Across America, coronavirus test results arrive at the
public health departments by phone, email, post (!), and more commonly, fax.
Fax complies with the American privacy standards for health information. The
Austin city office receives 1000 faxes every day, many of them duplicate. Some are
sent to the wrong address. If sent through a server to a computer, the health
department prints the report for someone to manually enter it in a database
later.
Fax machines are so overwhelmed, they frequently run
out of paper. Office floors are overrun with paper. Washington State called 25
members of the National Guard (a military unit) to enter data manually.
Nationally, 80% of the results are missing demographic
information, and half don’t have addresses. The Trump administration has stated
that laboratories should report patients’ age, race, and ethnicity, but the
rules will come into force only August onwards. Laboratories should also
furnish patients’ address and phone number, but this is optional.
When reports come in duplicate, on the fax pages on
the floor, the department employees, if physically present, pick the pages up. Most
records come only with the patient’s name and birth date. With the address and
phone missing, employees start calling the provider or going through
directories.
The doctors, labs, and health authorities have
different systems; they don’t talk to one another. (Like one Apple charger not
fitting another Apple device.) Information is expected to move from the doctor
to the lab to the public health authority and back to the doctor. It doesn’t always.
Errors are possible when dealing with blurry printouts and analog data.
Many health offices get the necessary information about
a test result 11 days after the test. By which time the patient has managed to
infect hundreds. Health officials are advising people to assume they are positive,
since the faxing system makes the process nearly as long as quarantine itself.
The report has a beautiful quote from a Health
department director. “The data is moving slower than the disease.”
*****
In a 2017 interview, Barack Obama admitted this to be
the biggest failure of Obamacare. His administration had desperately tried to
get doctors to move from paper to digital, but couldn’t. $27 billion were
pumped in to improve the medical system buried under mountains of paperwork. A
special HITECH act was passed in 2009. Many American hospitals have some sort
of electronic medical system in place, but they can’t transfer the data to
another hospital outside their system. In countries like the UK or Canada, a
patient has a unique ID number, which makes aggregating data easier. In the
mid-1990s, the USA congress passed laws preventing the federal government from
creating new ID numbers.
*****
UK’s National Health Service (NHS) was, until two
years ago, the world’s largest buyer of fax machines. By the end of 2018, with
more than 11,000 machines in use, the health secretary said he was ashamed of
this backwardness. By sheer
chance, NHS was ordered to get rid of all fax correspondence and go
digital by 31 March 2020. In India, I don’t recall seeing a fax machine in the last
ten years.
*****
Before a national rollout of 5G, the USA may be better
off getting rid of their fax machines.
Ravi
Yes when we last in a hospital in A&E (not too serious), a nurse stood behind the doctor taking notes on paper. We then saw the Doctor entering this into a computer!!
ReplyDeleteI had seen a working fax machine in maybe 2007
ReplyDelete