Software for the finest computer – The Mind


Posted by Tim Bryce on March 11, 2013


– Why +830,000 physicians rely on this aging technology.

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As a small businessman, I haven’t had to use a fax machine in quite some time. Like most people these days, I rely primarily on e-mail. If I have a lengthy document, I convert it to a PDF file and attach it to the e-mail. Many years ago, we relied heavily on fax machines to communicate with customers overseas (and TWX machines before that), but in recent times we have little use for such devices. We keep a fax machine in the office for “just in case” situations, but we mostly leave it unplugged to avoid the many spam faxes still plaguing the public. I am also able to interface with other systems to upload/download data in a variety of file formats with Delimited ASCII being the most prevalent.

I recently visited my doctor for a routine checkup. We’ve known each other for years and I am always fascinated by the latest medical technology in his practice. His office consisted of a modest sized staff with the typical number and type of computers you would expect to support administrative needs. Interestingly, I noticed he had a fax machine which was slowly chugging away and spitting out voluminous reports. Frankly, I was surprised to see a fax machine being so actively used; certainly he transmitted/received data by e-mail or some other computer protocol I thought. Actually, No.

Although physicians have abundant computer software available to them for communication purposes, it is not as actively used as the fax machine which is the true work horse of their office. The doctor claimed his office received on the average 18,000 faxes each year. This does not include sending documents which is probably just as voluminous. Patient records, test results, prescriptions, hospital reports, etc. are all regularly sent by fax, and no other device. This means the data has to be re-keyed into the doctor’s computers by his staff. It doesn’t take a systems man like me to realize this is not an efficient or cost-effective approach for operating any office. Frankly, I was thunderstruck just how primitive the office systems were, and this was just one office. As I was to learn, most doctors operate in the same manner thereby representing a model of system dysfunctionality on a colossal scale.

A mandate from the federal government a few years ago requires doctors to digitize all of their medical records (see “Turning Everyone into Data Entry Clerks”). This means every medical institution in this country has been busy entering data about all of their patients, a herculean task which the medical community is currently embroiled in. To accomplish this, a variety of medical software packages have been introduced with little or no compatibility between them. This means your medical records with your General Practitioner cannot be read by another doctor, unless he happens to use the same medical records software, which would be a very remote coincidence. There are, of course, strict privacy issues concerning the exchange of patient records. Regardless, assuming consent is given by the patient, there is no easy way to electronically exchange data.

Blame for this incompatibility falls squarely on the shoulders of the federal government who has not devised a standard file format for exchanging data. They may have mandated all doctors digitize their patient records, but they never devised a means for exchanging data. This incompatibility issue is so glaring, you have to suspect it is premeditated.

Now consider the enormity of this problem; there are over 830,000 physicians in this country, all of which are busily digitizing patient records, none of which can be exchanged electronically with other doctors. So how do they communicate? You guessed it; by fax. It also means all of these doctors and their staffs have to work double-time to record patient data as transmitted by fax. Doesn’t make a lot of sense does it?

Let’s take it a step further, assuming my friend’s office annual workload of 18,000 faxes is an average, and considering there are over 830K doctors, this translates into over 15 trillion pieces of paper being printed each year by physicians alone (not counting hospitals). This isn’t exactly environmentally friendly, but certainly supports the bottom-line of paper companies.

This system snafu places a significant burden on doctors and inhibits their ability to practice medicine and care for their patients. Not surprising, a mutiny is in the offing. Tired of growing governmental bureaucracy, many physicians are opting to retire early or quit their practices outright, thereby creating a shortage of competent doctors.

My visit to my doctor’s office taught me a couple of things; first, the fax machine is the Achilles’ heel of any physician’s office, without it, the doctor is lost. Second, this need not be the case if the federal government would just devise some simple standards for data exchange. However, knowing the government, I do not think I’ll hold my breath. I’m quite confident doctors will go on killing trees for many years to come.

Keep the Faith!

Note: All trademarks both marked and unmarked belong to their respective companies.

Tim Bryce is a writer and the Managing Director of M&JB Investment Company (M&JB) of Palm Harbor, Florida and has over 30 years of experience in the management consulting field. He can be reached at

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Copyright © 2013 by Tim Bryce. All rights reserved.

NEXT UP:  POST OFFICE INEFFICIENCIES – How far behind is the USPS operating behind its competitors?

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  1. Tim Bryce said

    A U.V. of Largo, Florida wrote…

    “Typical of the government – mandate without thinking it through first.”


  2. Tim Bryce said

    A B.F. of Lubbock, Texas…

    “It is odd that the doctors have not gotten rid of the fax machine as much as possible, isn’t it?”


  3. Francis Dryden said

    The reason we “had” to use FAX transmission for as long as we did was because of the propensity of legal size paper use in Real Estate documents… when somebody woke up and put the forms into letter size… Duh!

    Could this simple bit of oversight be causing the demise of so many trees? lol


  4. Tim Bryce said

    A B.H. of Boulder, Colorado wrote…

    “Some things to consider….

    1. FAXes, by definition, are harder to “spoof” and to “hack” than email … thus, offering the doctor’s more “security” in exchanging information over email. Not impossible, just significantly harder. Spoofers and hackers go after “soft” targets, and typically avoid the really difficult ones.

    2. HIPPA, literally FORCES doctors to be paranoid about exchanging personal data about patients, including prescriptions. Would you want your prescription for a narcotic painkiller to somehow get into the wrong hands?

    3. There is NO commonly accepted encryption standard for the medical profession (or any other profession, for that matter…other than the military)

    4. As you note, there is no commonly accepted data interchange format or standard – as a result, there wouldn’t be a “Rosetta Stone” program that would be able to translate between the sundry formats into a common one.

    One thing I’’e noticed over the years …

    Next time you go to a dentist, take a moment to look over their patient record and billing forms. They are IDENTICAL from dentist’ office to office. The only differences will be in the dentist’s address and the insurance billing address on the top of the form. They use common codes for procedures, and the pictures and entries appear to be consistent across practices.

    On the other hand, check out the doctor’s offices. Every insurance company has their own billing codes, their own DRG’s (diagnostic related/reporting groups) they use to code their claim forms, and the forms are unique to every insurance company … no standardization across billing, itemization or whatever. Might be somehow related to how different medical schools teach different practices for taking notes and documenting the doctor’s actions.

    And, we wonder WHY health care costs are skyrocketing? I used to play racquetball with a doctor. He told me that every time they accepted a new insurance, there was always a new form to get paid, and they didn’t get paid to learn the new system…so it took their office people a while to learn how to properly code the billing statements so they could get paid, resulting in re-billing a number of times which is costly and inefficient, to say the least.

    FYI, about 10 years ago I had a medicated stent placed in my Right Coronary Artery. Now, to be sure, this is a marvel of modern medicine and technology. However, when the bill was presented to the insurance company from the hospital, there was an entry “Miscellaneous Hospital Expendables – $10,000.00”. Imagine my shock at that one. I mentioned to someone that if you were asking ME to pay that bill, you’d damned well better be prepared to tell me IN DETAIL what those “miscellaneous expendables” were that were so costly. I later found out, that was the cost of the stent. But, it was not just that little 1” long piece of metal mesh that they stuck in my artery, it was the delivery system that the doctor used when he poked into my femoral artery to snake that catheter up to the RCA and place the stent, the balloon (angioplasty) they used to fix it into place, and then the miracle device that left a dissolvable sponge on the inside of the artery and the outside when they removed the needle to make sure the artery didn’t bleed me out. Maybe that’s a fair price to pay for that device, but calling it a “Miscellaneous Hospital Expendable” is INEXCUSABLE.”


  5. Tim Bryce said

    A J.S. of Skidway Lake, Michigan wrote…

    “While the government could and should have implemented a standard universal software for efficient exchange of medical data, the experts at AHIMA are the ones who should be designing it and promoting it. AHIMA is the American Health Information Management Association, a group to which I belonged to for all the years of my professional employment. Registered Heath Information Administrators and Technicians specialize in organizing and managing patient and hospital medical information. We take an oath of confidentiality and are educated in designing forms, filing systems, databases, etc., conducting audits and studies.

    Leaving the task of organization to the government without oversight by professionals is just irresponsible. The government hasn’t done a stellar job with anything else. Can we really trust them with our health information?”


  6. nprc2012 said

    A P.M. of Palm Harbor, Florida wrote…

    “Of course, then what happens to patient confidentiality when a patient’s record is faxed to the wrong number, huh? Mistakes do and will continue to happen…”


  7. Tim Bryce said

    An H.S. of Florida wrote…

    “I have been following your internet postings for a few years,,I have never met you, but I started to read your articles years ago and signed on ,,,You know your business.”


  8. Phil said

    Apparently faxing is still alive and well – online faxing, if not the fax machine:


  9. […] me talk about system snafus in Doctor offices, both systems and their inordinate dependence on fax machines. Suffice it to say, doctor offices are perhaps the most barbaric from an administrative point of […]


  10. […] have discussed the changing medical culture in the past; see (1), (2), (3), (4), (5). Herein I want to describe an actual experience I was involved with recently. Let me […]



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