Dr. Aris is currently locked in a silent, high-stakes staring contest with a beige plastic box that looks like it was salvaged from a 1984 office supply liquidation sale. The machine is emitting a sound that I can only describe as a digital seizure-a series of high-pitched shrieks and grinding gears that suggest a piece of paper is being violently digested. He looks at me, a man who has spent 14 years mastering the complexities of the human brain, and he simply shrugs. He can’t see my MRI. Why? Because the imaging center across town hasn’t faxed it over yet, and their machine is currently out of toner.
It is a moment of profound, systemic absurdity that I’ve spent the last 24 minutes rehearsing a conversation about in my head, imagining all the witty, scathing things I would say to the administrative staff about the irony of practicing 21st-century medicine with 19th-century hardware.
The Helplessness Index
There is a specific kind of helplessness that comes with being told your health is on hold due to a ‘handshake error’ between two pieces of equipment that should have been in a museum 34 years ago.
We live in an era where I can stream a 4K video of a cat in Tokyo from a moving train in Montana, yet my neurological data is trapped in a copper wire bottleneck. The fax machine has become the ultimate survivor, a stickroach of the telecommunications world that refuses to die, primarily because the medical industry has collectively decided that physical paper moving through a phone line is the only truly ‘secure’ way to handle our most sensitive secrets. It’s a convenient lie, a shield made of regulatory inertia that protects large organizations from the terrifying task of actually updating their infrastructure.
THE ANALOG BARRIER
The Fragility of Old Instruments
While this was happening, I couldn’t help but think of Claire T.J., my piano tuner. I had seen her just 4 days earlier. Claire is the kind of person who sees the world in vibrations and tensions. She’s been tuning for 24 years, and she treats my upright piano with a reverence that borders on the religious.
As she worked on the middle C, she told me that the most common mistake people make is assuming that because an instrument is old, it’s durable. ‘It’s the opposite,’ she said, her voice muffled by the soundboard. ‘Old things are fragile because they’ve forgotten how to adapt to the climate. They’re stuck in the air of the room they were built in.’
She was talking about the mahogany and the felt, but sitting in that sterile exam room, I realized she was actually describing the American healthcare system. It’s an instrument that hasn’t been tuned in 54 years, and we’re all just trying to play a melody on strings that are ready to snap.
[Regulatory compliance often becomes a shield for organizational inertia]
Security Theater of the Highest Order
The paradox is that the fax machine is seen as a bastion of privacy, despite the fact that a faxed document often sits in a communal tray in a hallway where 114 different people can walk by and read your cholesterol levels or your psychiatric evaluations.
It’s a cognitive dissonance that costs lives, or at the very least, costs us 234 hours of our lives every year spent sitting in waiting rooms while someone looks for a lost piece of thermal paper.
I once worked in an office where we had 4 different fax machines, and not once in the 14 months I was there did anyone verify who was on the other end of the line before hitting ‘send.’ We just trusted the number on the sticky note. Yet, if I suggest a secure, encrypted cloud-based transfer, I am met with a wall of HIPAA-induced panic. It’s as if the industry believes that hackers are incapable of intercepting a phone signal, but are masters of breaking through 256-bit encryption.
The Failure of Transfer
Diagnostic Center
Treatment Facility
I remember one specific instance where a friend of mine needed a prescription for a rare condition. The pharmacy needed a prior authorization from the doctor. The doctor sent it. The pharmacy didn’t get it. The doctor sent it again. The pharmacy said the line was busy. This went on for 14 days. 14 days of a human being’s health hanging in the balance because two machines couldn’t agree on a protocol. This is where the model breaks down.
This is precisely why the model at eye doctor queens is so disruptive without even trying to be-by simply existing as a centralized hub where the person taking the image and the person reading the image are under the same roof, the need for the beige box of doom evaporates. You don’t have to fax a document to the room next door.
The Staggering Number: 74%
The friction of the ‘transfer’ is where the errors live. I read a study recently that claimed 74% of medical errors occur during transitions of care. That’s a staggering number. It means the danger isn’t necessarily the surgery or the diagnosis itself, but the ‘hand-off.’ In the world of the fax machine, that hand-off is a blind toss into a dark room.
The cost of relying on analog hand-offs.
We’ve become so accustomed to this friction that we don’t even see it as a problem anymore; we see it as a fact of nature, like gravity or taxes. We accept that it will take 4 weeks for a referral to clear, not because the doctor is busy, but because the paperwork has to move through a series of analog checkpoints.
The Sound of Sympathy
Claire T.J. finished tuning my piano by the time I got home from that neurologist appointment. She hit a final chord, a lush, resonant G-major that seemed to vibrate through the floorboards for at least 14 seconds.
‘There,’ she said, packing up her levers and mutes. ‘Now it’s talking to itself again.’ When a piano is in tune, the strings vibrate in sympathy with each other. If you hit one note, the others hum along in support. It’s a unified system.
That’s what’s missing in my doctor’s office. There is no sympathy between the machines. The MRI scanner doesn’t know the fax machine exists, and the fax machine is too busy screaming at the phone line to care about the patient. It’s a collection of isolated islands, and we’re the ones drowning in the channels between them.
The Tuesday Morning Collapse
I often wonder what would happen if we just turned them all off. If every fax machine in every clinic in the country suddenly developed a terminal mechanical failure at 4:04 PM on a Tuesday. Would the system collapse? Or would we finally be forced to adopt the technology that literally every other industry has used since the year 2004?
The comfort of the tangible confirmation page.
The Price of Easy Apologies
We tend to blame ‘the system,’ but the system is just a collection of choices made by people who are tired and overworked and afraid of being sued. It’s easier to keep the 1984 Brother IntelliFAX plugged in than it is to overhaul the entire IT department and retrain 144 staff members. It’s easier to apologize for a delay than it is to innovate.
Expectation vs. Reality
We expect precision from our surgeons; why don’t we expect the same precision from their communication tools? I spent $474 on that MRI, and the idea that its value is currently being held hostage by a machine that requires a physical dial-up connection is enough to make me want to take up piano tuning myself. At least there, the problems are honest. If a string breaks, you replace it. You don’t pretend the silence is part of the music.
But every time a doctor shruggingly tells a patient that the ‘fax hasn’t come through yet,’ a little bit of the trust in that relationship erodes.
Running on an Analog Heartbeat
In the end, the neurologist did get my results. They arrived at 5:44 PM, long after I had left the office and gone home to listen to Claire T.J. finish her work. The results were fine, which is the part of the story where I’m supposed to feel relieved. But instead, I just felt exhausted. I felt the weight of those 44 minutes of waiting, multiplied by the millions of patients who are doing the same thing every single day.
We have mapped the human genome, but we can’t seem to figure out how to send a PDF from one side of the street to the other without that screeching beige box.
