Despite the ADHA waging all-out war this appeared last week.
Are GPs ready to let go of the fax?
Zilla is a Sydney-based freelance journalist covering business, finance and practice management topics.
23rd July 2019
Rumours of the death of the fax machine, it seems, are greatly exaggerated.
It’s been almost three years since the RACGP identified what it said was a new national priority to save patients’ lives by eliminating faxes and letters as the chosen means for doctors to communicate with each other about patient care.
The safety stakes can be high. In 2015, a patient with Hodgkin lymphoma, Mettaloka Halwala, was found dead in a hotel room near Shepparton, Victoria, where he was staying while undergoing chemotherapy at Goulburn Valley Hospital.
A PET scan had revealed severe, rapid-onset bleomycin toxicity affecting both lungs, but Mr Halwala’s haematologist, Dr Robin Filshie, did not receive these results until five days later.
The report had been faxed to the wrong number, a fax machine used by 20 specialties on the ground floor of the hospital where Dr Filshie worked, rather than to the one nearest his office on the sixth floor.
In the meantime, Mr Halwala was given another dose of the chemotherapy, which proved fatal.
Dr Filshie told the inquest that the treatment would not have gone ahead if he had known about the scan results.
What are the alternatives?
There are many other cases of fax communication failure. So why has the humble fax machine not been consigned to the scrapheap?
Dr Oliver Frank, a GP and a senior research fellow at the University of Adelaide, says it’s taking a long time to get rid of the fax because many sections of the healthcare system, other than general practice, are still using paper records.
“For general practice and those other parts of the healthcare system that are using electronic clinical records, electronic secure communication is still not as easy as it should be and needs to be,” he says.
The Australian Digital Health Agency (ADHA), the government-funded organisation tasked with bringing Australian healthcare into the digital age, is well aware of the problem, which seems rooted in the simple fact that the numerous secure messaging systems out there can’t all talk to each other.
Or, to put in IT-speak, there is an interoperability problem.
There are four, big secure messaging platforms on the market — Argus, HealthLink, ReferralNet and Medical Objects — but there are also a significant number of smaller platforms used in various parts of the health system, such as Aboriginal Health Services.
To overcome this issue, ADHA has been offering $30,000 to software vendors to help fund the integration of new features into existing systems.
Participating companies will be required to release enhanced versions of their software by 15 May next year.
And yet, they persist
However, this is just the latest scheme in the search for a fix that has been running for at least 10 years.
When ADHA CEO Tim Kelsey was newly recruited from the UK three years ago, he said it was time for a “bonfire of the faxes”.
Their demise would transform healthcare just as the digital revolution had transformed other industries, he said.
But, faxes persist, despite concerns about safety, and despite them being an anachronistic technology in an industry that spends hundreds of millions on robotic surgery and MRI machines.
An Australian Doctor poll of 551 GPs in 2015 found that more than 90% still used fax machines and 35% thought it remained the most effective and secure way to communicate with other healthcare professionals.
Certainly, faxes are simple and quick to use, and they provide a delivery receipt (even if no one sees the fax).
Plus, it is easy to look up fax numbers.
Although GPs are highly digital, they face the problem that some of the referral networks they have to use — including specialist clinics and both private and public hospitals — are not.
Why fix what isn't broken?
For Lynelle Hales, CEO of the Sydney North Health Network, the fax seems to be the path of least resistance because they ‘work’ most of the time.
“Newer technology needs to be significantly more efficient before people will switch. Some GPs have said to us they would love to go paperless, but unless their whole referral network is capable of secure messaging, they can’t.”
Using fax machines does create risks for GPs, she says. These include the potential for breach of privacy.
“There are lots of examples of faxes going to the wrong place,” she says.
Even within the practice, the documents that arrive by fax are seen by staff who are not the intended recipient and have to be processed (scanned or moved) to the clinical software system for the intended GP.
“Plus, there are safety issues. When it does go to the wrong place, who follows up?”
There’s also the inconvenience. Faxed reports, which are scanned into clinical records and saved as an image, are not easily searchable.
There is vastly more of the anti ADHA subversion here:
Certainly the most comprehensive article on the fax in a while!
A sour note in all this is that when I suggested the clinician who did not follow up a seriously important and expected test result might bear part of the blame for the death I was ‘censored’ and my comment was removed.
What do others think on that point?
David.
1 comment:
Would seem right for peak bodies and colleges to remind everyone of a need to ensure you follow through on process and procedures diligently. Do not get complacent thinking technology will deal with it. Be it the fax, email secure messaging etc... these are tools to assist in communication. They are not “smart” or “intelligent ”.
When a safety issue happens in other industries their representative bodies tend to show a bit more leadership and rarely call for the persecution of a standard.
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