In 2009, President Obama and the Congress signed into law the HITECH Act as part of the federal Recovery Act. HITECH provides up to $44 billion in federal incentive payments for hospitals and doctors to adopt and use health information technology. It also established future Medicare reimbursement penalties for those who chose not to.
By most accounts, the HITECH Act has had historic impact on our health care delivery system: At record numbers, doctors and hospitals are making the switch to electronic medical record (EMR) systems. At last measure, 72 percent of office-based physicians had adopted an EMR system and 85 percent of hospitals were using EMRs -- up from only nominal use a few years before.
Skeptics argue that EMR systems are ill-organized, technologically unsophisticated, and cumbersome -- and as a clinician who has used four different systems in my short career, I agree with all of these criticisms. The usability of most EMR systems leaves much to be desired, and many presently do little more than convert paper-based documentation into electronic format. Nonetheless, I remain optimistic about health information technology to improve quality, reduce cost, and reduce waste in health care.
As they evolve, EMR systems will enable physicians to more closely monitor their patients' care and also to measure, audit, and improve quality of care. As our health care system focuses more on managing population health, EMRs will be a foundational capability for identifying gaps in care -- and helping patients address them. Truly, the possibilities created by health information technology are endless.
That said, in the immediate term, I have a far less ambitious goal for information technology in health care:
Let's retire the fax machine.
The health care industry continues to use fax machines to: transmit prescriptions to pharmacies, share notes across doctor's offices and facilities, process and adjudicate claims and billing information, transmit radiology and pathology results, and register new patients. The fax is the dominant technology we use to transmit sacred, sensitive health information across settings.
It's time that we start thinking about mothballing it for good.
First, fax machines are fine for transmitting information, but there is nothing that makes that information immediately usable or actionable. Important data are lost among stacks of less important information. Paper is subject to the vagaries of whether the right piece of paper is delivered to the right person at the right time. Faxes are easily lost -- without so much as a trace; when important data are being transmitted, it necessitates hours of time-consuming follow-up and confirmation. Faxes are not searchable documents. Every clinician knows of a clinical error in which a fax machine was a central protagonist.
Second, there is nothing private or secure about fax as a format. In most settings, fax machines sit open and accessible to a wide range of individuals. Any expectation of privacy and security of health information is suspended because stacks and stacks of one's personal health information can often be left unattended in a fax machine's receiving tray. If we really want to get serious about health information privacy, the fax machine -- not the EMR -- is public enemy #1, #2, and #3.
Third, and most important, fax machines employ an optical format that makes the analysis or use of the information transmitted difficult. Health information is powerful when it exists in a usable format that enables queries. Fax-based data -- which is merely just a picture of a document and not a usable data file -- provide no such capabilities.
What do we need in place of the fax machine? In short, an interoperable nationwide health care internet. The good news is that the pieces of this health care internet already exist.
As part of the HITECH Act, the federal government has invested heavily in the Blue Button initiative and the Nationwide Health Information Network (NwHIN) -- a set of standards, services, and policies that enable the secure exchange of health information over the Internet. The NwHIN's DIRECT project provides a simple, secure, scalable, standards-based way to send authenticated, encrypted health information directly to known, trusted recipients. Hundreds of health care organizations are already beginning to use the DIRECT standards to exchange health information.
The bad news is that adoption of these standards has not kept up with the need. Even as the technology and standards to securely transmit information have blossomed, adoption of these technologies -- which will require important workflow changes -- has remained slow. Why? In short, inertia. As we all know, sometimes it's comfortable to keep doing things as we always have -- even when we know a better way exists.
That's why I am proposing a simple New Year's resolution for the whole of the health care industry: physicians, hospitals, health plans, governments, home health care agencies, pharmacies, pharmaceutical and device manufacturers, clinical research organizations -- no sector should be excluded.
By Jan. 1, 2015, we should commit to retiring the fax machine from health care -- with a good, long, warm sendoff. Like with any resolution, this one won't come without its hiccups and challenges -- moments of failure and doubt that test our resolve. Nonetheless, the juice is worth the squeeze.
Health care needs to put the fax machine to rest. For good. And for the good of patients.
Disclaimer: The views in this piece solely reflect the opinions of the author and none of the institutions with which he is affiliated.
Sachin H. Jain, MD, MBA (@sacjai) is Chief Medical Information and Innovation Officer at Merck; Attending Physician at the Boston VA Medical Center; Lecturer in Health Care Policy at Harvard Medical School; and Co-Editor-in-Chief of Health Care: The Journal of Delivery Science and Innovation.
The Merck | Heritage Provider Network Innovation Challenge is currently underway. It's a first-of-a-kind collaboration between a pharmaceutical company and an Accountable Care Organization, created to help crowdsource the very best solutions for managing the problems of people with chronic disease. The winner will be announced at The Healthcare Experience Refactored in Brooklyn, New York May 13th - 14th. Learn more about the teams by visiting The Merck | Heritage Provider Network Innovation Challenge.
This blog series is produced in partnership with Health Data Challenges, creators of The Health Data Challenge Series, a formal initiative of the Health Data Consortium, powered by Luminary Labs. The platform seeks to foster the use of data to drive innovation that will ultimately transform health and healthcare through high-stakes innovation challenges. Learn more at www.healthdatachallenges.com.
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