Digital technology has transformed healthcare. Patients can message providers and view test results through a patient portal, doctors can use their smartphones to dictate clinical notes, and nearly every hospital or clinic in the United States uses electronic health records. So why is faxing still common in medicine?

Medical records systems don’t speak to each other

One word captures the primary reason faxing is still common in medicine: interoperability. 

Interoperability means different computer or software systems can exchange and use information. It’s the big missing link in digital health. 

Think about it this way: there are hundreds of different electronic health record (EHR) vendors with their proprietary technology. Your primary care doctor might use Epic, which controls about 30% of the EHR market. But the dermatologist they referred you to keeps records in NextGen, used by just 5% of doctors. Each doctor is happy using their software, but there’s no way to send your medical records from one system to another. 

While no one planned to have medical records siloed this way, regulators could have avoided it. 

Between 2008 and 2015, the number of hospitals using electronic records grew from 9% to 83% in response to a federal incentives program rolled out by the Obama administration. But there weren’t requirements or incentives for private companies making EHR software to share patient records with other systems. 

Efforts are underway to align EHR data structures so that the leading software systems can speak to each other. But as companies vie for market share, they have little incentive to speed up this process. 

Paper is the clunky workaround

The result of siloed EHR systems is that providers and hospitals using EHRs often print and fax patient records, even though the receiving provider also uses an EHR.

According to recent research, around 70% of healthcare organizations still use faxes. Faxing continues, of course, at a time when 90% of office-based physicians and over 96% of hospitals keep digital medical records

At clinics where faxing is still common, doctors often find a stack of paper records on their desks at the beginning of each workday. These are patient records faxed from other practices, which they must manually enter into the EHR before each visit. 

Here’s how a hospitalist with Penn Medicine describes receiving faxed records: 

“Just last week, we received faxed medical records for a patient that made a stack two inches thick. It came in two or three different faxes because they ran out of paper halfway through, and it was all disorganized, and there were missing sheets. It was a mess.”

Considering this workflow, it’s no wonder physicians spend more time on documentation and paperwork than ever. 

Why is faxing still common?

The faxing workaround seems insane. But, in addition to competing EHR systems and poor interoperability, it continues for two reasons: 

  1. Everyone else does it
  2. HIPAA rules make email a risky strategy

The “everyone does it” effect is a powerful reason why healthcare keeps faxing. Doctors, pharmacists, and insurance companies all use fax. It’s a known workflow, it usually works, and there isn’t an easy alternative. It’s what everyone does, so everyone keeps doing it. 

But why hasn’t medicine, like every other industry, switched to email as the preferred way to send documents? 

The simple answer is HIPAA. Laws protecting patient privacy don’t prohibit emailing patient data, but they do require providers to “apply reasonable safeguards” when transmitting electronic personal health information. 

Reasonable safeguards include using encrypted email, only sending email internally (behind a firewall), or using access controls like password-protected documents. 

If that sounds like a big hassle, it is. And unless healthcare institutions make it very easy, most doctors would rather just send a fax.

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