Rage Against The NHS Fax Machine

fax-amarys

So I haven’t posted on this blog in a while, largely due to recently getting my first full-time position in a year as a Specialty Trainee in Critical Care i.e. the path to becoming a consultant in Intensive Care Medicine (yay!). Also, there’s been a lot of depressing Brexit chat to avoid.

This post is just me complaining about a relatively minor but still important thing.

I hate fax machines

To become a critical care trainee, you need a background in internal medicine, emergency medicine or anaesthetics. It’s all very complicated but because my background is anaesthetics, I don’t have the requisite competencies in medicine. This August, I started work on an acute medical unit doing acute medicine, a specialty I’ve not been involved with for three years.

One of the frustrating things about working in acute medicine is drug histories. Trying to determine what drugs a patient is on is difficult if they don’t bring a prescription or their medications with them. Trust me, no doctor knows what “the little blue pill” is unless they’re science-fiction fans and you happen to be Neo from The Matrix.

As such, during the day if you’re seeing a patient, you’ll often have to phone their GP’s surgery (though now some trusts have a centralised record system). If the list of drugs is long, rather than bother a GP, secretaries will often just send you the list.

However, they always, always insist on fax. I had to organise this for the first time in a long time a couple of weeks ago; fax is bad for a number of reasons.

Why not just use email?

Evidently, confidentiality is an issue in healthcare. Clearly, you shouldn’t send confidential information via Facebook chat. However, we have trust NHS email addresses. These end .nhs.uk and generally have the initialisation of the trust ie Leeds Teaching Hospitals use @lth.nhs.uk, Nottingham University Hospitals @nuh.nhs.uk etc. These are given to staff when they start at a particular trust and deleted when their contract ends.

It’s generally considered safe to send confidential information via email within the trust using this system (though nobody has actually confirmed this with me). However, for sending information outside of the trust, you need an NHSmail email address. These end @nhs.net and are personal ie they go with you as long as you work within the NHS.

At least, that’s my understanding. A few days ago, I tweeted NHS England and received a response from @grant_me who according to his bio is an “IT Professional working in NHS Primary Care”. That’s the best I’ve got to go on after not really trying very hard.

Given the lack of clarity about this, secretaries stick to the tried and trusted method of fax.

What’s wrong with fax?

1. It’s really annoying

I don’t use fax machines because it’s not 1992. I’m not particularly technophobic, I like my smartphone. However, I’ve used a fax machine about twice in my entire life.

Whenever a doctor needs to use the fax machine, we find a friendly ward clerk or secretary and look forlorn at them until they realise we’re not going away until they send the fax. I can be very good at looking forlorn.

(NB: any medical students reading this: make friends with the secretaries. I’ve seen them ignore a surgeon they didn’t like who asked for a form, saying they didn’t know where it was. They then found the exact same form for me 10 minutes later, and sent it for me because I’m all sweetness and light.)

2. It’s hilariously unsecure

I rang the GP. I explained I was a doctor at the local hospital on the acute medical unit. I gave my name and – after them insisting they wouldn’t send it to an email address – faxed me a copy after I eventually found out the fax number.

I could have been any muppet who bought a fax machine. There was no security or check to see if had gone to the right machine. No check to see I was actually a doctor. Literally, you could ring up a GP and do this yourself if you have a fax machine (but don’t because you’ll go to jail).

3. It can be incredibly complicated

At the hospital I work at, to make a referral to the anticoagulation clinic on discharge, you have to fill out a form, fax it to the clinic then ring them to make sure they’ve received the fax. This means that if you discharge a patient at 6pm, after the clinic has closed, you can’t ensure a referral unless you’re in the next working day.

There’s no guarantee you’re going to be in. The patient will have gone home. If it’s a Friday and you’re on nights the next week, it means you may not be able to check for about 10 days at which point, the patient hasn’t got their anticoagulation appointment and they’re at risk of stroke or blood clots or being struck by lightning. OK, anticoagulation does not decrease lightning strike risk but it is important.

Communication within the NHS

This is generally bad, particularly because we deal with a lot of sensitive data. I have worked in hospitals where non-urgent referrals were done by an A6 piece of card to the secretary of the relevant specialty. Like they never got lost. Some services ask for fax (like anticoagluation). Some are on the hospital intranet. Some are Word forms filled out and sent via email. Some are via an online request system. And don’t get me started on the bleep system (something for another time I feel).

I worked with a cardiology team who set up an email address at the trust that was “cardiology@trust.nhs.uk” to replace the aforementioned card system. They went from seeing something like 60-70% of their referrals within 24 hours to seeing 100% of their referrals by the end of the next day, and 100% within the same day if the referral was sent by email.

Firstly, given NHSmail exists, all NHS staff who handle confidential information should have an NHS.net account. This should be the standard form of written communication between NHS bodies. Fax should be banned. Tomorrow.

Secondly, trust emails should exist for all specialties and services to which referrals can be made, with delivery reports. This gives a clear trail as to whether a service has received an email. Creating an email address is presumably not a massive step for an IT dept and it’s a familiar system to most people.

Obviously, this is more complicated than I’m making out. But also, you know, it’s not. Especially, given it’s been done already. Pff. Unfortunately, I’m not sure anybody’s that bothered and so many people seem to love fax machines. Sigh.