During my research for Health Attitude: Unraveling and Solving the Complexities of Healthcare, I discovered Coupon Chile, a website which lists valid coupon codes, voucher codes, and online discount deals. The company had done some research about fax machines and found there are 46.3 million of them around the world, 17.4 million in the United States. They estimated the total number of faxes sent each year is 16.9 billion, representing 853 miles high of paper, which equates to 2 million trees cut down every year.

The fax machine and the Internet have something in common. They both provide integration for incompatible data. Anybody with a fax machine can send anybody a fax and know the recipient will be able to read it or have it translated. The Internet’s World Wide Web allows anyone with a browser to be able to connect to any server and retrieve information, regardless of what kind of server contains the information. In effect the Web provides integration and removes any incompatibilities. If the Internet had arrived sooner, there would have been no need for fax machines, which have since seen a steady decline in usage throughout the business community, except in healthcare.

Jeff Tangney was the founder of Epocrates, a smartphone app which replaced the 3,250 page Physician Desk Reference, and is used by one million Epocrates subscribers. Jeff is now CEO of Doximity, a social media company networking service used by more than 50% of U.S. physicians. Tangney said, “Fax machines are the lingua franca of healthcare.” Faxing is ingrained in the workflow of physicians. When you call most healthcare providers, you will typically not hear, “Our website is…  or our email address is”. You will most certainly hear, “Our fax # is….”.  Tangney added, “It’s still an industry that runs by and large by the fax machine.” It is not that doctors like paper or faxes, but I believe many feel they are chained to the eco-system of which they are a part.

Healthcare is making slow progress toward paperless in some areas. For example, e-prescribing is improving patient safety and streamlining the process of getting a prescription from the doctor to medication in your hands. However, it doesn’t always work that way. Millions of prescriptions are handled by specialty pharmacies operated by all the major pharmacy companies. They handle medications needing refrigeration or some form of special preparation or handling. When a physician completes an online e-script to a specialty pharmacy, the e-script is converted to a fax. When the specialty pharmacy receives the fax, someone manually keys it into his or her system. It usually takes an extra day for an e-script to be filled in this manner, and the extra steps add cost to the fulfillment. When it comes to scheduling an appointment for a Covid-19 vaccination, many seniors are overwhelmed with the poor responsiveness or difficulty to use the available websites. While the healthcare industry is making some strides in adopting the Internet, it has a long way to go. Without the fax machine, healthcare would come to a screeching halt.

In some cases, even fax machines are deemed too progressive. I recently had a routine shingles vaccination. The provider sent me a Health Insurance Claim Form to send to my healthcare insurance payer. I asked to get the form by email. Cannot do. How about fax? No. Paper only. I called UnitedHealthcare, the largest health insurance provider in America, to ask where to send the form. Can I email it to you? No. Surely I can fax it to you? No. Paper only. “And don’t forget to include a receipt”. Called the provider again. Receipts can only be sent by USPS mail. From the day of vaccination to the day my reimbursement gets into my bank will likely be six months.

There are numerous reasons why our healthcare is so expensive compared to other countries, and one of them is not because the care is better. One of the reasons is the healthcare industry has been slow to adopt progressive information and communications technology to reduce waste through improved administration. One study projected the adoption of administrative standards for healthcare billing and payment would save $300 billion. (unnecessary tests and procedures is at least three times that). The other failure is the U.S. government has not demanded standards for healthcare information like we have with the Internet, banking, and railroad tracks. 

In his book, Faxed: The Rise and Fall of the Fax Machine, Jonathan Coopersmith, an associate history professor, whose speciality is the history of technology, likens the fax machine to the rise and fall of the Roman Empire. He said that the fax machine reached the mighty heights of the business machine world and then crashed spectacularly. There are two places you can find fax machines. One is in technology history museums. The other is in every healthcare provider’s office or in pharmacies.