Do we need to take a local axe to the fax?

It's just over two years ago now that the RACGP put its foot down on the continuing use of the fax in general practice, issuing a position paper calling for healthcare services and government agencies that communicate patient information with general practice to cut out the paper and move instead to secure electronic means.

The college had high hopes that this could happen in three years, what with alternative means such as secure messaging already a mature technology. But while progress has been made by the industry to achieve interoperability between secure messaging providers, the fax machines are still there, cranking out as much paper as ever.

So we took a liking to an article this week in one of the RACGP's publications about how some GPs simply aren't going to take it anymore. Adelaide GP Oliver Frank has decided to refuse to use the fax machine and is doing his utmost to make it harder for others to turn to it.

While we're aware of pockets of this sort of rebellion breaking out in other parts of the country, sometimes it seems they are a lone voice. And some GPs don't make it any easier for their colleagues: we've mentioned before the Victorian telepsychiatrist Richard Harvey, who subscribes to four different secure messaging services but can't get GPs to refer to him electronically.

New Zealand is way ahead of Australia in terms of axing the fax, with the Auckland DHBs pretty much only using secure messaging for referrals. Wellington is also moving in this direction.

In Australia there are some bright spots – Tasmania hopes to build a statewide eReferral network, Victoria has had an eReferrals project working through some of the obstacles facing the hospital sector, and some practices in Sydney are moving on to newer technology such as smart forms – but while this progress is good, it still doesn't solve the problem of specialist and allied health correspondence with GPs and vice versa.

And while NZ has its GP2GP system to electronically transfer entire patient medical records, in Australia that capability is a pipe dream.

Perhaps it is time to adopt what seems to be a successful campaign being run in the UK to rid the NHS of its fax machines. The grand old socialist lady was most embarrassed by an investigation mounted by the Royal College of Surgeons in July that showed it was one of the world's highest users of fax technology, with 9000 of the machines churning it out.

Last month, Leeds Teaching Hospital committed to binning almost all of its fax machines by January 1. It has got together with a public relations firm to launch an “axe the fax” campaign that seems to be catching on. Some of it is a bit naff, to use a Britishism, with NHS trusts asked to sign a pledge setting a goal date for axing the fax. There is also a dinky little animation that you can see here.

The campaign materials are all a bit silly but then again, so are fax machines. And naff or not, it seems to be working, with a number of healthcare organisations joining up. We wonder it it could take off here in the next year or so. That three-year goal set by the RACGP is getting closer and closer. Tick, tock.

That brings us to our poll question for the week: Would a local axe the fax campaign work?

Sign up to our weekend edition to vote or leave your thoughts below.

Our poll last week asked: Should the RACGP endorse software products? Absolutely not, say our readers. 89 per cent said no, and just 11 per cent said.

Tags: RACGP, secure messaging


0 # Dr Craig Hilton 2018-10-06 10:08
There's a lot of hot air talked about ditching fax machines. People are using faxes because they perform the job better than any other option currently front of them. How about looking at and logging the many ways a practice's fax machine is used, by how many different people, and then see if electronic communication is actually offering an improvement in all of those tasks. Ask the fax users what the disincentive is to using electronic. Speak with real people in the real world.
Dr Craig Hilton, Brighton Victoria.
0 # Chester Wilson 2018-10-08 22:37
I spend a lot of my time doing locum work.
Faxes are the lifeblood of communication, which may surprise you.
- Anyone can use a fax machine. They do not have to learn a new software package every place they go.
- They are simple, reliable and accurate.
- Nearly everywhere in this country I need to send information of a page or three has a fax machine.
- They are secure, as long as they are not one machine available to everyone, but even then with competent and honest staff there are no problems.
- I can be called out in the middle of the night, produce a letter about a patient, fax it to the retrieval team, fax it to the receiving hospital, and have the retrieval organised in reasonable time. Yes, I can send emails of varying security, but I have to chase up a scanner (not usually available in the middle of the night), sort out the programme to drive it and then email it provided the recipient has access at that time to email.
- With the regular fall-outs of the NBN and Telstra recently, faxes have been the only continuing form of urgent medical communication.
It is true that they have poor resolution, are only black and white, and if you have dishonest staff they may be able to access them (but they can access all sorts of other things too!).
Remove them, and you will make life a lot harder, and you may well reduce safety for patients.
Yours faithfully, Chester Wilson
0 # Dave Wain 2018-10-09 09:25
Hi Chester,

The NBN is the now biggest problem with faxing!
In case you were not aware, PSTN lines are being disconnected across the country and faxes are being forced onto NBN hybrids which don't work.
We have converted over only to be forced onto GoFax due to the high (>50%) failure rate of faxing over NBN.
IT Officer
0 # Chester Wilson 2018-10-10 17:50
Dave, you have my empathy about having working things pulled out from under your feet, and count this as a thoughtless fault in NBN. Having to go to ATA / GoFax / AutoPrint is great for getting grey hair!
Security: information in a tray: if the area is common but not public, you have lost nothing.
8 or 10 digits finding a destination regardless of all digits being correct? Huh? Yes, that's exactly how it is meant to work! Usually a mis-dial lets you know very quickly.
No problem learning new technologies. You may have noticed that the highest initial uptake of technology was by rural GPs. However, there is no one standard for transferring information currently done with faxes. If you have 10 people to send data to, you will have 5 or 6 different techniques to learn to send it all! And several require an annual subscription. Can you get a world-wide (or at least Australia-wide) protocol with consistent operation techniques for such things running in the near future?
All the best! Chester.
0 # Dave Wain 2018-10-09 09:21
I would be 100% for Axe the Fax.
Sure, faxes are the first choice because they are familiar. They have been around for decades and do require any learning to use.
Having been forced onto NBN and ditching ISDN/PSTN we have had to add an ATA to the fax machine ($$) and still have had so many transmission problems we have now been forced onto GoFax ($$) and AutoPrint ($$) just to replicate the fax functionality.
As for the security of faxes, how is patient information printed and laying on a tray in a common area secure? How is dialling 8 or 10 digits manually secure if it still finds a destination regardless of all digits being the correct ones?
GPs arguing against having to learn new technologies is a joke. They learned email, they learned MD/BP/CC/etc.
If it’s okay to learn to push a button to start your new Volvo instead of turning a key, then you can learn a new data transmission method too!
+1 # Ian Mcknight 2018-10-09 22:48
In the same way as "we're going completely paperless" was overly simplistic and unrealistic a few years ago, "Axe the Fax" is unachievable at the moment. Because general practice involves the interaction of so many different organisations from different parts of the health sector, we can only move to new methods when all of our communication partners have embraced the same ideas. Specialists and hospitals are the obvious examples, and for things to work properly, it can't just be some of them.
What we should be doing though is looking at every opportunity to move away from faxing. There is definite growth in electronic messaging, and it wouldn't be the worst thing if referrers started to favour those who use this method. Healthlink smartforms is another example of a product embedded in mainstream GP software that could be ideally tailored to hospital referral, (as has already bee done in 1 instance) There are many medical facilities that have all the software they need but choose to ignore the capability..... .......because interrupting reception to send a fax 20 times a day makes so much more sense.
I agree with most of what Dave said, although I might have put it more diplomatically (insert pause for irony!). Certainly claiming that faxes are secure is completely misguided, as is saying they are reliable. What they are is an accident or security breach waiting to happen.

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