I guarantee my 19 year-old sister would look at me open-mouthed, frowning if I asked her if she knew what a fax machine was. The long form facsimile according to Wikipedia is, “…from the Latin fac simile or “make alike” and is a copy or reproduction of an old book, manuscript, map, art print, or other item of historical value that is as true to the original source as possible.” Of course in this tech-savvy age we are all digital creatures. In our personal and business lives we live, breathe and consume instant, digital and paperless communication. Even in Australia where the majority of the world’s perceptions are still based on Crocodile Dundee and of course The Simpsons episode when the family travels Down Under, we (naturalized) are surely some of the most advanced people on earth.
Strangely in my work career in the UK I can barely remember seeing a fax machine. So why in 2014 is a sizeable chunk of my business development, sales and communication in the healthcare industry purely by the humble fax or even at times “snail-mail”? The bigger picture gives us some insight into Australia’s attempts at digitizing health. I would even go as far to suggest it is a microcosm of the country’s unbelievable advances on one hand and painfully stunted evolution on the other. It is a world of paradoxes and contradictions. Which ironically makes it such a land of opportunity for budding entrepreneurs that even harness a manual, old school approach or are way ahead of their peers in space-age technology. NEHTA or The National E-Health Transition Authority begun the official mission to encourage patients to use eHealth in mid-2012 so that your GP or hospital you attended can access your medical history. They were and are responsible for controlling the PCEHR or Personally Controlled Electronic Health Record.
Having heard occasionally about their progress, last week their successes were highlighted in the media announcing they have now signed up over a third of public hospitals to the system. But what about General Practices and Medical Centres? On a personal level and knowing only a limited amount about the system, I am fully behind their broad goal. The Australian system, especially for temporary residents, naturally encourages you to seek quick, bulk-billing doctors, essentially the cheapest option. Again this is purely a generalisation and my experience. My health record in Australia is currently in several different medical centres and hospitals dotted around Sydney, on paper and saved to hard drives. Now I am married and living near our local GP in Sydney’s Northern suburbs I am finally getting some consistency and seeing my wife’s family GP. He is an incredible doctor that is also generous with his time and I have no issues with being privately billed.
I do have some catching up to do though and even emailed my former GP in the UK for my medical records but was told this not possible. In the UK this same GP has been my only family doctor for the whole of my first 25 years before I moved to Australia. I am certain I had multiple files, due to my comical medical history, and Dr S knew more about me than my mum did. But when I have spoke to Doctors, non-clinical health managers and even the general public at various healthcare conferences around Australia, the view is clear(ish); it is black or it is white. You embrace technology or you ignore it with disdain.
As I eluded to earlier my business experience is similar. Having worked in medical recruitment, specifically general practitioners but now working in the after hours primary care industry, I am seeing first hand the chasm in approach to technology. When visiting medical centres across metro and regional Sydney I have been stunned by some of the most advanced modern centres I have stepped foot in. Everything appears smooth and hums with efficiency, right down to the shiny glass doors and the electronic waiting screens and systems. On the other hand I have walked into people’s houses that have doubled as general practices and thought I was in my Grandmother’s house (which is extremely nice and cosy by the way). The desk is dwarfed by the swarming, yellowing paper files stacked high like a long forgotten library.
Working in after hours health currently we send patient reports electronically and securely to practices that opt in. However in the Sydney basin this accounts for approximately only around 30%. A similar number have websites, with the other 70% relying on fax and post for their communication. These particular Practice Manager’s trust the fax. It is a physical piece of paper that they can feel and file, no matter how faded or ineligible. Some have commented to me that it is the most reliable form of communication for them. Perhaps it may be if staff do not even check their practice email, if they have one, but surely all it takes is for the machine to run out of ink, toner, paper, break down or power off when the electricity is down. Even Medicare still ask for documentation from us by fax though they do now offer email. The potential ramifications of an important report or test not getting through certainly keep me speculating.
I still tell the story now to friends, colleagues and in business meetings that in my recruitment role just two years ago I called to send across a form that the practice could fill out and return with details of their GP vacancy. The pleasant lady on the phone asked that if I gave her an exact time I was sending the fax that she would sit by the phone and switch it’s function to fax, wait for the fax to come through and then switch it back to phone function again. There was also the time I asked our administration support to send out an important update fax by hand. This person had to type in fax numbers one by one to send the same communication to practices over and over again. When we moved to a new accounting model and billing system we proposed a quarterly billing cycle to email invoices, easier on everyone you would assume. If they did not have an email address then we were taking a step even further back by having to post these documents to them.
But it seems we are moving forward, at least my organisation is. E-fax is taking my world by storm. Crazy I know. But perhaps my excitement is premature. For example you still have to create the memo in Word, PDF the document, attach this PDF and email it to the specified number followed by typing “@wonderfulefax.com.au”. For the foreseeable I have conceded I will continue to be subject to the tug of war between the fax and its foes. Of course I prefer instant communication but I am a realist. Remarkably the fax machine was born before the telephone in 1843 (I assure you this is not a typo) and has outlasted VHS, Compact Discs and DVDs (with the advent of Blu-Ray). It’s a sure bet it will be singing it’s smug high-pitched tune for some time longer.
Disclaimer: Firstly this article is purely my personal experience and opinions, in no way can it be considered gospel or reflect on any employer’s views or actions. I can also make clear I am far from a health technology expert.