this post was submitted on 14 Nov 2024
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I'll admit, I'm pretty frustrated right now lol. me and my doctor have been trying to submit a referral to a specialist but for the last several weeks, when i call them, they still haven't gotten it yet. they told me it's because they only have one fax machine so it refuses any incoming faxes if it's in the middle of printing a different one.

my problem is, why haven't we come up with a more modern and secure way of sending medical files?!?! am i crazy for thinking this is a super unprofessional and unnecessary barrier to care?

luckily I'm mobile enough to drive a physical copy to their location, but not everybody who needs to see this type of doctor can do that, nor should they have to.

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[–] Nemo@slrpnk.net 55 points 14 hours ago (2 children)

In the eyes of the law, a fax is a secure way to send personal information. An email, even an encrypted one, is not. We need to fix the law, but lawmakers as a rule do not understand technology.

[–] commandar@lemmy.world 63 points 13 hours ago* (last edited 13 hours ago) (2 children)

Speaking as someone who works directly in the field: this is just plain factually incorrect. Encrypted email is compliant with patient privacy regulations in the US.

The issue is entirely cultural. Faxes are embedded in many workflows across the industry and people are resistant to change in general. They use faxes because it's what they're used to. Faxes are worse in nearly every way than other regulatory-compliant means of communication outside of "this is what we're used to and already setup to do."

I am actively working on projects that involve taking fax machines away from clinicians and backend administrators. There are literally zero technical or regulatory hurdles; the difficulty is entirely political.

[–] stinerman@midwest.social 19 points 13 hours ago (1 children)

I work with healthcare software so I can echo most of what you're saying.

The thing is the lowest common denominator is a fax (usually a fax server that creates a PDF or TIFF of what comes over the wire), so that's what people go with. It's the interoperability between different systems that's the problem. There's no one standard...except for faxes.

[–] commandar@lemmy.world 8 points 12 hours ago* (last edited 12 hours ago) (3 children)

There’s no one standard…except for faxes.

HL7 and FHIR have been around for decades. Exchanging data is actually the easy part.

The problem is typically more on the business logic side of things. Good example is the fact that matching a patient to a particular record between facilities is a much harder problem than people realize because there are so many ways to implement patient identifiers differently and for whoever inputs a record to screw up entry. Another is the fact that sex/gender codes can be implemented wildly differently between facilities. Matching data between systems is the really hard part.

(I used to do HL7 integration, but have since moved more to the systems side of things).

[–] Bo7a@lemmy.ca 3 points 2 hours ago

I feel this - I'm often on the other end working with data from clinicians in the field for massive studies. The forms that come in can have an infinite number of possibilities just for noting sex. Enough so that our semantic layer needs a human reviewer because we keep finding new ways field clinicians have of noting this. Now imagine that over the whole gamut of identifiers.

tl:dr - Humans are almost always the problem in data harmonization.

[–] mesamunefire@lemmy.world 1 points 7 hours ago

EDI as well

[–] stinerman@midwest.social 3 points 10 hours ago (1 children)

I work in a particularly niche area (home infusion/home medical equipment) and while HL7 and FHIR are indeed things, practically no software that was built for those lines of business had any sort of module for that. We have a FHIR interface now and...no one uses it. They prefer faxes.

[–] commandar@lemmy.world 1 points 1 hour ago* (last edited 1 hour ago)

That's likely a peculiarity of the niche you're in. HL7/FIHR are the norm for enterprise-level systems. Hospitals couldn't function without it and at any given time we typically have multiple HL7 integration projects rolling just as a mid-size regional.

Definitely less defined in the small-practice and patient-side space. Though, like I said, the big problem there ends up being data normalization anyway.

[–] BearOfaTime@lemm.ee 6 points 12 hours ago* (last edited 12 hours ago) (1 children)

"embedded in many workflows"

Key statement right there.

And once people see what that really means, and what it would take to move past it (including time, cost, and risk), they may start to understand. You're dealing with it first hand, so you know what's involved.

It became the de facto way to send stuff with high confidence it went to the right place. Then tech addressed the paper-to-paper over one phone line issue with modem banks into a fax server. So all the same fundamental comm tech (so fully backwards-compatible), but a better solution for the company with that infrastructure. Such a company has little motivation to completely change to something new, since they'd have to retain this for anyone that hasn't switched. Chicken-and-egg problem, that's slowly moving forward.

It'll be a long time before it's gone completely. Perhaps in 20 years, but I suspect fax will still be around as a fallback/compatibility.

[–] commandar@lemmy.world 3 points 12 hours ago

Such a company has little motivation to completely change to something new, since they’d have to retain this for anyone that hasn’t switched.

They've had motivation since the HITECH Act passed in 2009. Medicare/Medicaid compensation is increasingly directly tied to real adoption of modern electronic records, availability, and interoperability. Most healthcare orgs rely heavily on Medicare/Medicaid revenue, so that's a big, big deal.

You’re dealing with it first hand, so you know what’s involved.

I do. Which is why I'm actively and aggressively removing fax machines from our environment. Efaxing (e.g., fax-to-email gateways) will stick around for back-compatibility purposes with outside organizations, but the overall industry trend is to do everything you can to minimize the footprint of fax machines because they've traditionally been used in ways that will cost the company serious revenue if they cause you to miss CMS measures.

[–] cheers_queers@lemm.ee 13 points 14 hours ago (3 children)

this makes no sense to me when patient portals exist. why isn't there a provider portal that can handle sending medical info back and forth? I can see all my medical details online already.

[–] Killn1@lemmy.world 1 points 29 minutes ago* (last edited 28 minutes ago)

m banks into a fax server. So all the same fundamental comm tech (so fully backwards-compatible), but a better solution for the company with that infrastructure. Such a company has little motivation to completely change to something new, since they’d have to retain this for anyone that hasn’t switched. Chicken-and-egg problem, that’s slowly moving forward.

Thats the thing. Most if not all insurance companies HAVE provider portals. They cannot get rid of fax until every mom and pop clinic, dentist office, and hospital use these portals.

Example of a Provider Portal: https://www.floridablue.com/providers https://healthy.kaiserpermanente.org/northern-california/community-providers/claims

[–] halcyoncmdr@lemmy.world 7 points 13 hours ago (1 children)

See, you're thinking 21st century, but this is both a healthcare management technology and a government regulation issue, so you're 2 centuries too new. We need to go back to 1843 with the electric printing telegraph, which used pendulums and electric signals to scan images and send them over telegraph wires. That's where healthcare technology regulations stopped.

[–] 4am@lemm.ee 3 points 12 hours ago* (last edited 12 hours ago) (2 children)

That is patently false. Encrypted email and patient portals are absolutely allowed under regulation.

What you have here is a practice that has probably been in operation since the 80s or before, and they refuse to change their ways.

[–] BearOfaTime@lemm.ee 4 points 12 hours ago

Well before.

And "refuse to change their ways" - are you going to underwrite the project to implement a transition and hold all the liability for the risks?

Its not like changing systems is just a click of a button, this is an extensive project, that you better get right or you're dealing with records going the wrong way, potentially having serious life and safety implications.

Plus, you have to maintain this legacy fax system because not everyone else has migrated to something new. So for the remainder of your career, it still doesn't go away, and you'll have to continue to pay for its maintenance.

Companies have systems they've built up over years, that works. They'll move forward as it makes fiscal sense.

[–] halcyoncmdr@lemmy.world 2 points 12 hours ago

I never claimed that email or patient portals weren't allowed.

[–] TORFdot0@lemmy.world 1 points 12 hours ago (1 children)

Providers have a market incentive to provide the most convenient experience to their patients. The market incentive does not exist for sending information to other providers so they will take the path of least resistance to be compliant with regulation

[–] cheers_queers@lemm.ee 2 points 12 hours ago (1 children)

read my post again. this is a provider that is probably losing business because people can't get their referral in to see them unless they walk it through the door themselves. how is that convenient?

[–] King_Bob_IV@startrek.website 1 points 11 hours ago

I have never seen a specialist without a giant wait-list. These providers tend to have too many patients so they have a negative incentive for trying to make it easier to reach them.

[–] Kolanaki@yiffit.net 17 points 14 hours ago (2 children)

Shit, they could just get a better fucking FAX machine that can put new incoming faxes into a queue. The last fax machine I used (like well over a decade ago) could at least do that.

[–] Brkdncr@lemmy.world 4 points 10 hours ago

You can even have multiple fax machines on the same phone number if you really need it.

[–] cheers_queers@lemm.ee 5 points 14 hours ago

no kidding! i have enough to deal with, without having to babysit a doctor's office that won't update their equipment.

[–] deranger@sh.itjust.works 12 points 14 hours ago (1 children)

Referrals are electronic for those running a modern EMR, like Epic. The systems exist, it’s up to both sides to implement them.

[–] cheers_queers@lemm.ee 2 points 14 hours ago

thank you, this is exactly the type of answers i was hoping for!

[–] Today@lemmy.world 6 points 14 hours ago

I have to fax docs a lot. Couple of years ago we started using stonefax so it's like an email. I wish the faxing was the worst part - most take 1-3 calls to the doc to get them sent back.

[–] finitebanjo@lemmy.world 3 points 14 hours ago (1 children)

Unfolding a Xerox copy faxed over a phone line wont infect your entire network.

Opening an email, tho...

[–] bjornsno@lemm.ee 7 points 13 hours ago (1 children)
[–] finitebanjo@lemmy.world 2 points 13 hours ago

Its not the fax over phone line that was compromised, its the internet connected printer. In fact, HP even has services where you email to your own printer in order to print.

[–] henfredemars@infosec.pub 1 points 14 hours ago (2 children)
[–] cheers_queers@lemm.ee 4 points 14 hours ago (4 children)

i understand HIPAA. i don't understand why we are still using the technology we started using in the 60s. my question is why haven't we found a better way since then?

[–] stinerman@midwest.social 1 points 10 hours ago

Plenty of people still use landlines. That tech is much older than faxes. Internal combustion engines have been around for about as long. There have been improvements, of course, but the basic idea of spark plugs igniting fuel, which pushes down a piston is quite old.

Like many things the 1960s tech is "good enough" and the government hasn't mandated a specific standard.

[–] droporain@lemmynsfw.com 3 points 13 hours ago

You can't even stop junk snail mail or end daylight savings time. Good luck.

[–] halcyoncmdr@lemmy.world 2 points 13 hours ago

The "modern" fax machine using telephone was invented in 1964 by Xerox, but technically the fax machine goes back to 1843. Bain patented the electric printing telegraph, which used pendulums and electric signals to scan images and send them over telegraph wires.

[–] tiredofsametab@fedia.io 2 points 14 hours ago

it's generally harder to fax to a wrong number, have that actually hit a fax machine, and have it print than to accidentally email the wrong person or something. There are things that could be implemented into certain systems to only send to certain addresses, etc., but that information also exists in multiple places that can be accessed as well. For a fax, the message exists on the sender's side (physical if any, machine memory possibly), receiver's side (same), and briefly on the wire. This is opposed to hard drive, cloud, etc. where it is always vulnerable.

[–] aramis87@fedia.io 0 points 12 hours ago

Can you pick it up and deliver it to the new office in person?