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Comment by codingdave | Hacker News Reader

Back when I first started working in tech, in the early 90s, up to when I left enterprise IT in 2011, email-to-fax gateways were a thing. You just emailed a specific address format, something like: 999-999-9999@your.fax.gateway, and the email server would send an image of the email and attached documents to that number, via a connected fax machine. Likewise, incoming faxes to your number were received as images in an email.

Do those things no longer exist? You would think, if anything, that would be easier today than it was 25 years ago.

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Inane bureaucracy and primadonna users make change difficult.

Doctors can’t be bothered doing anything differently, and they often don’t work for the place they are providing service at, and don’t have reliable access to email.

As doctors get swallowed up by medical networks/cartels, fax will shift to EMRs and patient portals that will leave you wishing for a fax machine.

> Doctors often don’t have reliable access to email.

Why? It would be very unusual for a doctor in a wealthy country not to have a smartphone with service, or the ability to get one.

HIPAA requires any email with patient data be encrypted. That kills any attempt to receive email on a smart phone.

[Repeat rant about people not adopting PGP when we've had it for 27 years]

Nothing about a smartphone prevents email from being encrypted. The fact that nobody's sending encrypted email does, but that's a user adoption problem rather than a technical problem. The technical problem is solved, solved well, and has been solved for decades.

Encryption is easy. Key management is not. PGP is a lousy solution. Too difficult to use and sacrifices too much functionality.

The world needs something like iMessage but more open.

Key management is moderately difficult, and more of a UX problem than a technical one. A UX very much like that of iMessage could be built on top of PGP and keyservers.

We've had the ability to do this for a long time, but only a few major players are in a position to ensure sufficient user adoption, and they're not interested in creating anything that doesn't drive users to their walled gardens.

The bigger problem is that neither Apple nor Google have implemented device-local PGP encryption in their default email clients. Apple is one-step ahead and actually has had s/mime support for a while, but it really needs wide support on Android phones as well to become ubiquitous. It would set an implied standard for all other email apps on iOS and Android.

If you’re in a hospital, a doctor has privileges there, but is often not an employee.

You also have the scenario of unaffiliated doctors... your GP doesn’t work with your urologist, and they do not have a secure way to communicate.

It is possible to use things like Zix or other “secure” email solutions, but all are painful and all will vary from organization to organization.

I think that was a common and pretty simple thing to do back when businesses still had modems and POTS lines — there were several popular FOSS and commercial solutions for setting up your own local fax gateway (print-to-outgoing-fax and incoming-fax-to-email being how I remember them working). By the late 90s most consumer modems could handle faxes.

I think the persistence of the fax is almost entirely a social problem, not a technical one. This article links to another, which contained this statement I found fascinating:

> Lately, doctors have taken to hand-delivering the most important records. > > “We used to fax the labor and delivery records, but they didn’t get > them or they were misplacing them,” says Hilda Moreno, who manages > the office’s medical records. “We kept getting calls like, did you > send this? And we’d say we did. So we started printing them out.”

They absolutely exist. A previous company I worked for had the same system as a legacy product but it still got plenty of traffic.

We also had fax -> email. Believe it or not there were plenty of accounts sending email -> fax which they had configured to forward using fax -> email. ‍️

They incured costs on both ends rather than just sending an email. Stupidity knows no bounds...

eFax had some patents that it used aggressively for a long time to shut down competitors, though it looks like the main one expired recently.

https://news.ycombinator.com/item?id=16660890

Twilio has a Fax API: https://www.twilio.com/fax

We had issues faxing rural areas through Twilio, like their SMS offerings (which lack shortcode support) it seems to be a partially baked solution. I asked them about it at SeaGL in Seattle, and the staff at their booth had few suggestions.

Idk about the fax issues in rural areas, I'm sure it's possible cause fax is hard, but Twilio definitely has SMS Shortcode support.

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