The Creaky Fax Backbone

Due reasons of proximity to our family doctor and loyalty to a locally-owned pharmacy, we have our prescriptions filled at Murphy’s Parkdale Pharmacy.

Murphy’s is nominally a member of the Guardian pharmacy group, and through that connection it supports using the Diem mobile app for requesting prescription refills.

It turns out that rather than a bona fide end to end digital system, requesting a refill sends a fax to the pharmacy.

On the other end of the equation, when renewals expire and the prescribing doctor needs to update the prescription, the pharmacy sends a request to the doctor. This request is sent by fax.

It’s remarkable that a mission-critical system is built on an ancient technology that amounts to a telephone-based network of remote printers. We once talked about building an online pizza ordering system using the same setup, but that was in 1995.

In my case, this creaky retro tech was exacerbated by the pharmacy having the wrong fax number for our doctor in their system, and so repeated faxes requesting approval for renewal went undelivered. But nobody knew that, because faxes.

I didn’t know that until today, though.

Last night I used the app to request a renewal, and everything went through without issue, but when I arrived at the pharmacy to pick it up this afternoon, it was nowhere to be found. While the pharmacy clerk was looking into the issue, one of their colleagues called me to tell me the prescription had expired and couldn’t be refilled.

The prescribing doctor is out until next week. Our family doctor’s office is closed. What to do? Fortunately the pharmacist had the discretion to issue a “continuing care” supply to keep me going.


Andrew's picture
Andrew on May 26, 2021 - 18:54 Permalink

...and this explains exactly why my work used to receive prescriptions. It’s insane that such a critical component of personal health care is built on antiquated infrastructure.

Theses facsimiles used to show up with peoples’ personal information and medication information (type, dosage, etc). So much for privacy.

David Fleming's picture
David Fleming on May 26, 2021 - 20:40 Permalink

Having spent some time in health informatics, fax is positively post-modern. So much of our modern-ish innovative e-health infrastructure sits on a patchwork of COBOL servers and legacy systems with one vendor left who effectively have a permanent contract maintaining a system nobody can (or wants to pay to learn to) migrate from.

Maryanne Fitzpatrick's picture
Maryanne Fitzpatrick on May 27, 2021 - 08:09 Permalink

Our faxes are now received on computer, which is a start. E prescribing is not legal here yet, as with most jurisdictions in Canada presently. Physicians will require software to do this, which can sometimes be the bottleneck.