When Healthcare Faxing Goes Wrong

I recently wrote a tongue in cheek post about The Perfect Interoperability Solution. Go and read it and you’ll see what I mean. We’ll be here when you get back.

For those of you too lazy to click over and read the post, the punchline is that I was talking about all the beautiful parts of faxes in healthcare. Faxes have a lot of really redeeming qualities. That’s why they’ve survived so long in healthcare. However, we should learn from their great qualities and take interoperability to the next level.

In the comments on that post, regular reader R Troy offered this tragic story about why we should do better than faxing in healthcare:

At best, fax should be a method of nearly last resort, voice calls being the only thing that is worse (highly prone to miscommunication). Sure, there are solutions such as Brian noted, and I’m not suggesting that it go away because it does help to make the best of a poor method of communication. It’s just that in real life fax’s are often partially or completely unreadable, can’t get through, don’t reach the right person or entity, or even something as stupid as someone forgetting to press SEND or OK. Of course, if the fax came from an EHR, quality would likely be fine – but typically, someone fills in something on a photocopied form – perhaps legibly, and then that sheet is put into a fax machine and maybe even gets both sent and received.

Real life scenario; doctor sends a patient to the ER for an emergency transfusion, to be followed up by related infusions (which were going to be done on an outpatient basis the next day until the situation worsened). The doctor writes up the orders to have someone fax to the ER, but along the way, something unknown happens and the ER never gets the fax. Patient arrives, ER has no clue what to due, figuring the orders will eventually arrive. One nurse figures that the problem is with the pharmacy. The patient’s family pushes hard and finally – 6 hours later, discovers that no orders have arrived; doctor is phoned, and 10 minutes later the ER has the instructions.

What should have happened? In very plain terms, the doctor should have logged into the EHR (albeit a different system than the hospital uses), put in orders, and those orders should have gone straight to the ER’s EHR (I gather via Direct Messaging) so that when the patient arrived the ER would know what to do. OR – the doctor should have logged into the hospital’s EHR remotely and entered the orders. But that’s not what happened, and the patient waited many hours for badly needed blood, and a valuable ER bed was occupied for those same hours with no treatment being done.

Fax does have its uses – but IMO they should be limited to situations where there is no other choice, not be ‘how we do things’.

BTW, the scenario above actually happened. Oh, and the ER in question is now being expanded, an expansion that might not be needed if 1. it had decent communications with doctors feeding it patients, 2. it’s EHR was fully connected to that used by the rest of the hospital, 3. It had a viable and efficient work flow revolving around the EHR. Instead, patients are stacked up in the hallways and waiting room waiting for treatment, for techs to come, for orders to hopefully show up. The hospital is spending 10’s of millions to expand but not addressing the root causes of their problems, the biggest of which is poor communication based primarily on phones and fax machines.

The sad part is these miscommunications happen all day, every day in healthcare. Stories like this is why we can and need to do better than fax for healthcare interoperability.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

2 Comments

  • Brian again, from OpenText, which makes and sells RightFax and Fax2Mail. Obviously we have a lot at stake in faxing, and yet we’ve come out with two offerings (RightFax Healthcare Direct and Fax2Mail for Healthcare) that help bridge the world of fax to the world of Direct Messaging, by automatically converting faxes to Direct messages.

    As people who “live and breathe” fax, we’re well aware of the shortcomings of fax as a document transmission method; no one believes the future of interoperability in healthcare lies with fax. But I have to ask again, if fax is such a poor choice, what is it still so broadly used?

    Those who study change say that there will be no change in a system unless the dissatisfaction with the current state times the vision of the desired state times the level of understanding regarding tangible first steps toward the vision becomes greater than the natural human tendency to resist change.

    With regards to faxing in healthcare, which is the weakest link? What keeps us faxing? Is it lack of dissatisfaction, lack of vision, lack of first steps or a huge cultural resistance to change?

    Fax is funny; I get that. I collect fax jokes. But the model above still holds. I don’t think that lack of dissatisfaction or lack of vision is the problem (see excellent post quoted above). Resistance to change is both natural and, in certain systems (e.g., healthcare), likely not a bad thing. If the weakest link is the lack of tangible first steps toward the vision, we at OpenText think we can help. Those who know fax may be the best to help move away from fax in a way that’s workable.

  • Brian,
    Fascinating conversation around what it takes to create change. I think the lack of a better alternative as compared with the current state is exactly why it’s not changing. The other thing I would add is how much of healthcare’s reimbursement is tied to faxing. I’d argue almost none. They’re going to get paid whether they get or send the faxes or not. Plus, they don’t get paid more if the communication happens faster or slower.

Click here to post a comment
   

Categories