Faxing in Japan: Anything but a relic

My fellow programmers bemoan the dastardly fax machines in our office.  They are slow, there are always problems like “Only half of the page came through”, busy signals, out-of-service numbers… they all add up to describe a system no one would ever choose in this day and age. And we don’t. Many successful EMR systems HAVE closed that paper gap already and are proud of it. We are weeks away from being there, as well.

However, according to an article in the New York Times, a large contingent of the Japanese population prefer faxes to other types of modern communication.

In Japan, with the exception of the savviest Internet start-ups or internationally minded manufacturers, the fax remains an essential tool for doing business. Experts say government offices prefer faxes because they generate paperwork onto which bureaucrats can affix their stamps of approval, called Hanko. Many companies say they still rely on faxes to create a paper trail of orders and shipments not left by ephemeral e-mail. Banks rely on faxes because, they say, customers are worried about the safety of their personal information on the Internet.

If the Times article is representative of the Japanese sentiment, this might make sense.  However, the article does not mention this phenomenon in Health IT so I looked around. I found a BBC article and a Wall Street Journal article that echo the Times article.  The WSJ journal explained

[the] reason is that computers, at the outset, never worked well for the Japanese. The country’s language — a mix of three syllabaries, with thousands of complex “kanji” ideograms — bedeviled early-age word-processing software. Until the early 1990s, Japanese was nearly impossible to type. Even today, particularly for older Japanese people, it’s easier to write a letter by hand than with a standard keyboard. Japan also relies on seals, called “hanko,” that are required for most official documents.

The BBC added that part of the cause was that Japan’s population is an aging one, where older people are more reticent to give up their paper and the subtleties of communication and respect in a handwritten fax.

One more report by John Halamka, a leader in health IT reported that

Japan has a state-of-the-art wireless and wired networks, arguably the best in the world. However, few hospitals and clinicians use this infrastructure to exchange heathcare information, coordinate care, or engage patients/families.

He doesn’t say the word “fax” but I suspect that this is what he is talking about.

Maybe the HIT community will get to bypass the days of HL7 2.x and live happier lives because of it!



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