. (Updated January 4, 2021). In: StatPearls (Internet). Treasure Island (FL): StatPearls Publishing;
Royal College of Surgeons of England. NHS fax machines still gleaming; RCS find over 8,000 owned by hospitals. July 12, 2018.
Singh P & Aggarwal S. We need to axe the fax in health care now. Toronto Star, March 24, 2021.
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