back to article OK, it's early 2019. Has Leeds Hospital finally managed to 'axe the fax'? Um, yes and no

Leeds Hospital NHS Trust has created what it is calling an "electronic" fax in its bid to ditch the legacy message-slingers. The hospital committed in September to remove all of its 350 fax machines in early 2019, and shortly after health minister Matt Hancock announced NHS trusts would be banned from buying the outdated …

  1. katrinab Silver badge

    What about scan to email?

    You will probably still use the same device, you just press the scan button instead of the fax button, and enter an email address instead of a phone number. The email address will likely be a bit more descriptive, so less risk of entering the wrong one, otherwise, it doesn't make much difference to your workflow.

    1. GreggS

      Re: What about scan to email?

      "Pharmacies and nursing homes won't necessarily have access to the NHS email system." She added that they often need "something they can print and physically stick in their paper records".

      And also less secure and open to phishing/spear attacks etc. etc. and they still won't have the paper record fro their files!

      1. Prst. V.Jeltz Silver badge

        Re: What about scan to email?

        " they still won't have the paper record fro their files!"

        why do they need a paper record fro their files!" ?????????

        1. Ochib

          Re: What about scan to email?

          why do they need a paper record for their files!" ?????????

          Well most of them don't have IT systems and still use paper system.

          Paper systems work, you don't need to train the staff to read a piece of paper and you can keep the paper file in the patients room.

        2. Anonymous Coward
          Anonymous Coward

          Re: What about scan to email?

          Do you work in medicine ?

          1. Caver_Dave

            Re: What about scan to email?

            I have a child who is a medical student. At the hospitals where they have gone paperless, the consultant looks at the tablet to see all the charts, drugs, etc. and there is nothing for anyone else to look at and learn from. At the other hospitals, the medical students get to read the paper at the bottom of the bed and understand why the consultant is asking the particular questions or prescribing a particular course of action.

            There doesn't seem to be any option to share the tablet, or have more than one tablet.

      2. katrinab Silver badge

        Re: What about scan to email?

        You can email to oxfordstreet3@boots.com or whatever.

        Anyone who knows the fax number can send a fax to it, so I don't see how email is less secure than that.

        1. phuzz Silver badge

          Re: What about scan to email?

          Because your average scammer doesn't have a fax machine, or indeed, know what one is.

    2. Prst. V.Jeltz Silver badge

      Re: What about scan to email?

      "What about scan to email?"

      I dont think your thinking big enough - why are you holding that bit of paper you want to scan-to-email in the first place?

      1. Doctor Syntax Silver badge

        Re: What about scan to email?

        "why are you holding that bit of paper you want to scan-to-email in the first place?"

        Because it contains important hand-written notes. They were hand-written because all the computers were down because of the latest virus infection.

        And you don't actually want to scan-to-email. You just want to transfer it to someone else quickly and reliably. Start from the requirement, not the solution. "Quickly" probably leads to some electronic means of transmission. "Reliably" strongly suggests having a fall-back. "Quickly and reliably" means that sending a courier to the consultant 50 miles away isn't the best backup.

        It's just as well to remember that when it all goes wrong you'll probably need the hard copy for the coroner's court.

        1. Anonymous Coward
          Anonymous Coward

          Re: What about scan to email?

          In many cases medical staff who can sometimes be IT illiterate don't have time to login and type details when caring for multiple patients. While it is not perfect they do have a tried and tested paper based system where they can jot down notes and sign quickly. As the records stay with the patient the medical data is instantly available for others to understand and is a ready made legal record. The only issue is the physical size of the paper based files and risk of losing them. When will computers provide this level of efficiency ?

          1. Anonymous Coward
            Anonymous Coward

            Re: What about scan to email?

            In many cases medical staff who can sometimes be IT illiterate don't have time to login ...

            In many cases medical staff who take pride in being IT incapable cant be bothered to login...

            FTFY

    3. Anonymous Coward
      Anonymous Coward

      Re: What about scan to email?

      A number of reasons

      1) E-mail is not considered secure enough (yes, faxes are not fully secure but considered more secure than standard e-mail)

      2) Not everyone has the ability to send from/to the NHS accounts

      3) E-mails can get put in 'junk', not responded to, get forwarded accidentally etc. E-mails also hang around for a long time and can have multiple copies so it is more difficult to ensure security and conformance when the is a subject access request or subject change/delete data request.

      4) Nearly all the NHS is set up with all the required numbers for the relevant people you need to fax to and it just 'works'. It would need a major multi-agency change in procedures, ways-of-working, training etc to convert. The attitude has been - if it is quick, effective and has not caused significant problems then why change it?

      5) Significant malware outbreaks can see e-mail use locked down or even IT systems restricted. Fax still works and people can communicate using that and the telephone.

      If patient had agreed to be part of the NHS digital system and it was fully implemented then it might be easier, but a lot of people still find NHS Digital controversial. It would also require a significant investment in IT equipment. However the correct way would be a fully secure platform with endpoints and software for all relevant people to digitally send information to each other. One that is secure and remains secure even if the device is lost or stolen - using MFA and preferably no passwords. (Doctors are not the most technically savvy people and do not necessarily use best practice in security).

      1. Terry 6 Silver badge

        Re: What about scan to email?

        Yes. Just yes.

      2. Anonymous Coward
        Anonymous Coward

        Re: What about scan to email?

        Email is considered secure enough, and the budgets were all agreed over 10 years ago to remove Fax. All other government departments and most PCTs moved away from Fax because they took responsibility. unfortunately the solution that they came up with was not the best. All this Fax issue highlights really is a complete and utter lack of leadership in the IT part of this PCT and there should be some firings within the management community over this. But as always they blame goes back onto the staff for using this method, rather than a change in business practice being implemented correctly many years ago.

        1. Anonymous Coward
          Anonymous Coward

          Re: What about scan to email?

          ..."most PCTs moved away from Fax..." As in don't have any Fax machines? Where is the evidence for that?

          "All this Fax issue highlights really is a complete and utter lack of leadership in the IT part" Or that they just have more pressing things to deal with.

        2. Doctor Syntax Silver badge

          Re: What about scan to email?

          "But as always they blame goes back onto the staff for using this method"

          And as always the blame would go back onto staff for not using the now withdrawn method when an alternative was unavailable for any reason.

          I'd like to think that front-line NHS staff had a strong preference for any working method that came to hand rather than the recommendations of a Whitehall committee.

        3. Rathfelder

          Re: What about scan to email?

          PCTs were abolished quite a long time ago.

  2. Anonymous Coward
    Anonymous Coward

    Problem ?

    If faxes work, and folks are used to them, what's the issue? I suspect the migration and upheaval costs will far outweigh any savings.

    Why do some folks have an obsession with having to have the latest shiney when what they have is perfectly functional for the task at hand.

    And has anyone come accross a fax machine that was vulnerable to Wannacry?

    1. Anonymous Coward
      Anonymous Coward

      Re: Problem ?

      Has anyone come across a fax machine that implements any type of security and isn't DOssable? Don't you remember the days that when you wanted to piss off your mate you just sent him a 100 page empty fax?

      1. Doctor Syntax Silver badge

        Re: Problem ?

        "Don't you remember the days that when you wanted to piss off your mate you just sent him a 100 page empty fax?"

        No; at least I don't remember mates like you. I trust you're not making any decisions that affect the NHS.

      2. david 12 Bronze badge

        Re: Problem ?

        >Has anyone come across a fax machine that implements any type of security <

        Yes. They're sold to hospitals, doctors and other people who need Encrypted / HPIIA compliant / TLS fax machines.

        Not much in the UK only because hospitals were told not to use them.

    2. vtcodger Silver badge

      Re: Problem ?

      If faxes work, and folks are used to them, what's the issue?

      The issue is that much of the human race prefers illusion to things that actually work. There are some real problems with fax. It's slow, Isn't always provisioned with paper when it should be. Thermoprinted paper used in inexpensive fax machines fades over time. Etc, etc,etc. OTOH, the shiny digital solutions preferred by many tend to be costly, complex, not to be interoperable with other shiny digital solutions. etc,etc,etc. They have a bunch of problems of their own.

      Personally, I belong to the "If it isn't broken, don't fix it" school. But some things really do work better after proper repair. The optimum way to deal with an older technology is probably to ask first if it really needs fixing, and second if there is a tested, widely deployed, solution that actually fixes real problems and doesn't come with unfortunate side effects.

  3. Arty Effem

    What could go wrong?

    So next time their network gets attacked, they also lose the ability to send documents. Better fax everyone a directive to keep a fax machine handy.

    1. DougS Silver badge

      Re: What could go wrong?

      They probably lose the ability to send faxes anyway, since I imagine they converted to a VOIP based phone system at some point.

      Even if they still use POTS for faxes, where would the documents you are going to fax come from if employees can't login to the network, access their file shares / cloud storage, or print to network printers? The only thing standalone fax machine + POTS would let them do they can't with the network based solution is receive faxes. That's not a big deal as when the send fails the sender will know this and try again later.

  4. Hans 1 Silver badge
    WTF?

    paper records

    It is 2019, and somewhere, somebody still relies on "paper records" ?

    1. Pete 2 Silver badge

      Re: paper records

      What's wrong with paper records?

      They are long-lasting, unhackable, easily copied. They have a universal format (writing) and can be used without any technology at all.

      They don't suffer from "software rot". Nether do they become unreadable due to technology incompatibilities. They don't need licensing and they won't suddenly become unsupported if a supplier goes bust or gets bought out. Plus, they don't mysteriously stop working.

      And best of all, they don't need to be constantly upgraded for no apparent reason.

      1. katrinab Silver badge

        Re: paper records

        Paper rot is something that happens though.

        1. Kane Silver badge

          Re: paper records

          "Paper rot is something that happens though."

          Photocopiers are your friend.

          1. Doctor Syntax Silver badge

            Re: paper records

            "Photocopiers are your friend."

            If you don't have one handy you can always fax yourself a copy.

            1. tin 2

              Re: paper records

              and of course fax machines nearly always have a photocopy function.

    2. ckm5

      Re: paper records

      Almost all prescriptions require signed paper documents. Most pharmacies expect to get these faxed to them by doctors for confirmation.

      That is the *default* way things happen. Do you really want to screw around with a system that your life might depend on?

      1. Prst. V.Jeltz Silver badge

        Re: paper records

        "Almost all prescriptions require signed paper documents" and that abosulutely INANE premise just backs up the other prehistoric obsession with faxes. going round in circles.

        "Almost all prescriptions require signed paper documents"

        What , with a biro signature? that is responsible for "securing" the prescription , but actually has a security ability / rating of absolute zero.

        I recently had to post a form from a bank to australia so that somone could daub a mark on it with a pen.

        WTF? what the hell does that prove?

        In decades past a signature used to some form of authentication, hence you signed a cheque or whatever , and that meant that you had authorised it , then , over decades we realised that security was important and came up with flashy new things like PIN and passwords etc

        WHY is your signature on your bank card??? your PIN isnt ffs!

        In summary: despite being used for centuries a signature is of NO VALUE as security / authorisation,

        so lets top pretending it is and printing shit out so we can scrawl on it and then scan it in again. Develop some digital signature that says "click here to sign" that then stamps some ecrypted usernamr based sig on the document ... or whatever ...

      2. monty75

        Re: paper records

        All my prescriptions have been going electronically from GP to pharmacy for several years now. No signature on them although for some reason the pharmacy then prints them out for me to fill in the back of it.

      3. Doctor Syntax Silver badge

        Re: paper records

        "Almost all prescriptions require signed paper documents. Most pharmacies expect to get these faxed to them by doctors for confirmation."

        It's over a decade since I had anything to do with prescription systems so I've no idea what the back-end of the current ePrescriptions is but I'd be surprised if it was fax.

        However the current system seems to depend on the patient having a specific pharmacy registered to the prescriber, the latter being a GP practice. This means that other prescribers such as dentists will still rely on paper. Also, at least in our case, the registered pharmacy is not the one next to the surgery so if a doctor wishes to write out a new or one-off prescription they will write or print off a paper script as this is a lot more convenient than chasing off to our registered pharmacy.

        Slightly OT: Years ago our then GP's receptionist had a printer next to the PC. They obviously couldn't be bothered going to buy regular printer paper so they loaded it with FP10C, the fan-fold prescription forms, face-down. All prescription forms were produced as secure stationery, ordered by a secure process and consequently much more expensive than regular fan-fold. Even when it had print-out on the back the paper coming out of that printer would still have been valid prescription forms; the waste should have been securely disposed off if they weren't going to turn it over and print scripts on it.

    3. Doctor Syntax Silver badge

      Re: paper records

      somebody still relies on "paper records" ?

      When your email system went down and you didn't have a backup and the patient died the coroner might want to see them.

    4. Anonymous Coward
      Anonymous Coward

      Re: paper records

      If the supplier loses the data, who are you going to call ?

      1. John Brown (no body) Silver badge

        Re: paper records

        "If the supplier loses the data, who are you going to call ?"

        Faxbusters!!!!!

    5. dogcatcher

      Re: paper records

      Yes. As I sat in front of the consultant last week as he gazed at the screen in front of him and then thumbed through a three inch fat file to see when I had last been operated on for cancer in another hospital in another city, I was glad that he had 25 year old records he could read.

  5. Pete 2 Silver badge

    The IT failure is not having anything better

    > NHS trusts would be banned from buying the outdated devices.

    If they still do the required job they can hardly be called outdated.

    They might be inefficient, expensive, slow or unreliable. But if they haven't been replaced by something better, that tells us that the "alternatives" aren't actually better (however you choose to define the word).

    That would seem to me to be a pretty damning failure of IT. That is it unable to come up with a solution that is acceptable.

    But we know that many IT solutions aren't in fact solutions at all. Just more complicated substitutes. Ones that often perform the basic function worse than the thing they replace (not surprising if the original has been refined and modified over decades of use and experience) and offer a load of unwanted and never-user ancillary functions. Ones that seemed to the IT people to be a good idea, or were just easy to implement.

    1. TRT Silver badge

      Re: The IT failure is not having anything better

      So long as it conforms to Group 3 standards and downsamples the 9600dpi scan from a modern scan head to the 400lpi Ultrafine setting of V.34...

      Personally, I don't see anything wrong with retaining it until it eventually dies a death through disuse. As was pointed out earlier, in the event of WannaCry etc, you dare not turn on a computer on the network, but a dumb terminal, single-function device on the end of a phone line that only connects to other dumb terminal, single function devices can have an advantage. Until the phone line becomes VOIP of course, and the DNS/switch/router/power supply goes down.

  6. Doctor Syntax Silver badge

    eFax had to be "part of our digital transformation journey"

    That little word* "had". Whatever happened to "could"? Did anybody ever decide whether removing fax was feasible or do they wait until their network goes down to discover that?

    * The bigger word "journey", of course reveals the entire statement to be wanker-speak.

  7. Doctor Syntax Silver badge

    "never underestimated the enormity of the task"

    enormity

    noun

    1. the great or extreme scale, seriousness, or extent of something perceived as bad or morally wrong.

    2. a grave crime or sin.

  8. Cuddles Silver badge

    Electronic fax

    Because the existing fax machines aren't electronic?

  9. Terry 6 Silver badge

    Onwards into the new(ish)

    We seem to be stuck in a view that as soon as a new thing comes along the old has to vanish. But it isn't so.

    Progress means that new replaces old because it does the job better. My parents had a stand alone washing machine and a mangle. It went as soon as modern machines with spinners arrived. No one had to make them.

    But fax machines do the job effectively and well for most use cases for most users. Which is why they haven't jumped ship to some newer technology. It works.

    1. TRT Silver badge

      Re: Onwards into the new(ish)

      I was still using a 1960's era twin tub and mangle right up until 1994. Sad to have had to get rid of it really. Made a lovely noise. Sounded exactly the same as the launching sequence of Thunderbird 2.

      1. Chloe Cresswell

        Re: Onwards into the new(ish)

        Friend of mine runs a small white goods shop, he says if he could get twin tubs today, he could sell (literally) tonnes of them.

  10. Anonymous Coward
    Anonymous Coward

    Paper rules in the NHS

    When I go for my annual Blood Test (Leukaemia almost 10 years in remission), the Doc that I see copies down the BT results from the screen into the paper records. He then dictates a letter to my GP and 7-10 days later I get a copy. My paper record file is around 4in thick now.

    They could send the GP an email (I know that he has access to the Hospital BT results system) and also an email cc to me but no, it all is done via snail-mail.

    sigh. one day perhaps.

  11. Lee D Silver badge

    20 years ago, I started working for schools.

    I was amazed even then that they were still using fax.

    One of the my early projects for any school I worked for was to eliminate it. Mostly because, by then, almost all faxes received were spam anyway. High consumable cost. Plus telephony costs. Plus there were viable alternatives just sitting there.

    I spent many years going to boot sales and snapping up "real" modems (serial, not Winmodem). I still have a stash. I would then connect those modems to a machine and install something like hylafax.

    Now they could fax direct from the program by just printing to a network-wide printer. All users could do it (with controls to ensure only those who should could use it). All programs supported it. And it all went out from one number so it could be monitored.

    All incoming fax automatically dropped into an email account as a PDF and were distributed that way. Users who "needed to sign" something could even fax direct from the scanners / copiers if they so desired.

    In every school I ever did this, actual fax usage was shown to be absolutely minimal. Spam faxes were treated like spam email. The only faxes going out were few, and they got even fewer as time went on. By the time that everyone had automated banking and communications (i.e. no longer accepting or printing cheques, school parents getting reports online etc.) fax was dead and gone.

    My current place has a fax line that works this exact way. I couldn't even tell you the last time we needed to fax. The technician I tasked to set up and manage the current fax system left over a year ago. It's still working, but it honestly doesn't receive anything worthwhile at all and never sends out. We keep a single analogue line up as an emergency backup for a SIP trunk, and that operates as a fax line when it's not an emergency. It's not even worth a line on its own.

    That there are modern organisations with fax still based on physical fax machines churning out paper (even MFP's), I find unfathomable. If primary schools ditched the technology 20 years ago, you should have as well. At best an all-electronic system is an acceptable substitute, but that's literally lost in the error margins of any telecommunications contract - one fax line per site, with a box to manage it but to be honest most telecoms devices nowadays just let you nominate a line as fax-to-email and you're done. Even the big SIP-trunk people have that kind of functionality.

    Anything you're faxing is going to be a patient record of some kind, or a legal document (the only reason for retaining a fax in many workplaces was literally "because the solicitors say we must fax it" - but email has far taken over in that respect). Thus it needs to be monitored, stored, and accessed appropriately, not churning out on a bit of paper in an office, never to be put back into someone's records or destroyed.

    They should have just turned all the lines off. Literally, if the switchboard detects fax tones on a non-fax-to-email line, it drops the call. Any analogue telephone lines should be cut and - at best - centralised to use the core switchboard as the only endpoint (so you can still make calls through them, but there's no possibility of sending stuff outside just because you snuck a fax machine in). That should have happened 10-15 years ago. VoIP is SIGNIFICANTLY cheaper that it should have been done years ago on a cost basis alone.

    They are just asking for trouble, and their deadline is 20 years too late as it is. Zero tolerance should be applied. At worst, these are official communiques and need to be logged, audited and searchable in such a large organisation.

    If your switchboard can't handle it, there are boxes designed expressly to convert such devices. I have a bunch of Hylafax-compatible modems if you want to do it the cheapest way possible. Most cost me £1 each.

    1. Doctor Syntax Silver badge

      Are you saying the use cases of the NHS are those of primary schools?

  12. Anonymous Coward
  13. Dan 55 Silver badge
  14. Christian Berger Silver badge

    But (group 3) fax is digital

    Also it's a low risk environment with devices off the computer network with fairly smooth attack surfaces.

    Besides there currently isn't any sane standard to replace it. Sure some faxes are able to send PDFs, but unless you standardise on a strict subset of the PDF standard, your viewers will be highly complex. Sending "Office software" files through e-mail is just a desaster waiting to happen. (or depending on your company a desaster that already has happened)

    Before you can think about abolishing Fax machines, you should think about how to actually use computers in a sane way.

  15. Terry 6 Silver badge

    In general terms

    Maybe less of an NHS issue (maybe not though).

    People seem to not read emails - let alone respond to them - like they do to paper correspondence, whether fax or snail mail.

    I've been to too many places where staff have hundreds of emails in an inbox, most of them unread, many of them haven't even been noticed in the list. It's too easy to send trivial emails and too difficult sort through them quickly. A fax requires enough effort to send.to make people think. And enough effort to ignore to make reading the bloody thing worthwhile.

  16. Anonymous Coward
    Anonymous Coward

    A common excuse

    I have heard some GPs insist that they must be communicated with by FAX not email as they are too remote to get email!

    Where are these remote GPs then? Auchtershuggle? Ecclefechan? John O Groats? No to all of those. These are practices in the remote wilds of the "West Midlands". They have the choice of multiple broadband providers and might even connect a MiFi to the 4G prevalent in their area.

  17. Chris Miller

    I was responsible for a (very minor) project to introduce virtual fax machines that took incoming faxes and attached them as an image file to an email. This was in Windows 3.1, so would have been around 25 years ago (and I don't claim it was a pioneering implementation). [pauses to stroke long grey beard]

    1. Adrian 4 Silver badge

      I don't see that virtual faxes are much of an improvement over paper faxes. You're still sending images instead of semantic content, with all the problems of searching, indexing and storing that implies.

      And while we're at it, can we cull the people who write a Word document and email it as an attachment when plain text would have been entirely adequate ?

      1. Doctor Syntax Silver badge

        "can we cull the people who write a Word document and email it as an attachment when plain text would have been entirely adequate"

        Yup, just as soon as we've finished culling all those who write emails in HTML without embedded links to graphics (we cull those after we've culled those who include links).

      2. Chris Miller

        @Adrian

        I don't see that virtual faxes are much of an improvement over paper faxes.

        True, but we had these annoying people called customers, and we couldn't dictate how they chose to communicate with us.

      3. Terry 6 Silver badge

        Some years ago my boss was given, and passed on, instructions from the IT dept that we couldn't send emails >100 words. Above that limit it had to be an attachment. Why? No fucking idea. If that was explained she wouldn't have understood, but I'd have bet good money that it wasn't. In fact I did try to find out. And no one actually could tell me.

        Either way there were plenty of reasonably shortish emails being written in WORD then attached.

  18. Sandtitz Silver badge

    My solution

    "significant number of faxes are being sent across internal departments."

    Just configure the MFP to scan-to-ftp operation and send the scanned document via FTP to another printer.

    Add each printer's FTP address to the LDAP.

    Problem solved.

  19. Daedalus Silver badge

    Bozocalypse, medical edition.

    Here's the thing about fax machines. They are "real objects" that exist in "one place", and using them can be, and usually is, delegated to a few people who "know how to use them".

    Every time something is sublimated into the virtual world, the expectation is that "everybody will be able to use it everywhere".

    Wrong. Everybody is an id10t. Everywhere is a very big and dodgy place. Connectivity and maintenance issues multiply faster than the teams put in place to fix them. As always, there are lessons to be learned in the history of photocopiers, the original tech/drone mashup. When everybody could use them, they broke down a lot. When behind the walls of a copy centre with a dedicated operator, they hummed along flawlessly.

    Software is afflicted with boneheadedness on all sides, feature creep, hype, version instability, update chaos and lack of planning. Copier manufacturers learned early: keep it simple, use the Big Green Button design principle, expect the unexpected.

    There are too many tales of medical staff and administrators being utter plonkers for anyone to feel comfortable about ditching fax for any software substitute.

POST COMMENT House rules

Not a member of The Register? Create a new account here.

  • Enter your comment

  • Add an icon

Anonymous cowards cannot choose their icon

Biting the hand that feeds IT © 1998–2019