Fax ban brings chaos to Austria's healthcare system

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The abolition of fax machines is causing chaos in healthcare in Austria. A fax ban has been in force there since the beginning of the year for data protection reasons. There are apparently no exceptions for encrypted fax transmissions, and such devices are rare anyway. Warnings from healthcare staff about difficulties without faxes were thrown to the wind. Now the excitement is great.

This is because there are problems with communication between hospitals, doctors in private practice and insurance companies. In some cases, findings and similar documents on data carriers such as USB sticks or CD-ROMs have to be transported by courier services, cabs, or even ambulances. This causes waiting times for patients and practitioners alike and forces operations to be postponed. Der Standard reports that faxes are still sometimes used as an emergency solution because the new communication system has failed.

Fax “was the preferred form of communication for all large parts of the healthcare system, i.e., hospitals, doctors in private practice and social insurance companies,” confirms Andreas Krauter from the Austrian Health Insurance Fund (ÖGK), the provider of the Austrian compulsory insurance, to ORF (Austrian Broadcasting Corporation). ÖGK has been providing a web browser-based system as a fax replacement since December 15. It runs on cloud servers from the company FTAPI (File Transfer Application Platform for Integration). The servers are located in Germany.

German cloud servers “extremely complicated”, incompatible

However, the Austrian medical profession is annoyed that this system is mostly incompatible with the IT systems commonly used in Austria. There is also a lack of usability: “It is extremely complicated to use, impossible for hospitals and hospital doctors, for example,” criticizes psychiatrist Dietmar Bayer, Vice President of the Styrian Medical Association, in an ORF interview.

Of course, FTAPI is not alone in this. A study of the changeover from paper to an SAP system at a surgical department of a hospital in Graz came to a devastating conclusion: while doctors were able to spend more time in hospital rooms, nursing staff were more occupied with electronic documentation and were less able to look after patients. In terms of usability, the SAP system failed all user groups. The authors of the study recommend that healthcare staff should be involved right from the development phase and workflows should be considered.

FTAPI entries are made via the Internet: The user has to draw a ticket on a website, whereupon a hyperlink is sent to them by e-mail. This link, opened again in the web browser, then allows documents to be uploaded. After 90 days, uploaded data should be deleted automatically.

New proposal: e-mail

Last week, the Medical Association made a new proposal at a crisis summit: the so-called “directed transmission of findings”. It should work like e-mail, but with data protection, and only between e-mail addresses that are registered in a separate directory of medical service providers.

The ÖGK is cautiously open to the proposal: “We are all in favor of an even better solution for Austria,” says Krauter, “but this must first be proven and discussed.”

The ban on remote copying does not come as a surprise; it was actually supposed to come sooner. However, during the coronavirus pandemic, the ban was postponed until the end of 2024. The problems are just as unsurprising, but the alarm raised by doctors has apparently gone unheard.

ELGA construction site

Speaking of ELGA: The Austrian Court of Audit was harshly critical of the implementation of electronic health records in the fall: For “meaningful use of the ELGA core application 'eBefund', a complete recording of findings by healthcare providers is needed. However, at the end of 2023, eight years after the ELGA rollout, essentially only the (…) hospitals were writing eBefunds.”

Accordingly, there is no central data storage and therefore no central search. According to the report, the data is distributed across 13 storage areas, none of which is intended for private practices. There is also a lack of structured file formats for specialist medical findings. Radiological image data or laboratory data from private practices were not stored anyway. This is due to happen in July 2025. The ACA's recommendation: “Preparation of data in a structured and easily searchable form”. Dentists will remain excluded from ELGA for the foreseeable future.

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