LONG LIVE THE FAX MACHINE

By TIM BRYCE

- Why +830,000 physicians rely on this aging technology.

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As a small businessman, I haven't had to use a fax machine in quite some time. Like most people these days, I rely primarily on e-mail. If I have a lengthy document, I convert it to a PDF file and attach it to the e-mail. Many years ago, we relied heavily on fax machines to communicate with customers overseas (and TWX machines before that), but in recent times we have little use for such devices. We keep a fax machine in the office for "just in case" situations, but we mostly leave it unplugged to avoid the many spam faxes still plaguing the public. I am also able to interface with other systems to upload/download data in a variety of file formats with Delimited ASCII being the most prevalent.

I recently visited my doctor for a routine checkup. We've known each other for years and I am always fascinated by the latest medical technology in his practice. His office consisted of a modest sized staff with the typical number and type of computers you would expect to support administrative needs. Interestingly, I noticed he had a fax machine which was slowly chugging away and spitting out voluminous reports. Frankly, I was surprised to see a fax machine being so actively used; certainly he transmitted/received data by e-mail or some other computer protocol I thought. Actually, No.

Although physicians have abundant computer software available to them for communication purposes, it is not as actively used as the fax machine which is the true work horse of their office. The doctor claimed his office received on the average 18,000 faxes each year. This does not include sending documents which is probably just as voluminous. Patient records, test results, prescriptions, hospital reports, etc. are all regularly sent by fax, and no other device. This means the data has to be re-keyed into the doctor's computers by his staff. It doesn't take a systems man like me to realize this is not an efficient or cost-effective approach for operating any office. Frankly, I was thunderstruck just how primitive the office systems were, and this was just one office. As I was to learn, most doctors operate in the same manner thereby representing a model of system dysfunctionality on a colossal scale.

A mandate from the federal government a few years ago requires doctors to digitize all of their medical records (see "Turning Everyone into Data Entry Clerks"). This means every medical institution in this country has been busy entering data about all of their patients, a herculean task which the medical community is currently embroiled in. To accomplish this, a variety of medical software packages have been introduced with little or no compatibility between them. This means your medical records with your General Practitioner cannot be read by another doctor, unless he happens to use the same medical records software, which would be a very remote coincidence. There are, of course, strict privacy issues concerning the exchange of patient records. Regardless, assuming consent is given by the patient, there is no easy way to electronically exchange data.

Blame for this incompatibility falls squarely on the shoulders of the federal government who has not devised a standard file format for exchanging data. They may have mandated all doctors digitize their patient records, but they never devised a means for exchanging data. This incompatibility issue is so glaring, you have to suspect it is premeditated.

Now consider the enormity of this problem; there are over 830,000 physicians in this country, all of which are busily digitizing patient records, none of which can be exchanged electronically with other doctors. So how do they communicate? You guessed it; by fax. It also means all of these doctors and their staffs have to work double-time to record patient data as transmitted by fax. Doesn't make a lot of sense does it?

Let's take it a step further, assuming my friend's office annual workload of 18,000 faxes is an average, and considering there are over 830K doctors, this translates into over 15 trillion pieces of paper being printed each year by physicians alone (not counting hospitals). This isn't exactly environmentally friendly, but certainly supports the bottom-line of paper companies.

This system snafu places a significant burden on doctors and inhibits their ability to practice medicine and care for their patients. Not surprising, a mutiny is in the offing. Tired of growing governmental bureaucracy, many physicians are opting to retire early or quit their practices outright, thereby creating a shortage of competent doctors.

My visit to my doctor's office taught me a couple of things; first, the fax machine is the Achilles' heel of any physician's office, without it, the doctor is lost. Second, this need not be the case if the federal government would just devise some simple standards for data exchange. However, knowing the government, I do not think I'll hold my breath. I'm quite confident doctors will go on killing trees for many years to come.

Keep the Faith!