These requirements for faxing are becoming almost silly. Not only is the PSTN infrastructure in some areas so bad (40 year old corroded copper lines and such) that there are potential problems every time it rains, but incumbent carriers are trying to do everything they can to rip down what is left of the copper infrastructure. I don’t blame them as this makes practical and financial sense (remove copper phone lines, replace with fiber, offer data and voice through the fiber).

The dream is that the PSTN will be done away with entirely, with all traffic going through the internet.

A big problem is with fax machine manufacturers simply claiming that their machines “are not voip compatible” which is ridiculous, but the extra effort involved with getting faxes to work smoothly over voip can be a nightmare, and not something any vendor wants to be involved in supporting.

The result of this is clients with $15k fax machines reporting a myriad of problems, which the fax machine vendor claims that the only solution is a PSTN phone line for the machine, which in many areas is no longer possible due to the incumbent carrier phasing out the infrastructure or making it incredibly difficult to obtain.

There are a lot of “Efax” services whose purpose is to get around this problem by making the “fax” step just a transparent formality to appease regulatory constraints. Users can send an email with a specially formatted subject, then the “efax” company will actually “fax” the document specified in the email to a phone number owned by the efax company, which is then emailed to the intended receiver.

IT Manager of a large medical centre in Australia here. I've been spending quite a lot of time trying to minimise the number of faxes we send and receive but there's only so far I can go.

Email and fax-to-email services are generally frowned upon by the relevant medical accreditation boards, as they consider these to be insecure unless PGP is used. Email addresses have the ease of use and interoperability that fax numbers have, but PGP throws that right out the window.

Beyond the technical discussion, I remember reading that fax is considered "secure" from a regulatory/legal standpoint because fax lines are subject to wiretapping laws just as a regular phone line is. An email however, sent in plain text, can be legally read by anyone along the line who has the authority to do so. No surprises there, we know what GMail does.

What we've ended up with in Australia is a trio of internet-based secure messaging systems which have only just recently been in discussions about interoperability between themselves. I believe two of them are just end-client software which automates the PGP encryption/decryption of a given email address that you register, sending and receiving directly from your practice's clinical management system. Uptake has been kinda miserable. Until the systems are interoperable and have a large centralised directory of all health practitioners in the country, uptake will remain low. It's also only for medical practices and hospitals. It doesn't cover all the crap we get from legal and insurance firms.

Other legal issues are also stymieing progress. I have been told specifically by the CEO of a large specialist group that they won't be using any of the above systems, because having the software available means they might get electronic referrals directly from GPs.This would be instead of paper referral letters that simply go with the patient. This changes the legal onus of who is responsible for following up with patients who don't make that specialist appointment when referred. It matters when a patient decides not go do anything with a given referral, and then finds out they're terminal months later.

And so, we fax and get faxed. And it sucks.

To me, a person that doesn't (and never did) live in the US, faxes there seem to be even more ubiquitous than this article paints. Imagine my amusement when I registered an Amazon account only to get it suspended with the request to verify it by... faxing bank statements and whatnot. Internationally on a +1 number. [0] And yes, support was not been able to offer any alternative to that.

[0] https://www.amazon.com/gp/help/customer/display.html/?nodeId...

It's that "Faxes" are //exempt//, they are, by far:

    * Obsolete
    * Insecure (no encryption in transit)
    * Insecure (no recipient validation)
    * Insecure (no validation of sender or data integrity)
    * Horrid quality (200, maybe 300, DPI, monochrome)
    * Like PTSN interlinked phones, fairly ubiquitous.

Sadly, that last line item there is why they still exist.

The exempt status also precludes any real attempt at security which makes 'fax the thing' quick and easy for untrained end users. Fire, and forget until someone pokes you about a failed fax, or even claim you tried and just assume gremlins ate all record of the first (never happened) actions.

There's also not a /ubiquitous/ replacement. The mere cost of telephone calls and duration makes blindly trying to fax out spam that way not-cost-effective (plus the negotiation of fax technology inhibits just recording a dumb audio file to play against VoIP lines). Email is practically free, but HORRENDOUS for file transfers, and at any corporation where data retention is required for legal discovery holding on to EVERY file transferred forever is hell.

While some better standards do exist, they aren't ubiquitous and often require 'non standard' software (mostly because Microsoft is highly allergic to any protocols/formats not invented by them).

Also, it needs to be part of the /default/ OS install. It would be really great if Windows Explorer (the desktop shell) understood SFTP (SSH file transfer).

If someone was to build a device that could clamp on to the phone line and listen for incoming faxes and copy the signal and sent it of to a remote server, would that force us to rethink the use of faxes? Sadly I think the answer is no.

One argument that could be made for the fax is the lack of availability. Some government office in Denmark have been known to email sensitive information to wrong email addresses, because of poor spelling. Some guy owns anders.dk and have a catch-all email address, and employees of the city of Randers sometimes do check that they actually typed randers.dk and not anders.dk. That guy receives have received a boat load of sensitive data. The solution is to block his domain in the citys Exchange server.... Yeeeah.

Neither fax, phone or email is particularly well suited for transmitting sensitive information, but the fax is seen as more secure, because when was the last time someone received a fax by mistake.

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.

Only if your telco still supports it.

In Australia, perhaps not.

Our home phone service was moved from copper to VOIP as part of the NBN rollout. The technician who did the installation confirmed our multifunction laser printer would no longer fax, as the network didn't enable it.

> Law and Medicine Still Rely on the Device

And a vast number of businesses in Japan, unfortunately

My desk phone at work has automatic inbound fax detection and reception. And one of the local medical firms has a phone number with a prefix that is one digit off from my desk phone direct line. You can guess what happens.

It's kind of amazing what kinds of things they will put in a fax. Stuff I would find very personal, for sure, and wouldn't want to have faxed around carelessly.

I just dealt with American Public Life. I had to mail or fax (I went mail, fax is harder for me) all my forms and documents to get a claim started. Several days later, I was able to see that my claim required more information online by manually checking the site several times a day, no email notice about a claim update, I also got a notice in the mail 3 days later. I was able to ask them, via a contact web form, "is there a way to send docs electronically?" to which I got a "secured" reply to my email via "proofpoint" stating I must mail or fax all documents. Noticing there was an option to attach a file in proofpoint system, I ignored the requirements and sent the PDFs anyway. They accepted them but with a stern warning that I should mail or fax all documents if I want to ensure they will be associated with my claim. All this printing, signing, mailing, waiting, waiting, waiting, rinse, repeat, is a huge waste of resources and human life.

It makes me wonder what other legacy telecom systems are still in use somewhere.

Are there any public X25 networks still in use? What about telex? Telex over HF? Inmarsat C? Any X400 gateways still running? Can you still send a UUCP mail?

This kind of digital archaeology has a strange fascination to it.

During the hiring process for my previous internship a problem with my credit score was discovered (equifax had someone else under my SIN). This ended up delaying my start date.

The only way to fix it in any "reasonable" (weeks) amount of time was to fax them a bunch of documents.

Fax is not more secure than email.

Japan still loves its faxes. Gotta maintain a sense of tradition, I guess. Take pride in doing things the same way their forefathers did.

Don't forget that in the US utility bills are still often used as proof of living address. signatures are compared in some cases of identity verification (e.g. voting). Paper checks are still used as means of payment, even in retail.

It's hardly surprising that fax machines are still used.

My company deals with medical professionals and we absolutely need to maintain a fax line. The IRS loves faxes, too.

I noticed real estate also heavily relies on it. Everything still seems to be done with paper and fax.

I keep an account at Anveo for incoming and outgoing faxes. It's very cheap. $2/month, I think, if you just need a phone number that can send/receive faxes. There's a simple web interface to send a pdf as a fax.

My insurance company mailed me a pdf to make a claim but they made me snail mail my printed copy with signature on it to them, they said they would have accepted a fax but would never accept an email with a photo of the same documents.

Purchasing departments still use fax also. Where I work, most purchase orders with established vendors are sent by fax.

It is still omnipresent in Germany.Even startups have to use (usually just a cloud service).

FAXes have legal standing in California. As much as I hate supporting them :-)

And I’ve had two employers furnish me with pagers.

And I bet they use Microsoft Windows.

> I have been told specifically by the CEO of a large specialist group that they won't be using any of the above systems, because having the software available means they might get electronic referrals directly from GPs.This would be instead of paper referral letters that simply go with the patient. This changes the legal onus of who is responsible for following up with patients who don't make that specialist appointment when referred. It matters when a patient decides not go do anything with a given referral, and then finds out they're terminal months later.

Oh my. The unexpected legal implications and associated perverse incentives. Thanks for sharing that!

Reminds me of what I heard about information security space, where some large companies don't want to know their risks too well, as if something would happen, they wouldn't be able to say "we didn't/couldn't have predicted that".

Why not have an official secure data exchange layer, so that when one hospital wants to talk to another one, they all do it using this secure channel, not by sending e-mails or faxes.

Like.. the one Estonia has and uses for all the government services, registries and hospitals.

https://en.wikipedia.org/wiki/X-Road

Source: am Estonian.

So weird seeing other countries doing backwards things.

I wonder how this squares with the NBN, given that, once activated, the traditional phone line ceases to exist, and you use VoIP instead. And that the POTS will be entirely deactivated (in theory) once rollout is complete.

Doesn't Medical Objects try to end this insanity without email or fax involved? Or are they the ones with email+PGP in the background?

Is anyone in Australia using Direct Project secure messaging? It should meet the legal requirements and is easier to use than PGP.

http://wiki.directproject.org/Main_Page

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.

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