Bottleneck for US Coronavirus Response: The Fax Machine (nytimes.com) 187
Public health officials in Houston are struggling to keep up with one of the nation's largest coronavirus outbreaks. They are desperate to trace cases and quarantine patients before they spread the virus to others. But first, they must negotiate with the office fax machine. From a report: The machine at the Harris County Public Health department in Houston recently became overwhelmed when one laboratory sent a large batch of test results, spraying hundreds of pages all over the floor. "Picture the image of hundreds of faxes coming through, and the machine just shooting out paper," said Dr. Umair Shah, executive director of the department. The county has so far recorded more than 40,000 coronavirus cases. Some doctors fax coronavirus tests to Dr. Shah's personal number, too. Those papers are put in an envelope marked "confidential" and walked to the epidemiology department. As hard as the United States works to control coronavirus, it keeps running into problems caused by its fragmented health system, a jumble of old and new technology, and data standards that don't meet epidemiologists' needs. Public health officials and private laboratories have managed to expand testing to more than half a million performed daily, but they do not have a system that can smoothly handle that avalanche of results.
We've had faxmodem cards back in the 1990s (Score:4, Insightful)
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Fine, now instead of a pile of paper you have a folder full of unidentifiable files with obscure names consisting of time/date received and maybe sender's number. Not much of an improvement. Plus you still need an expensive analog line, which can only receive one call at a time.
Faxing may be OK for your realtor sending you new house listings, but not for anything that is done in volume.
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Re:We've had faxmodem cards back in the 1990s (Score:4, Informative)
Faxes are a 19th century technology (literally) which is utterly inadequate for 21st century applications.
https://en.wikipedia.org/wiki/... [wikipedia.org]
Scottish inventor Alexander Bain worked on chemical mechanical fax type devices and in 1846 was able to reproduce graphic signs in laboratory experiments. He received British patent 9745 on May 27, 1843 for his "Electric Printing Telegraph"
The only reason why the US medical system relies on fax machines to this day is because doctors are possibly the only people cheaper than bankers and more inflexibly hidebound than lawyers.
Re:We've had faxmodem cards back in the 1990s (Score:5, Insightful)
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This. The secure transmission, digital storage, and subsequent access methods of private patient data are problems that the health care system has been wrestling with... you could argue incompetently... for decades.
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We've had e-mail encryption for over 20 years now. Why aren't healthcare providers using it? Most health insurance companies figured this out a long time ago.
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Oh, and if you're receiving faxes on a computer rather than paper they have to be dealt with by a HIPAA-compliant record keeping system. You cannot legally receive confidential patient data on your desktop PC, the fines for doing so can be astronomical and even include decertification.
Paper records are not covered by HIPAA, they could toss the paper faxes out the window like confetti and the only laws they would be in violation of are against littering.
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Paper records are not covered by HIPAA, they could toss the paper faxes out the window like confetti and the only laws they would be in violation of are against littering.
You've been sadly misinformed. Health information in any form, whether electronic or paper or whatever, is all covered the same by HIPAA.
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When HIPAA was being instituted my employer (physical security company) thought they saw an opportunity to secure medical records rooms. To our shock we were informed that HIPAA did not cover paper records at all, so they really didn't care. Brass keys were sufficient, and everyone from the janitor up had a key to the records rooms. A year or two later one hospital had moved their records to a room that already had access control so they had me set a timezone on that reader which unlocked the door from 7
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To our shock we were informed that HIPAA did not cover paper records at all, so they really didn't care.
Then someone told you about the 2003 "Security Rule" which clarifies electronic records but neglected to mention the 1996 "Privacy Rule" which applies to records in all mediums.
Please see: https://www.hipaajournal.com/h... [hipaajournal.com]
Although the HIPAA guidelines for medical records maintained on paper are not as comprehensive as those for electronically-maintained medical records, many of the same standards still apply .
Thus, throwing paper medical records out the window as confetti would be a massive violation of HIPAA.
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No, the cleaning crew had access to the door. It was just for ease of access. The night shift was accustomed to doors being secured so carried their key cards with them at all times, while the day shift frequently didn't since everything was unlocked.
Oh, and it was in the same unsecured hallway that led to the back parking lot.
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Bullshit.
The HIPAA guidelines for medical records do not exclusively apply to medical records that are created, stored or transmitted electronically. All medical records are subject to the HIPAA Privacy Rule and the same considerations should be given to maintaining the integrity of paper medical records and preventing the unauthorized disclosure of PHI.
Although the HIPAA guidelines for medical records maintained on paper are not as comprehensive as those for electronically-maintained medical records, many of the same standards still apply. Covered Entities and Business Associates should implement a process for logging records and tracking their location while in transit. They should be stored in areas where there is controlled access and only be used in areas that have safeguards in place to minimize accidental disclosure of PHI.
Further HIPAA guidelines for medical records maintained on paper can be found under the "General Principles for Uses and Disclosures" section of the OCR's Summary of the HIPAA Privacy Rule [hhs.gov].
Since your second part is demonstrably false we can presume your first statement is as well.
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I know of hospitals where the doors to the record room are unlocked 24/7, and the door is clearly labeled "Patient Records". Of the over a dozen hospitals my employer at the time (physical security company) had as customers not a single one would spend a penny securing those records although they spent millions on the software. I know of one site where old archives were stored in a pile of boxes in the parking garage for the several months of a remodel project, utterly unsecured and unguarded without even
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there are different HIPAA rules (Score:3)
There are a number of different HIPPA rules.
The EHR security rule ia specific to electronic health records
https://www.hhs.gov/sites/defa... [hhs.gov]
The privacy rule requires that ALL records, in any format, be protected by appropriate measures
https://www.hhs.gov/sites/defa... [hhs.gov]
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Lawyers and doctors are not the hidebound elements in either system. It's the law itself, which needs to be forcibly-of-necessary updated to digital validation and recordkeeping. We have public key e-signatures that are more secure than handwritten. We can do secure emails if we really wanted to, and we can move medical records to digital if we really wanted to. It takes a medical crisis like this to motivate everyone to change.
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American ISDN is very different compared to Euro ISDN and isn't nearly as good, that's why it never was popular there.
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Clear, metric ISDN is superior.
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It kind of is - the DSS1 standard was superior to the American NI-1, so it was adopted by many countries outside of Europe. But nowadays it is moot anyway, ISDN is essentially dead everywhere, even here in Germany where it used to be more popular than anywhere else.
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I'm surprised you can still get such things considering that even asymmetric DSL blows that away.
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Those PDF files will be created by scanning hand-written documents ith multi-function printers, so they won't be any better than faxes saved to files.
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Yes, I think most of them will allow you to add attachments, but someone still has to open the fax, associate it to the patient record, and put in their own system the test date/result. Plus there's the issue of if you're going to receive confidential patient data it has to be on a HIPAA-compliant system so you're not able to install that fax modem on your desktop PC, good luck convincing most IT shops to stick a modem card and a POTS line in their server room.
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County health departments? You're right. Hospital chains and insurance companies on the other hand are swimming in money, they could have funded an initiative to standardize data exchanges across their industry two decades ago for less than they pay a single CEO in a year.
Re: We've had faxmodem cards back in the 1990s (Score:2)
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One would think, except that there is no standardization among the forms. Every lab has its own format, every hospital chain has its own, every insurance company has its own, and none of them are in the least compatible. AFAICT the reasoning seems to be that inefficiency allows everyone to charge more for services so no one is willing to cough up the money to standardize. When you make a product it's in your interest to make things as efficient as possible, but when you bill for services inefficiency is
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Add OCR and a DMS. If my employer can import thousands of supplier invoices into SAP that way, it must be possible to do with what I assume to be test results in a fixed, pre-defined format.
OCR used once to build a database is fine, but when you send data digitally, print it out, fax it and then OCR the fax, that's an admission of abject failure.
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The problem probably has more to do with not having an electronic system to keep them in that is considred sufficent and secure.
Such systems are expensive and government agencies that are generally underfunded because they paid for with tax money ( aka dontations) tend to eschew (expensive) technolgy because they don't have the time and money to buy and deploy it as long as the 'old' system still works.
Re:We've had faxmodem cards back in the 1990s (Score:5, Informative)
This is not a "technology" problem, but a compliance problem--specifically HIPAA.
If you electronically store/transfer/process data that falls under HIPAA, you have to have really expensive compliance and security policies around it. Software compliant with HIPAA, encryption, access controls, upgrades, etc. All of these things cost a lot of money.
Fax machines are the exception to this rule. Because the fax technology is basically fixed and cannot be "upgraded", it is generally excluded from all of those expensive requirements.
It is the law of unintended consequences.
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And The way to get the intended consequences is to deprecate the safe haven for fax. Time to sunset this bizarre exception.
Re:We've had faxmodem cards back in the 1990s (Score:5, Insightful)
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It's not really that bizarre. Heard of any massive data breaches spilling millions of records over fax lately? (Actually, ever?)
No because people hacking fax machines generally need to have physical access to the IDF and if they're going to do that they probably have a very specific purpose in mind. Say, celebrity medical records or something. It's relatively low yield and because it's specific it gets sold off to a particular customer. It doesn't serve their purposes to broadcast the breech.
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I mean, I'm not concerned about a thief who wants my medical records specifically. I'm concerned about a thief who wants 10 million medical records which include mine.
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I mean, I'm not concerned about a thief who wants my medical records specifically. I'm concerned about a thief who wants 10 million medical records which include mine.
Yeah, that's just not worth it. I suppose you could go tap the line and wait your time, but it seems really inefficient compared to phishing some idiot in the healthcare organization or, as in the case of my previous example, just walking in there in scrubs at night, logging into the system using the login everyone including the janitor has, and blasting the entire thing to an external USB drive to take home and sort out later.
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And The way to get the intended consequences is to deprecate the safe haven for fax. Time to sunset this bizarre exception.
Agreed 100%.
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All of the HIPAA-compliant medical content management systems already have that baked in. Paper records are not addressed at all by HIPAA, while there are stringent requirements for storing electronic patient records you could pile boxes of paper records in the middle of the parking lot unattended and not be in violation of HIPAA.
This is simply a case of the for-profit healthcare/insurance system not wanting to spend the money on standardizing formats. That fax's data is going to be manually typed into th
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All of the HIPAA-compliant medical content management systems already have that baked in. Paper records are not addressed at all by HIPAA, while there are stringent requirements for storing electronic patient records you could pile boxes of paper records in the middle of the parking lot unattended and not be in violation of HIPAA.
This is the second time you've posted this misconception. HIPAA covers all medical info no matter what the medium.
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Interesting, the hospital lawyers at the time told us the exact opposite. I haven't been at that employer for seven years now, maybe they've changed their tune in the interim.
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You can have a secure team mailbox.
Or just replicate what many do today for HIPAA compliance: A Fax is in a secure room with access from a few people. Person goes in and RESCANS (and shreds) the incoming documents to PDF and securely emails the intended receipent in the network via a secure PC in the same Fax room. Basically sneakernet the dead tree message to electronic.
An upgrade of this is to replace the Fax with eFax that goes to the user/team's mailbox who then sends it on securely to intended party.
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It's not that the technology cannot be upgraded. Nor is it an unintended consequence. It's that "paper records are kept in a locked room and there are alarms and probably guards around" is considered more than adequate security. Computer records need more tech to secure.
Or, to put it a different way, a bank using technology from the year 2000 to secure their bank branches against armed robberies seems fine to me. If they were still using year 2000 tech to protect their online banking, I think we can all
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We've had faxmodem cards back in the 1990s ... Those cards don't exist anymore? No paper to spill on the floor.
We have one, we keep it in a display case the local computer museum along with the sole remaining fax machine.
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HIPA (Score:2)
do you want privacy or convince? Security or freedom? they are opposite sides on a sliding scale. The proper balance is something that is personal preference at worst and agreed social convention at best.
Re: HIPA (Score:2)
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Faxes only produce ephemeral copies and physical printouts are easy enough to secure. Computer records persist until deleted and therefore can be subject to a breach.
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And, along comes some asshole crackers who exploit a security hole or bug and suddenly 40,000 test results and their identifying information are on the internet.
That is why we can't have nice things.
Re:Why no eFax standard (Score:4, Insightful)
No, no, no. The whole idea of faxes is archaic. Direct digital transfers to secure mailboxes is the way to go for sensitive stuff. I just had an argument with BofA because they couldn't email me a document but they could fax it or USPS it.
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No, no, no. The whole idea of faxes is archaic. Direct digital transfers to secure mailboxes is the way to go for sensitive stuff. I just had an argument with BofA because they couldn't email me a document but they could fax it or USPS it.
Same here. I'll give you a few better:
In healthcare some documents can't be faxed or electronically submitted. They have to be signed in blue ink (thinking back to B&W faxes are we?) and some of them have to be actually USPS'ed. Then you get the crap that requires a notary with a raised seal. Um, you know how many times I've gone to a notary and they've actually done any due diligence that my ID is not forged? Zero. And these same organizations require that I submit a copy of a photo ID which has my s
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Let me know when there is an open, agreed upon, and ubiquitous standard for secure digital communication. In the meantime the USPS can put a piece of physical paper in your hands for $0.42 in 3-5 days with very little risk of any breech, zero risk of a mass breech, and a dedicated police department with decades long jail terms to enforce the safety of your letter.
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The wheels of government turn slowly. The people who make the laws still think fax machines are new fangled technology. Start today and in 10 years time you might see the changes put through. First you need a committee, then input from vendors and random dickheads, more committee meetings, rinse and repeat. Tech companies will get involved and lobby the outcome. Nothing but a mess.
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Sometimes this is a good thing as some tech fads are properly skipped because of heavier vetting due to more stakeholders involved in the review process. But, it can also slow real progress.
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Law.
Seriously. Fax and mail are the only ways to legally send a lot of legal documents and still be considered valid chains of evidence/contracts.
There's all kinds of weird conventions for the legal community that aren't actually secure, but have the weight of old false security weighing them down - like the TIFF image format.
It's all just hoops to jump through - pointless, except for the fact that people are paid to jump through those hoops, at very high hourly rates.
A lot of the most highly paid professi
Re:Why no eFax standard (Score:4, Insightful)
Yeah, dude, welcome to the 21st century [fdic.gov]. They're not. They haven't been for 20 years. And even before that we drafted contracts that expressly permitted contracts to be executed using counterparts that were copies of each other.
Or the weight of old false apocryphal stories being repeated by people who should know better.
You can't fathom the reasons because they don't exist, must less match up to reality.
Indeed, we mod people spouting incredible bullshit because they write up reasonable sounding stereotypes and earnestly believe them.
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I agree that it's bullshit - but it's bullshit with a pedigree.
That is - I've worked on software for lots of lawyers, and team software for lawyers. They all believe in these requirements as HARD requirements. They all believe that various entities need the FAX involvement, and anything but TIFF will be rejected at a pretty consistent rate.
This isn't rumor or conjecture - it's a nationwide lagging indicator - and it's way more than 20 years of lag.
Ryan Fenton
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Blame users (Score:2)
The Admins and Doctors who have resisted repeated attempts to move to digital document management over the years because fax was familiar and comfortable.
Even if you want to drop fax you can't because of every other behind the times hospital and clinic in the world who will only send records to you via fax. The only way you can really move away is to legally mandate an end to fax with heavy fines. It should have happened ages ago. Hell it should have happened with HIPAA.
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The Admins and Doctors who have resisted repeated attempts to move to digital document management over the years because fax was familiar and comfortable.
Perhaps for some, but most cite a different reason: the two laws HIPAA and The HITECH Act.
There was a big writeup in Vox a few years back [vox.com].
The short version is that laws require documents to be kept securely, transferred securely, and mandated that they share information in mutually-coordinated methods. The agency that oversaw the groups accepted that fax machines had to be grandfathered in, so rather than encrypted email (which is often expensive, digital certificate CA's charge a premium, and verification
Re:Blame users (Score:4, Insightful)
People who don't understand this need to step back a moment and see the picture. The doctors are very often either their own bosses, or a part of the collective ownership, they're not salary workers who get told what to do by the higher ups. At the same time, they're trying to figure out an ever changing workplace. So imagine you're here today using Microsoft Office (or LibreOffice) and someone shows up saying "hold on, all your work must now be done online using Office 365 on the Cloud!" We'd freak out - well, many of us already freaked out what a disaster that cloud was... Or, "please stop using Atlassian because we've gone and purchased a new state of the art tool suite from a 3 person startup!" Or, "throw away your desktop, we're doing all our corporate activities on the smart phone now!"
That's sort of what the doctors hear. They've got something that works now. Being told to use email makes no sense if their image of email is 99.9% spam for viagra and bitcoin scams. They know how the fax machine works, they don't really want to go through hours of training about how to log into the overloaded document management system to read the health alerts every morning. I know in the past there was a disconnect between going to their consultation office where they had a PC versus being in the hospital or examination room.
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I guess you don't go to the doctor these days. That's not the way that USA medicine works for the average American.
I asked my eye (this week) is he could explain something to me and he said "She will answer your question; I have to get to the next appointment". He also said that the remedy for my condition "is driven by Insurance" and unless
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Federalism (Score:2)
As hard as the United States works to control coronavirus, it keeps running into problems caused by its fragmented health system, a jumble of old and new technology, and data standards that don't meet epidemiologists' needs. Public health officials and private laboratories have managed to expand testing to more than half a million performed daily, but they do not have a system that can smoothly handle that avalanche of results.
Sounds like a central clearing house run by the federal government would have been perfectly positioned to address most of those problems and would have ensured access to accurate nationwide data which, when coupled with a coordinated national level response which included mask requirements, would have gone a long way towards fighting this pandemic and limited its economic impact.
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**sigh**
For-profit medicine will ensure the least efficient and most costly solution prevails, because that's where the profit lies. There is not a lot of standardization in the US medical system because it's so fragmented. For example, University of Washington Hospital is associated with Harborview and Swedish. All three have their own labs. The form for reporting the results of same test is different in all three labs has a different layout with fields in different orders, and possibly not even the sa
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For-profit medicine will ensure the least efficient and most costly solution prevails, because that's where the profit lies.
Huh? Have you ever worked in private industry? Every company I've worked for has been relentless about cutting cruft and inefficiency out of their processes because that means you can earn more profits without reducing prices. (This only makes sense when you realize that cost and price don't have a lot to do with each other, other than most often cost will be less than price.)
Of course, if one of your competitors also reduces prices, they now can also cut their prices a little, undercut you, and still wind
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Except this responsibility and job is not one of the few enumerated, supposedly limited, responsibilities, roles and power that the Federal Government is granted by the Constitution.
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Except this responsibility and job is not one of the few enumerated, supposedly limited, responsibilities, roles and power that the Federal Government is granted by the Constitution.
Well this whole pandemic thing has sure done a number on interstate commerce, hasn't it?
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You know, to date, the Feds have done waaaaay too much stretching of the interstate commerce clause to gain power they already should not have.
But in this case, I think what you suggest is far to thin to stretch it.
All in good time (Score:2)
The machine at the Harris County Public Health department in Houston recently became overwhelmed when one laboratory sent a large batch of test results, spraying hundreds of pages all over the floor
Says a spokesperson for the government agency, "We've updated our terminology to spokesperson quickly enough, but are still trying to get a handle on these newfangled "fax" machines."
Who would have guessed? (Score:2)
If only there were an entire support industry practically begging people for decades to stop using faxes for everything.
HIPAA (Score:5, Insightful)
Over 9000 words, but the one word is not found in the article: HIPAA.
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HIPAA allows medical professionals to share data with appropriate government agencies, and those agencies can release aggregated data if they so desire.
That said, it does hamper a lot of the response. For example, an employer does not generally know the results of medical tests*. And the HIPAA guidelines tend to be followed by agencies. The ridiculous age buckets used by most COVID reporting agencies are HIPAA age buckets. They can actually be more granular if they want to be, but That Would Be Work. Employ
Wrong tool for the job [Re: HIPAA] (Score:2)
A lot of the HIPAA standards are designed for "normal" circumstances, not a giant pandemic. What's needed is Executive Orders and/or calling upon existing emergency & war related laws to temporarily bypass those regulations getting in the way of high volume and/or faster responses. The President should get in a (virtual) room with subject matter experts, both medical and tech, top party representatives, and work out a compromise with regard to speed and privacy.
However, the current Executive is dysfunc
Tech solution, if you can pay for it (Score:4, Interesting)
Comment removed (Score:5, Funny)
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The virus is transmitted by fax (Score:5, Funny)
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Users are advised not to handle any received faxes for a day or two..
Does it transmit better over fax or 5G?
Ontario Canada has the same problems! (Score:2)
Expanding this idea, the entire country should use one Open Source and Open Audit platform where doctors and nurses are assigned keys that identify and link them to hospitals, practices and patients, so to look
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The fundamental problem is that the wonderful thign about standards is there are so many to choose from.
Doctors, and the nurses, and lightly trained receptionists who actually do this stuff aren't generally technically savvy people. Deploying PKI, making it functional, is tough within a specific organization, and virtually impossible between organizations. Even in Canada, doctors offices are private businesses, each with their own staff, own technology provider, etc... OHIP, and BC's MSP, both I beleive hav
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Because we have no open, audited, ubiquitous way to do so. But if you want to use my solution for health records, voting, etc, I could make it work.
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in Québec we had exactly the same problem... hospitals report covid dead people via fax
and is EPIC MUMPS any better? (Score:2)
and is EPIC MUMPS any better?
Houston, you have a problem! (Score:3)
Just yesterday did I come across 500 sheets of paper that were still in an old moving box. I had to think for a while for what I actually might need them for ...
In the past could one never have enough paper. Printers and copiers had to be fed on a daily basis. We had entire pallets of paper parked next to the printers. Bosses could make employees happy simply by letting them take home some paper from the office. Some folks didn't even ask and just took some. They will know who they are ...
How things have changed. I'm glad one can be paper-free these days. Just what should I do with the remaining sheets of paper?! I could send them to Houston. One cannot let Houston have a problem.
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They FAX confidential information? (Score:2)
Hell, an email would be more confidential...
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Hell, an email would be more confidential...
Not really. I worked in an office that dealt with medical records; everyone had a clearance from a BI, we had secure dedicated fax lines; badges and door locks to prevent unauthorized entry. It probably would be easier to hack into our emails than get a faxed document.
Failure to prepare (Score:2)
Politics aside, the pandemic revealed a failure for the US to do any meaningful preparations for any sort of massive health outbreak. This crosses multiple administration, both parties, its a shared responsibility. Whether its classifying PPE as a strategic necessity or figuring out a game plan for massive-scale testing, track and tracing, criteria for closing border entries, etc. There's just nothing here. And we did have an opportunity with SARS and H1N1 to be reminded to take biological threats serio
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Why are we stockpiling 'X' every year and why are we spending all this taxpayer money on all this equipment and supplies that just sit in a warehouse 'just in case'? It's 'pork barrel spending', it's just benefitting a few companies! It's cronyism at it's worst and it has to stop! I move that we sell off all those useless stockpiles of supplies and equipment and not spend money on things we don't need!
(Not an actual example, just meant to represent the mindset)
It *IS* all politics.
BTW you can quit hacking on military spending. I could go on for paragraph after paragraph about the myriad reasons why a 1st world country like the U.S. needs a strong well equipped military, but I really don't have time to sit here and write a couple thousand words, look up all the sources and evidence needed to back up what I'd ha
Outdated, yes, but in some ways I don't blame them (Score:2)
It's not just medical and legal that are using way
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You can just use the security part of the internet to do all this. We have had VPNs for a very long time. You can create secure adhoc networks of nodes pretty much anytime. And we have plent of real world examples like the global stock & future exchanges, SWIFT, Whatsapp, etc. The whole "internet is insecure" is actually "humans are stupid" problem and it very much exists for Faxes... just no one cares.
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The fundamental issue is not security, it's a mix of legal precedent, ease of use, and interoperability. Like it or not, some court, 30+ years ago, decided that a faxed version of a document was just as good as the original. Thus far, there hasn't been a similar ruling on electronically signed documents.
I've done the whole signed email, PKI, and all that stuff, and even with modern tools it's still a pain. There are ways around this (various drop boxes etc...) but it's still a pain compared to just dumping
I'm kind of impressed and amazed at the same time. (Score:2)
I can't actually remember the last time I saw or even used a Fax machine - and I'm 52.
I spent a huge amount of time in my early career as an apprentice, where one of my tasks was to send documents over Fax and ensure I manned that machine to collect, collate and staple whatever came in.
Heck, I was a draughtsman for years working with pen and ink on film, using huge ammonia filled printers to churn out paper copies, using tape, methylated spirits, benzine, razor blades on a daily basis, whilst chain smoking