There’s a growing push in Australia’s medical circles to do away with antiquated fax machines amid concerns the country’s medical referral and documentation system is outdated.
This week, the ABC reported on concerns around overcharging by specialists, and costly inefficiencies in the patient referral system.
Now there’s a call to move away from paper-based print and pdf documents in general.
Within days, the federal government is expected to introduce new legislation to force pathology and radiology companies to upload results in real time to individual My Health Record accounts or risk losing their Medicare payments and having to pay fines.
Prior to 2022 only about half of pathology reports and just one in five diagnostic imaging reports were being shared to My Health Record.
Health Minister Mark Butler said the digital record was also being updated to avoid being a “shoebox of pdfs”.
It was first created in 2012 but Mr Butler said over time a lack of investment meant it failed to keep pace with changing technologies.
“My Health Record is now old technology,” he said.
Samantha Prime co-authored a 2020 report by the Deeble Institute for Health Policy on Australia’s referral system and said it dated back to 1970.
She said the original 12-month expiry date on referral letters was established so that patients had to return to their GP each year and the GP could keep oversight of their patient’s care.
“That logic doesn’t necessarily prevail in contemporary healthcare, where we have digital solutions that enable the transfer of medical records between healthcare providers,” she said.
The Deeble Institute report called for an independent, evidence-based review.
Technology to help axe the fax
The Deeble Institute report also recommended the introduction of platforms for secure messaging and digital referrals rather than an over-reliance on fax machines.
Ms Prime said the medical profession’s continued reliance on faxed referrals was “absurd” and not secure.
“We just need to do away with fax machines, because they’re not safe,” she said.
“It’s just not contemporary healthcare. And really there’s no justification for keeping it as part of our healthcare ecosystem.”
Dr Rob Hosking is a Victorian GP who chairs the Royal Australian College of GP’s expert committee on practice technology.
He said faxes were still used because hospitals and specialists had been slow to adopt new technology.
“A lot of organisations are stuck in their ways or haven’t done the investment in electronic systems available,” he said.
“Quite often its hospitals, big state-run hospitals, they refuse to accept anything that’s not a fax.”
In 2023, Sydney Children’s Hospital Network committed to “axe the fax” and moved to digital referrals, noting more than 80 per cent of referrals to hospitals were still sent via fax, post or hand delivered.
Seven NSW health districts have also been moved over to a new electronic referral program between GPs and hospitals using the HealthLink program.
In the UK fax machines were banned from its National Health Service hospitals in 2020.
Hospitals, GPs and My Health Record need to talk to each other
Dr Hosking said a revamped My Health Record would improve information sharing but progress was slow.
There are now 24 million My Health Record accounts in Australia and an estimated 90 per cent of Australians have a record.
Nearly all GPs (99 per cent), hospitals (97 per cent) and pharmacies (99 per cent) have signed up to connect to the system but uptake remains far lower among specialists (59 per cent) and aged care providers (42 per cent).
The federal government has committed $1.1 billion over four years on digital health initiatives including updating the system which includes a personal record of every Australian who hasn’t opted out.
The first step includes a national standard for information exchange which is now being built into GP systems, specialist software, hospital systems and My Health Record.
States like NSW are also moving towards a single patient hospital record statewide.
“Queensland is very far advanced and NSW are a lot further advanced than Victoria. Some states have put more effort into it than others,” Dr Hosking said.
“The systems are catching up but it does need ongoing investment – you have to train admin and medical staff how to use these systems.”
A key problem is the commercial products sold to GPs for encrypted communications are incompatible with each other.
Dr Hosking said it was up to state governments to make sure hospital computer systems could speak to GP systems when they put out tenders for new computer programs.
“A lot of our problems in this area are due to our federated system — where state and federal government are responsible for different parts of the system.”