Dr Anand Segar

I am from New Zealand. As a country our health care system is pretty good. Free, safe, world class. Our education and training is great and the infrastructure is pretty good too. I could be biased though :-)

NZ was quite forward with implication of health IT. Since 1992, we have had a fully fledged National Health Index (NHI) number, which is a unique patient identifier. You get one at birth or your first engagement with the health system. This little sucker follows you around your whole life. It makes patient management easy as a doctor as we are able to see major diagnoses which are record against your NHI from any hospital in the country.

I think the implementation of such a number worked and continues to work in NZ because of our predominately nationalised health system. Unlike the fragmentation in the US or even Australia, communication is relatively good in NZ and this works well for docs and patient safety. Lets not talk about the counters like a) referring to patients as numbers (we do not, the NHI is simply an identifier for records) and b) privacy (yes a valid concern but I believe outweighed by the benefits).

Private providers also use the same identifier and this really makes a doctors life easy accessing records for patients who consume health services from different providers.

That’s why reading a recent article on The New Zealand Herald really saddened me and forced me to reflect on why we still use the FAX MACHINE. Yes a fax machine…In a country supposedly progressive with health IT.

Titled Heart patient dies after fax mistake  it draws attention to the illegibility of a faxed referral. The article describes, with the usual media spin, how a patient died because a key test result was illegible. It was printed on a pink, yes pink, piece of paper and faxed, yes faxed. But because it was on pink paper no one could read it. If it was legible, the patient would have been seen immediately and had potentially life saving heart surgery.

Now, I am not familiar with the case and do not know where blame, if any, lies. Sure there are a million mitigating circumstances in cases like these which none of us are ever privy too. Nevertheless my question is why we still use a fax machine! 

Who really still uses a fax? It is not like emails are new. I understand the security and privacy issues associated with emailing sensitive data but a fax is just not kosher in the 21st century.

Hospitals do not just use faxes for receiving external referrals. As doctors we used them as internal referrals too. I remember countless times requesting radiology procedures and being told that the fax did not arrive or the line was busy or as in this case, it was illegible. 

A few hospitals around the country are moving to eReferrals and props goes to Hutt Valley DHB who are using this system well. An accountable and trackable referral system will cut down on simple errors which in the worst case can cost a life. Unnecessary death avoided!

At this point I would also like to congratulate North Shore Hospital for using online referrals for radiology services. This was great. As the requester you could follow the document flow from request to receipt to triage to execution and finally the result. Now the system was not without flaw but was a great step in the right direction and allowed me to satisfy my compulsive nature to avoid mistakes!

More integrated systems of hospital IT exist which empower physicians and nurses with the tools they need, when they need it.  No longer do we need to search for a terminal to find that it is off and will take 30mins to reboot as it is running Windows 3.2. Or even worse is being used by the med student to print out their assignment…

Just look at CSC Suite  or this at&t solution or this Apple Hospital case study. I have never used and do not endorse any but form a brief look all seem to provide what we need. Portability. Clean Interface. Security. Privacy. Accountability. In my first job as a doctor I tried to suggest this to one of the medical staff at the hospital but was swiftly dismissed. Hmmm..

Anyway, what I want to get across is that we do not need to use fax machines anymore. Arcahic technology promotes errors and generates cracks in our health system. No one uses fax machine. I just take a photo of any documents, personal of course, with CamScanner for iPhone and email it. That way I am sure it has been sent and there is a record. Peace of mind.

Hospitals can implement technological solutions to provide staff, both hospital and family practice, with the tools needed to deliver the best possible service to patients. In today’s world, this is a necessity rather than a luxury. We just need some forward thinking. We have done it before in NZ and can do it again! 

Let’s kill the hospital fax machine!