Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Why does American medicine still run on fax machines?

vox.com

Post reply on HN
Print view View original

11–20 of 53 posts

Re: Why does American medicine still run on fax machines?

#11

Post by mcpherrinm »

interfixus wrote: post #9

> The clinic has digitized its own patient data. But its electronic system can’t connect with other clinics’ records. So when doctors want to retrieve records from another office — an ultrasound for a pregnant patient, for example — they have to turn to the fax Haven't these people at least heard of email?

They've heard of it, but aren't going to use it. Email is generally not encrypted when stored at rest in many hops along the way, which should be considered insecure.

While fax is unencrypted, it's generally not stored in any intermediate systems and has established history of being considered HIPAA compliant.

Re: Why does American medicine still run on fax machines?

#12

Post by flukus »

At least part of it is that no one has come up with a document format that suits everyone. Doctors want to scribble notes with a stylus but when you digitize that you don't really gain anything, other systems don't know how to interpret those scribbles. Suggesting doctors enter fields into a form instead of scribbling notes will get you no where, doctors are the stupidest and most stubborn smart people you will come across. Not that this is perfect anyway, sometimes you really do just need those random notes that don't really fit anywhere else. Some of the younger ones will type instead of scribble, but it's still mostly free form text and not data. The industry is still stuck on the idea that one doctor visit == one patient record as well, the thought that doctors could input blood pressure readings in their own section and have it display the history as a spreadsheet (or even a graph) has not gained any acceptance.

So it's not just about how we transfer information but how it's created as well, we haven't invented the right set of primitives to store it in the first place. I've spent a bit of time thinking about how I'd improve things and think things need to be more like emacs org mode or a jupyter notebook than any current EMRS, but even that might have to wait for a generation of scribblers to die.

Re: Why does American medicine still run on fax machines?

#13

Post by wutwutwutwut »

frik wrote: post #6

What should they use instead? Email isn't secure enough. Email got not forced TLS/GPG upgrade (compared to the web's HTTPS)

Create a protocol or API spec on top of HTTPS or something else and use it. I don't know where you ar at but surely the government can just say "hey guys support this secure protocol before 2022 or you're out".

I can log on and read any of my medical records at any time and the information is aggregated from multiple sources. What's the issue?

If you use fax you won't even be able to see some kind of central audit log for your data. That's pretty crazy.

Re: Why does American medicine still run on fax machines?

#14

Post by acchow »

mcpherrinm wrote: post #11
interfixus wrote: post #9

> The clinic has digitized its own patient data. But its electronic system can’t connect with other clinics’ records. So when doctors want to retrieve records from another office — an ultrasound for a pregnant patient, for example — they have to turn to the fax Haven't these people at least heard of email?

They've heard of it, but aren't going to use it. Email is generally not encrypted when stored at rest in many hops along the way, which should be considered insecure. While fax is unencrypted, it's generally not stored in any intermediate systems and has established history of being considered HIPAA compliant.

If email is encrypted, why does it matter that it is stored in any intermediary place along the way?

Re: Why does American medicine still run on fax machines?

#15

Post by mcpherrinm »

acchow wrote: post #14
mcpherrinm wrote: post #11

Earlier quoted context omitted.

They've heard of it, but aren't going to use it. Email is generally not encrypted when stored at rest in many hops along the way, which should be considered insecure. While fax is unencrypted, it's generally not stored in any intermediate systems and has established history of being considered HIPAA compliant.

If email is encrypted, why does it matter that it is stored in any intermediary place along the way?

I missed a negative. I've updated my comment.

Re: Why does American medicine still run on fax machines?

#16

Post by stmw »

frik wrote: post #6

What should they use instead? Email isn't secure enough. Email got not forced TLS/GPG upgrade (compared to the web's HTTPS)

It's a big and still-unsolved problem, but it's more than just TLS - need a proper set of APIs and platforms. We happen to be working on this, but it's not done yet... :-)

Re: Why does American medicine still run on fax machines?

#18

Post by interfixus »

mcpherrinm wrote: post #11
interfixus wrote: post #9

> The clinic has digitized its own patient data. But its electronic system can’t connect with other clinics’ records. So when doctors want to retrieve records from another office — an ultrasound for a pregnant patient, for example — they have to turn to the fax Haven't these people at least heard of email?

They've heard of it, but aren't going to use it. Email is generally not encrypted when stored at rest in many hops along the way, which should be considered insecure. While fax is unencrypted, it's generally not stored in any intermediate systems and has established history of being considered HIPAA compliant.

Security by presumed obscurity. We have a winner.

Re: Why does American medicine still run on fax machines?

#19

Post by rjbwork »

acchow wrote: post #14
mcpherrinm wrote: post #11

Earlier quoted context omitted.

They've heard of it, but aren't going to use it. Email is generally not encrypted when stored at rest in many hops along the way, which should be considered insecure. While fax is unencrypted, it's generally not stored in any intermediate systems and has established history of being considered HIPAA compliant.

If email is encrypted, why does it matter that it is stored in any intermediary place along the way?

Email actually generally isn't encrypted. Sure, you can do things like PGP encryption, but not even some of it's formerly strongest advocates bother anymore. Consider email open to anyone between you and the recipient.
Post reply on HN