Montreal City Weblog

Kate 11:08 on 2020-05-13 Permalink Reply  

• EmilyG 11:59 on 2020-05-13 Permalink

  I wish the document would say how many people have recovered (unless I missed it?)

• jeather 12:20 on 2020-05-13 Permalink

  I found out why Canada isn’t publishing excess deaths.

  https://www.theglobeandmail.com/amp/canada/article-archaic-paper-records-submitted-by-fax-hold-up-real-time-covid-19-data-2

• DeWolf 12:26 on 2020-05-13 Permalink

  Re. jeather’s link – it annoyed me when people reacted to that recent fax machine story by slamming Quebec, when fax machines are still in use in most Canadian (or even North American) health care systems. Outdated protocols is a systemic issue, not something unique to us.

• MarcG 12:35 on 2020-05-13 Permalink

  There’s tons of outdated technology holding our world together. Upgrading is difficult/time-consuming/expensive and often not a priority because it’s not broken. https://www.inputmag.com/tech/ibm-will-offer-free-cobol-training-to-address-overloaded-unemployment-systems

• thomas 13:22 on 2020-05-13 Permalink

  Fax machines are used in hospitals throughout North America for one simple reason. Doctors insist on handwriting down all info on paper. Inputting information on a computer looks too much like data entry and thus is beneath them.

• Kevin 15:34 on 2020-05-13 Permalink

  thomas
  That’s not so. Doctors are just like anyone else and will use electronic tech if it works.

  The medical system uses faxes because they are secure.

  Email is like sending everything via postcard, which is why you should never do stuff like send your passwords, SIN, or anything that requires security using it.

• Bert 17:27 on 2020-05-13 Permalink

  Faxes are no more secure than e-mail. Our records are already digital. There are plenty of solutions out there to provide secure, encrypted transmission and storage of any file / instruction.

  In my opinion, the reason that the medical profession insists on fax is to provide a buffer between customers / patients and the profession. “That must be by fax. Oh, you don’t have one? Too bad, find one and get back to us.”

  There is no reason why a doctor needs to fax an Rx slip to a pharmacy when it should be an on-line system anyways.

• Blork 18:15 on 2020-05-13 Permalink

  The actual reason why doctors use fax is because fax is easy to learn, highly stable, and never changes. Software (ANY software) is constantly going through updgrades, feature changes, bugging and debugging, more upgrades, incompatibility issues, learning curves, user error due to new staff and/or software updates that break things or change procedures, etc.

  Key word: stability. As in, it never changes, and anyone can learn how to use it in less than two minutes.

• mare 21:22 on 2020-05-13 Permalink

  Two other reason for faxes:

  inefficiency: hundreds of jobs will disappear when nobody has to transfer (re-type) the information on the fax to the internal hospital system.
  plausible deniability: faxing a requisition for a specialist consultation or an imaging request is a black hole. Don’t call us, we call you. If they never call you back they can always claim the fax got misplaced.
  waiting lists: the stack of faxes provides a physical representation of the waiting lists for a specialist. 10 centimetres of faxes? Hmm, maybe we should triage them some more and throw away the ones that are so old they can’t be urgent anymore.

  Unfortunately I’m not completely sure the above is completely nonsense…

• mare 21:24 on 2020-05-13 Permalink

  Sorry, my dashes were eaten by the comment system.

• Bert 22:22 on 2020-05-13 Permalink

  Doctors don’t send faxes, their secretaries send faxes.

  Software is fairly stable. In a business and particularly in an enterprise, regulated environment is tightly controlled and slow to evolve. I am sure that there full fledged doctors that are younger than email as we know it.

  Insisting on fax is simply to impose an artificial control and roadblock.

• Blork 00:03 on 2020-05-14 Permalink

  Yeah, I feel like most of you folks don’t have much direct experience with institutional institutionalism and its unique blend of simultaneous inertia and momentum. There is no nefarious decision making behind the endurance of the fax in the medical community. It’s just too hard to stop and to start something new. Too many balls in the air, not enough concrete reason at the individual level (multiplied by millions) to change.

• Alison Cummins 00:53 on 2020-05-14 Permalink

  Legal system too. When I was negotiating contracts with property managers, contracts had to be faxed, not emailed.

  The thing is we usually did both. Contracts were emailed back and forth, agreed to, signed, entered in a database and faxed. Faxed were parallel to electronic communication, not instead of it.

• Michael Black 08:43 on 2020-05-14 Permalink

  I was surprised to get email about something, but it was from a third party that is somehow involved. I’m still trying to figure oit how that helps me (I can see why it helps the drug company, and the email wasn’t random).

  But there were computers all over the Royal Vic last year, even in an emergency room. And computers in examining rooms at the Montreal General. One was so tiny I said something to the young doctor and then she said something that indicated she wasn’t reluctant about computers.

  When I was in the Royal Vic for three months last year, my file, which came with me every time I visited a department, got huge. Yet in a few appointments after I got out, the doctors all used computers. They all seemed to plug in a USB flash drive, so I assume it’s a security system. I also suspect the computers had to be used more as terminals, the data kept on a server since these offices weren’t specific to the doctor.

  The nurses certainly use computers.

  Oddly, one time a nurse said the fax machine wasn’t working. I actually wondered, after seeing so many computers, if there really were physical fax machines or if the documents were scanned into a computer and then sent via a modem over the phone line.

• Blork 08:49 on 2020-05-14 Permalink

  There’s no shortage of computers in the medical system. The problem is user access and account management.

  Every application, email account, and service requires a login, which means every doctor, nurse, assistant, (etc.) requires multiple login names and passwords, and that’s just for any given hospital. Now start crossing systems (hospital to hospital, hospital to pharmacy, doctor to hospital, doctor to pharmacy, pharmacy to gov’t service, doctor to gov’t service, hospital to gov’t service, etc. etc.) and you start to see how gargantuan and unmanageable it is, because all of these systems grew up independently.

  More complications; you don’t just need a username and password: every account has multiple layers of user access to deal with. Does the nurse have the same access as the doctor? (Yes here, no there, no there, yes here, no there, etc.) Does the doctor have the same access at one hospital as they do at another hospital?

  Bear in mind that these are all different systems with different programming behind them.

  They are somewhat connected by a mishmash of yet more systems that do nothing other than try to connect the systems. It’s like a three-dimensional array of three-dimensional chess games that is constantly moving in and out of a fourth dimension.

  I know this because I briefly worked for a company that was trying to manage all those user accesses. It’s one of the only jobs I’ve ever quit, and I quit because I just. could. not. (Brain exploding over and over. Total sense of hopelessness and futility on the job, etc.)

  Compare that to sending a fax.

• Joey 10:28 on 2020-05-14 Permalink

  This Atul Gawande article (“Why Doctors Hate Their Computers”) is fascinating reading: https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

  There are slow, frustrating processes in place to bring electronic health records to Canada’s many health systems. PrescribeIT, for instance, is focusing on electronic prescription management – you go to the doctor, you get a diagnosis, the doctor sends your script to the pharmacy, no paper/fax necessary, changes/questions are all managed via the system. Quebec’s Carnet Sante hosts all your lab results and can schedule appointments – if your doctor is participating.

  My sense is the gatekeepers – doctors – have two major concerns: one, excessive bureaucratization of ad hoc systems that work well enough, which is likely a major drain on their time and mental energy. Two, “democratization” of access to health information. Old school docs aren’t keen on patients having all the information in their files at their fingertips.

  @Alison, I think lawyers have moved to a secure email system in the last year and a half, but I can’t find a source for that…

• MarcG 11:48 on 2020-05-14 Permalink

  @Blork I imagine you’ve read this funny article before but in case you haven’t: https://techcrunch.com/2014/03/29/the-internet-is-held-together-with-bubble-gum-and-baling-wire/

• Blork 12:19 on 2020-05-14 Permalink

  Let’s not even start on the banking system, behind which is an archaic “network” of geriatric mainframes strung together with pipe cleaners and bent coat hangers, and whose programming is so obscure and arcane that nobody even knows how to do maintenance on half of it. (Only slightly exaggerating.)