Australian healthcare is poised for the wide-scale replacement of the fax machine with secure messaging systems for patient information sharing, according to the Australian Digital Health Agency, with the final problems solved in successful proof of concept trials.

“We’re pretty much done now – we’ve got it working with HealthLink and Telstra. We’ve had all the testing done and it’s all working,” said ADHA acting CEO and COO Bettina McMahon.

For the last two years, the ADHA’s Secure Messaging Program has focused on finding a solution to allow healthcare providers to replace their oddly ubiquitous fax machines.

Replacing the outdated technology has been a focus for many health systems: the NHS currently has an Axe the Fax campaign that is growing in momentum, while the US Centres for Medicare and Medicaid Services Administrator Seema Verma in August called for American doctors' offices to be fax free zones by 2020.

An Adelaide GP has taken matters into his own hands by refusing to share patient information by fax.

Dr Oliver Frank’s practice letterhead says, “In the interests of providing quality care safely and efficiently, we have no paper records. Please do not send letters, documents or messages via fax”. Healthcare professionals are urged to instead communicate via secure messaging systems.
‘It’s not as if this is theoretical or happening in the future. GPs can stop most of their faxing right now with the software they already have on their computers. It’s just a matter of getting on with it,’ Frank told newsGP.

Secure digital messaging services are available from a number of vendors but interoperability issues and the lack of a universal format have seen most GPs, specialists and hospitals continue to send referrals and discharge summaries via fax.

The ADHA had originally insisted on a single messaging platform for all healthcare providers to use but McMahon said the agency had to change tack to accept a small number of formats when it became clear the initial idea wasn’t practical.

“It was a pragmatic approach that industry agreed to. Logically it doesn’t seem like the best approach but our experience had shown that it was going to be difficult to issue a single format at a national level. What it does mean is that we can move away from the fax machine.”

The ADHA partnered with industry to identify data sharing standards and formats that allow different clinical information systems and messaging platforms communicate effectively.

“It’s about choice. A GP practice can choose its own CIS, can choose its own messaging vendor. They won’t be forced into picking one or having to use all of them,” said McMahon.

In its trials with Telstra and HealthLink, ADHA has overcome two final hurdles to making different platforms interoperable: universal message formats and the ability to search multiple databases of healthcare providers.

“The industry has agreed to the same interpretations and allowed their systems to display messages in a number of formats: RTF, PDF, CDA, and HL7 version 2,” McMahon said.

[Read more: Victorian man dies alone after test results faxed to wrong number – coroner slams use of “antiquated” tech | UK’s Royal College of Surgeons calls out the NHS reliance on “archaic” fax machines]

Being able to find the details of a healthcare provider, say for a referral, was another major hurdle; different healthcare vendors maintain their own databases and a GP using a platform from one vendor often can’t find clinicians using a different one.

After discussions with messaging vendors, the agency decided the best solution was a distributed directory that would allow clinicians with one vendor to be able to search all databases.

“It’ll be seamless to the healthcare provider. They won’t see this in the background. They’ll just put out a search and it will be a distributed search and it will return the data for that healthcare provider, no matter which healthcare system they are in,” McMahon said.

Now that the problems have been solved, according to the McMahon, clinicians in the trials have been sending messages and completing searches using the distributed database in live environments without issue.

She said the next step was for clinical information system vendors to include the new code in upcoming production releases.

“As GPs or hospital systems upgrade, they’ll get the interoperable software that will allow for the distributed searches and will allow for the ability to view a message and send receive receipts in their chosen format – everything that clinicians have been asking for,” McMahon said.

“It’s not a silver bullet. It’s quite a long process but we think it’s the right one and one of choice. A GP practice can choose its own CIS, can choose its own messaging vendor. They won’t be forced into picking one or having to use all of them.”

The move to axe the fax in Australia is not only one of convenience, there are dangers inherent in relying on the old tech.

In May, the Victorian coroner criticised the medical profession's reliance on "antiquated and unreliable” faxes and called for national communication standards after a cancer patient’s test results were sent to the wrong number and he died alone in a hotel room.

The 58-year-old Hodgkin's lymphoma patient, Mettaloka Halwala, was found in his bed by hotel staff when they opened the door of his room on the morning of November 17, 2015.

The father of two had died from chemotherapy complications.

Four days earlier a PET scan at Melbourne’s Austin Hospital had showed signs of potentially fatal lung toxicity linked to Halwala's treatment but the results were faxed to the wrong number.

“It is difficult to understand why such an antiquated and unreliable means of communication persists at all in the medical profession,” Coroner Rosemary Carlin said in her inquest findings.




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