[rubatuga]

People need to stop hating on fax. Hospitals still use fax because it is a much more punishable crime to tap phone lines which requires physical access, as opposed to a server that could be infected from a hacker halfway across the world.

[keithnz]

Fax is odd, it was a fantastic thing when it first came about, and it has some desirable properties.

- It's direct point to point communication (over a network)

- The transport network is dedicated and not open to anyone and covered by quite strong laws in many countries

- It's easy to see the history of communications

- It's easy to see if the other end successfully received something

- It's relatively standardized and ubiquitous ( in health )

Email would be the closest thing, but it doesn't have all the advantages, and the extra add ons that would make it better (like encryption, delivery receipt, digital signatures) are not standardized and/or ubiquitous ( and often hotly argued about )

So fax is the lowest common denominator, that, if it was proposed today, would not be accepted for many of its disadvantages, but it's now hard to find a way to replace it.

[gruez]

>- The transport network is dedicated and not open to anyone and covered by quite strong laws in many countries

is it? what if the hospital is using a VOIP solution?

[dredmorbius]

...when it first came about...

[analog31]

- It's easy to see if the other end successfully received something

I think this is a biggie. It means your workflow doesn't need to include going back later and checking to see if your document was received, and then trying to send it some different way. You don't have to guess which way the recipient is capable of receiving a message.

It's the original e-mail. ;-)

[XaspR8d]

Except seeing it was digitally received is often quite insufficient to seeing it was received by a human it was intended for. All too often in dealing with healthcare and gov't orgs our faxes get lost with no way of identifying where they went. Presumably it is a mismanaged shared fax inbox where individuals are not actually being alerted to their messages...

[keithnz]

somewhat ironically, the fax will be captured in digital form, some "middle" person will read it, then work out who it is for, then email it to those concerned / attach it to a patient record.

[DEADBEEFC0FFEE]

No quite, many fax system are just modems, image conversion to pdf, email. Plenty to go wrong. Paper faxes might be revived by the machine by you have no idea who read it, or who didnt. Fax machine are typically MFP devices, so now you may have some part of a medical record on your photocopier HDD.

Many fax machine can be programmed over the wire, so maybe you have default pins and now your faxes are being forwarded and you don't know.

[EamonnMR]

> It's easy to see if the other end successfully received something

This was not the case when I worked in healthcare. It was a constant back and fourth of "did you receive it?" over the phone.

[ses1984]

Some points seem contradictory. How do faxes have history that's easy to see, and if the other end successfully received, but it doesn't have delivery receipt like email?

[keithnz]

not sure I'm understanding? But fax sends data via a protocol, it knows it has sent by virtue of the protocol completing. The fax can keep trying sending and it will keep track of those faxs that have gone through vs those that haven't. Email doesn't have delivery receipts....it's either done by bolting it on in clients or various hacks used by spamme....errr..email marketing systems.

[ses1984]

Just because you get a receipt from the protocol doesn't mean it made it from the fax machine to the intended recipient. Folks who send faxes still regularly follow up with calls and emails, "just sent the fax did you get it?" and the answer is often "no, what fax?"

[kungito]

All these issues could easily be resolved on the internet if someone bothered a bit. Keep a whitelist of connections, private-public key communication (you can exchange keys off internet if needed), receive and read confirmation etc. It's not internet's fault that some idiot is storing passwords in plaintext and/or sending them over unencrypted connections

[TuringNYC]

I see you point in theory, but as a victim of identity theft, from what I can see almost none of these are enforced punishments. From what I experienced and from what I've seen friends experience in the US: - Someone can steal money in your bank account - Sign up for an expensive phone plan and get a $1000 iPhone upfront - Use your healthcare benefits

And you basically file a police report, hardly anyone cares, and you are left with a bunch of paperwork to go fix it yourself. You get the money back eventually with plenty of paperwork.

At which point do thieves committing all sorts of punishable crimes actually get punished? In my case, the person signed up for a line of credit at Lowes, purchased 20k of construction goods, presumable all in a videotaped store and got off scott free.

[pabs3]

Fax machines are just as insecure as that server. Last year taking over a network using just a fax number was demonstrated:

https://research.checkpoint.com/sending-fax-back-to-the-dark...

[roywiggins]

And because it's explicitly grandfathered in to HIPAA as a "secure" method of transmitting patient data.

Also, fax machines are very often just as internet connected as anything else. Email to fax, fax to email, fax-over-IP, it's not just modems dialing each other on copper anymore.

[jahewson]

I’m willing to bet that most digital PBXs out there could be infected by a hacker from halfway across the world too.

[pixl97]

Saw that happen yesterday. A vendor had insecure remote access setup to an older NEC PBX. Someone attacked it and was making international calls with it.

[pretendgeneer]

No Hospitals use fax because it's too hard to change, most information traveling through fax is sent via automated fax servers so it is the worst of both worlds, hack-able server and unencrypted transmission protocol.

[msla]

> Hospitals still use fax because it is a much more punishable crime to tap phone lines which requires physical access

Punishable, sure, but that's CYA thinking. It's less secure, because there's no way to encrypt fax like you can encrypt email. Punishment doesn't help anyone except the CEOs, unless, of course, it was the CEO's information that got leaked.

Also, yes, phone calls are sent over the Internet just like emails. The big difference is, yes, that phone audio isn't encrypted.

[EamonnMR]

Hospitals use fax because A) they think it's secure (it's not) and B) they think it's easier (it isn't)

[DEADBEEFC0FFEE]

That is not why they use them. Doctors like scribbling, and hate being told what to do, that's why.

[AzzieElbab]

it has nothing to do with security. Nurses like fax machines because it gets them a break. I've seen them print e-refferals just to fax to each other.

[HeWhoLurksLate]

That's not even the same thing.

People mess around with just about anything they can get their hands on- so what if the nurses send messages to each other and have fun? I'd be willing to give the people who take care of me a ream of paper if it meant they were in a good mood.

[AzzieElbab]

It has nothing to do with fun or messing around. It is about people being incentivized to avoid the tooling. I worked in US and Canadian health IT, my perspective is completely different from patient's. This may not have huge impact in high-end American hospitals, but in Canada where hospitals are underfunded and drowning in beuracracy it is a disaster