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Fix this faxing hell! NHS told to stop hanging onto archaic tech

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Re: User story

You forgot:

4, Form committee to agree a document transfer requirement that meets health-data-2000 principles and ISO-FOO and health data standard BAR and Eu standard WIBBLE

5, Get quote from approved suppliers

6, Discover only Crapita is willing to tender - consider shooting self

7, Wait 5-10 years for solution to be delivered

8, Consider just emailing the document - consider what would happen to you, your team, your hospital if the Daily Mail find out.

9, Fax it

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Re: User story

You forgot to mention Print document first, as these should be on the PC already. If you're dealing with paper forms, you have other issues to fix as well.

4. Use a Service management type tool. i.e. a web site.

Launch browser, log in, click upload, select document done.

No need to scan in, as document should already be in electronic form, and process should be fully traceable (no paper receipt needed).

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Re: User story

so not a solution really.

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Anonymous Coward

Re: User story

I gave a solution for paper which I agree in itself is a problem.

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Re: User story

How about option 4 - set things up properly so users can easily email scanned documents?

4. Place document on scanner, select your name on the touch-screen, press scan. Go back to your PC and find the reasonably named document under the folder "Scanner" in your "My Documents" folder, right-click, then send as attachment. Done.

With modern VOIP phone systems, supporting FAX machines is an absolute nightmare. Yeas, I know T.38 and all that, but just try to make it completely reliable. We tried for about a year, and about the fifth time some executive comes in on a rampage about their FAX not going through, you give up and order an analog line. We run a consumer call center on VOIP, and yet our one analog FAX line costs about 1/2 of our total monthly phone costs!

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Re: User story

And that's the main problem with FAX, it's the all too often needed analog line. A modern equivalent would allow one to hit a FAX app on your mobile, take a picture of the document you want, and send it to the person in your contact list. How they choose to receive such communications is of no concern to you whether it be on their mobile, desktop, or some digital FAX-like machine. FAX machines either need to catch up and go digital or be shoved aside.

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Re: User story

You forgot to mention Print document first, as these should be on the PC already. If you're dealing with paper forms, you have other issues to fix as well.

There's likely loads of paper forms. When the ED overflows into corridors, junior doctors can walk up and down assessing patients. A clipboard and a well designed form is much more efficient than a laptop (likely with a dying battery). Now you could probably replace it with a tablet computer but you still have battery life issues, and you're going to spend a fortune on the conversion for what gain?

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Re: User story

You forgot to mention Print document first, as these should be on the PC already. If you're dealing with paper forms, you have other issues to fix as well. Fax over digital lines has been possible for years.

Also, for many of these folk they're likely using fax servers. So, with something like RightFax, they can fax a doctor and it will come in to their outlook mailbox as a PDF. The doctor can fax back from their computer if necessary.

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Re: User story

"Print document first, as these should be on the PC already."

If the document starts life as a written note on ward rounds are you saying that the Dr should type it up so it can be emailed? Or wait until a secretary should type them up?

Different situations give rise to different use cases. Different use cases have different optimal solutions.

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Re: User story

"FAX machines either need to catch up and go digital or be shoved aside."

Are you saying they should use a digital format such as TIFF?

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Re: User story

"Are you saying they should use a digital format such as TIFF?"

What happened to all that software which served as a FAX server, back in the day?

There were quite a few to choose from, back in the late 90s.

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Dig

Re: User story

"User story

You have three options:"

I suggest a fourth.

4, Place document on scanner, Select your email address from list. Walk to PC, open email in forward mode, write "here's attached docs you asked for". You can check first that you did of course put them in the correct way round, haven't been screwed up or lost in the in tray. Not only that but you can add a read receipt, send to multiple people at once. lots of other benefits as well.

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Bronze badge

Re: User story

A scanner can behave like a fax machine now? How does it prove receipt?

The reasons why fax is still used is:

1. Sending and recieving happen live, in REAL TIME. Mail is not real time. The two endpoints are in constant comms back and forth during scanning, sending and printing. If the fax machine at the other end breaks, the sending fax knows this. Email has some way to alert of delivery failure but its not able to tell you the email never got to the users inbox because the disk failed after the smtap server accepted the message.

2. You get a status report printed by the sending machine that will let you cover your arse when the other side claim you never sent it.

In basic terms the fax machine is the digital (i doubt many analogue ones are left about) version of a live phone call, only with images. Email is what it allways have been, the electronic version of paper post.

There however is something the NHS can use to replace fax. EDI. Electronic Document Interchange is a well defined standard for doing this sort of thing over almost any link from morse code to email or direct as2 connections. However, it is typically used for ordering and invoicing of products so im not sure if it is fully suitable.

To replace fax, you must replace fax. Not squeeze something that does half a job into the same hole because its more modern. You need a direct replacement.

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Trollface

Re: User story

Are you saying they should use a digital format such as TIFF?

Oh goodness no! I was hoping for something far more advanced, like WMF or BMP.

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Re: User story

"There were quite a few to choose from, back in the late 90s."

I know. I used them. It was a complete pain coordinating 3 lines with a lot of faxes to send.

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Re: User story

"Now you could probably replace it with a tablet computer but you still have battery life issues,"

A proper tablet with epaper will last for weeks, if not months. Stop being windows-centric.

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Re: User story

That analog line.

That still works when the network goes down ...

VOIP is OK, when it works, but it is less reliable than a simple phone line.

I'm guessing reliability may be a tad important in NHS?

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Anonymous Coward

Re: User story

> A proper tablet with epaper will last for weeks, if not months. Stop being windows-centric.

... and a paper form will NEVER run out of battery, although the pen might run out of ink!

Stop being a tech wanker!

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Bronze badge

Re: User story

Awaits fax machines being banned immediately with no replacement or plan to replace them.

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When the computers were brought down by that virus, I bet fax was the main communication system used between hospitals.

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Not the only Guvmint dept to use fax

About 2-3 years ago I had a little problem with HMRC (UK Inland Revenue). I had to fill in and sign a form and send it back to them. As I'd left it rather tight for time post-wise I phoned and said I could scan it and email it. I was told very firmly that they could only accept a fax. I said I hadn't owned a fax machine for years and asked what was wrong with email, she said, rather frostily, 'because of security...'

I hadn't the heart to tell her how many documents I'd seen faked on fax machines...

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Re: Not the only Guvmint dept to use fax

she said, rather frostily, 'because of security...'

Well, congratulations to someone at HMRC who understands that sending an email is like sending a post card - which can be read by anyone who handles it. I have been asked a large number of times , and refused, to email sensitive information; I ask what encryption they use ... generally they not understanding.

I have been using PGP/GPG (encryption for email) for years but most people do not support it. I suspect that the likes of GCHQ discourage it where they can - they like postcard-like email.

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Happy

Re: Not the only Guvmint dept to use fax

Some years ago in a land far away the customs wanted a form showing all the right signatures. So with a bit of cut and paste experience from the past I soon had a suitable prototype, then with a bit of artistic recreation the art work as ready and entrusted to the trusty(?) FAX machine. Honour done the customs then cleared the goods and everyone was happy. The contractor of the time wanted the original artwork to frame for his home office wall as a reminder of the good times he enjoyed in the land of the FAX machine.

Of course all those security minded folks do not remember the bloody awful paper that faded in 101 different ways, that jammed, that ran out at the wrong time and so on and so forth.

My local lot electronically transfer a lot of stuff point to point on their internal network not via the fred.bloggs.net network, pharmacists receive electronic prescriptions and place orders with the suppliers. I have even had MRI scans transferred that way. Better than the bloody paper files which are never in the right place when you make 60 mile round trips and pay a fortune for parking but cannot have a proper appointment, 'because the main file is missing'. Nothing too important of course, just what the references say is an aggressive cancer. I try again on Monday week, so one cancelled appointment, one useless appointment and now into week three. FAX was tired and useless in the 1980s that some clowns still have 1880s systems is their dumb fault, better not drop their quill pens into their damned FAX machines.

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Anonymous Coward

Re: Not the only Guvmint dept to use fax

There certainly was a time where a signature sent via faxed was considered to be an actual signature for legal purposes while an email of a scan of the same signature was only an image of the signature and did not in itself have legal standing (that the actual signed document ... or faxed version ... would have).

That's why a few years ago the David de Gea transfer from ManU to Real Madrid fell through when 10 mins before the transfer deadline when the transfer documents were ready to be exchanged the ManU office found their fax machine wasn't working so the "signatures" couldn't be sent to the relevant authorities in time to meet the deadline.

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Re: Not the only Guvmint dept to use fax

I once had the joy of attending a HR training course on checking an applicants right to work in the country. I was told that we could only take a photocopy of passports / visa documentation as scanning an electronic copy could easily be 'photoshopped'. Photocopies were more secure as they could not be altered. I tried to explain how a modern MFD works and that even taking a picture on a smart phone would offer the same level of security.

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Silver badge

Re: Not the only Guvmint dept to use fax

"About 2-3 years ago I had a little problem with HMRC (UK Inland Revenue). I had to fill in and sign a form and send it back to them."

The last time I needed a FAX from home, I'd already got shut of mine, so I set off for the local Post Office, which had one. On the way I spotted a café which offered the service, so used that instead.

That was last century though.

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Re: Not the only Guvmint dept to use fax

"There certainly was a time where a signature sent via faxed was considered to be an actual signature for legal purposes while an email of a scan of the same signature was only an image of the signature and did not in itself have legal standing (that the actual signed document ... or faxed version ... would have)."

There was a mindset back then that said a fax was a faithful replication of the original, while anything scanned into a PC could be easily edited, even if the user only had the default MS Paint app. And to an extent, that was true. Faking a fax took a little more effort with actual scissors and glue/tape.

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Silver badge

Re: Not the only Guvmint dept to use fax

I was told that we could only take a photocopy of passports

Are you sure you can take a photocopy of a document that Her Maj own's the copyright to ?

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Boffin

Re: Not the only Guvmint dept to use fax

"Faking a fax took a little more effort with actual scissors and glue/tape."

Scan it, photoshop it, print it, done. If you create it on a computer and feed it to a fax service, you don't even need paper.

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Re: Not the only Guvmint dept to use fax

"Are you sure you can take a photocopy of a document that Her Maj own's the copyright to ?"

If you are an expat it's quite normal that the immigration authorities of the country you are living in will want a copy of your passport.

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Re: Not the only Guvmint dept to use fax

Yes, well I have had about half a dozen companies in the last year ask for a photocopy or picture of my passport.

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Re: Not the only Guvmint dept to use fax

As I'd left it rather tight for time post-wise I phoned and said I could scan it and email it. I was told very firmly that they could only accept a fax.

When I was dealing with them heavily last year, it took a will fit them to receive a fax. No word of a lie. The fax was received immediately, of course, but it took a week to be passed to the correct department internally.

It's like they deliberately invented a ridiculously inefficient system.

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Re: Not the only Guvmint dept to use fax

I was more concerned seeing a Triage Nurse trying to extract a paper jam with a metal forceps while still plugged into the mains.

Not wanting to delay a Child's diagnosis and not wanting to see a Nurse kark it on ger own ward I offered to assist.

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Re: Not the only Guvmint dept to use fax

Why are Triage Nurses being still being plugged into the mains?

Can't you get wireless ones now?

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They'd still be using...

Daisy-chained 128k Spectrums and thermal printers if they could get away with it at Colchester General - but they're more expensive than the utter cack that's there now (and arguably more functional) so that's out.

I'm surprised they aren't using carrier pigeons (carrier ducks were tried (for messaging and mowing the hospital lawns) but the messages got soggy. Also bird flu).

More funding would help, but at this point that's all it would do. The NHS is like a stage 4 cancer patient - it's already dead, the world just hasn't quite caught up yet. In order to fix the problems you'd have to divorce it from any government control and monetary limitations for at least 2 decades and probably more, while growing services and reducing hours (while increasing pay) and hoping fervently that there isn't any crises while you are doing it. That's about as likely to happen as Cliff Richard converting to Satanism (not that he hasn't sent his fair share of souls to the dark side - Mistletoe & Whine on repeat for example).

And for fscks sake - STOP doing pointless operations on 85-90 year olds. Some of them have so many artificial joints that if they go swimming at Southend sonar operators end up with tinnitus, in the bloody Baltic! When you can diagnose cancers and other diseases in teenagers and young people who are or will be contributing to the NHS, treat expectant mothers properly and with respect, not to mention a GP service that hasn't ended up locked in an era when landcrabs roamed the earth (Morris, not Macra). Then, and only then, may you start doing heart surgery on the meatspace equivalent of Cohen the Barbarian. Oh and if a consultant can't find their ass with both hands please kindly sack them.

The NHS was a good idea and still is a good idea. The enactment of that idea however has been an unmitigated example of how not to do it - for so long fuckup-ery is permanently and terminally ingrained

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Anonymous Coward

Re: They'd still be using...

My Mother had both her knees replaced in her 80's. She lived until just shy of her 96th birthday in her own home. IF she hadn't had them done she'd have spent up to 15 years longer in a care home.

The Economic case for her knee replacements is pretty clear don't you think?

Mum got her message from the Queen last month and still gets around the care home on her own. Perhaps in your ideal world she'd have been knocked off by the state years ago.

Pah, Bah Humbug.

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Silver badge

Re: They'd still be using...

And that rattling noise wasn't the big ends on my old Sceptre, it was you missing my point.

Yes, the operation helped your grandmother, one of them helped my dad and a new hip helped a friend of his who is one of the few people on the planet I have respect for. But both my father at 65ish and Peter were still working and contributing. My gran was refused a hip operation which arguably led to a fall which ripped her leg open and destroyed the sight in one eye. The other grandmother was murdered by the No Hope Service...

They'd paid all their lives and were refused help or given wildly inappropriate medication by the NHS. I was well on the way to being killed by NHS doctors prescribing me medication that I shouldn't have been within 100 yards of - multiple times (although on the upside I'm no longer allergic to cats).

Lucky old your grandmother, and <insert deity heres> speed to her. But if she or someone like her getting money for a transplant meant that my partner got a second rate (let's be honest here, sixth rate (technically 10-15 guns, but you know what I mean)) oncologist who cost her her life at 22... Then I'd be asking Dickie Briars to hand me the Uzi.

I'm not in any way against the elderly - they're the best resource a society can have - especially with some of the sub average cretins in the latest batch - but there comes a point when welding up old grannies is like welding up old Allegros - it's a cost benefit analysis. When someone has a memory that lasts a shorter time than the 0-60 of the average Tesla - and a bladder to match, do you really think it's a good idea to try for a quadruple bypass. Or would it be better to use the same money to fund cancer treatment for a teenage abuse victim...?

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Re: They'd still be using...

"And for fscks sake - STOP doing pointless operations on 85-90 year olds. "

Ok. But you get to be the one to tell each and every one of them why they can't have the operation. Especially the generally fit and healthy ones who are still active, driving and looking after themselves quite nicely thank you.

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Re: They'd still be using...

Even the most expenses implant, some device they stick in the heart, cost about 30,000 ground, only need to keep the patient in their own home for about 2 years for it to pay for it self, just 2 years.

Knee, hip and other artificial joints that keep the elderly in their own home are no doubt even more cost efficient. Some of them only cost a thousand pounds each. This is why we have NICE to actually work through all these costs and see what is cost beneficial and what isn't.

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Re: They'd still be using...

"Especially the generally fit and healthy ones who are still active, driving and looking after themselves quite nicely thank you."

And, let's add, also looking after grandchildren so their own children can hold down a job. Although I suppose if the grandparents weren't there to look after the kids the kids could be sent into the factories to clean the fud out from under the spinning frames or down the mines to open the doors for the tubs to be pushed through.

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Anonymous Coward

Re: They'd still be using...

> And for fscks sake - STOP doing pointless operations on 85-90 year olds.

Spot the Tory twat! I claim my £5

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Devil

FAX - They are like toilet paper...

...stuck to your shoe. I heard the last FAX machine in some office in the building finally died! It spawned itself two fold...Yes, there are now two, two I say! HOW is this moving forward with technology and security?

I've heard the phrase "Kill it with fire!" bandied about, I'm afraid that it's like feeding gremlins after midnight!

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Re: FAX - They are like toilet paper...

I think you mean getting them wet. Feeding a mogwai after midnight, but for gremlins, it's getting them wet.

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Pint

"baa-ruhr-reee-uh-reeee-uh-reee"

May I also give a warm welcome to Kai; last of the Brunnen-G.

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Anonymous Coward

The name that stands out in the BBC version of the article

"The survey follows a report last year by artificial intelligence company DeepMind Health which named the NHS as the world's largest purchaser of fax machines."

Deepmind can't slurp Fax machines as easily! For sure the NHS needs to modernize, but you have to look at the wider agenda behind things. Who are the messengers here and what's the message? We know Google Facebook like to bury / promote research that suits their world-view!

https://www.bbc.co.uk/news/health-44805849

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Big Brother

Re: The name that stands out in the BBC version of the article

Deepmind can't slurp Fax machines as easily!

I was just going to say that I've never seen a fax machine hacked, encrypt stuff and then ransom people, etc.

What do you suppose the cost/benefits of ditching the faxes would be?

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Re: The name that stands out in the BBC version of the article

10 minutes with the manual to change the header info that gets printed on the top of the page to indicate a difrrent originating number and company... 10 min in Photoshop producing a fake letterhead and you can fax anyone in the world pretending to be someone else.....

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Re: The name that stands out in the BBC version of the article

.. until the phone records are verified ....

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Anonymous Coward

Re: The name that stands out in the BBC version of the article

With VoIP hacking, those can probably be faked, too.

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Anonymous Coward

At a guess, it'l be the eye watering amount

of handwriting the NHS seems to run on which is driving the "problem".

(well, I say "handwriting" in the loosest sense).

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