Choke Point for U.S. Coronavirus Response: The Fax Machine

“There are standards that exist out there, but with the onslaught and the drastic increase in volume and the increase in the number of tests, they’re struggling to keep up,” said Jason Hall, who is the lead for the C.D.C.’s Laboratory Reporting Working Group.

Nationally, about 80 percent of coronavirus test results are missing demographic information, and half do not have addresses, according to Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.

“When things come in with missing information, we have to try to put the pieces back together,” she said. “We call the provider back or look at other data sources. But that takes time.”

The Trump administration issued guidelines in early June that required laboratories to report things like patients’ age, race and ethnicity, so public health officials can better understand the demographics of the coronavirus pandemic. The rules, which do not take effect until August, state that laboratories “should” also provide patients’ addresses and phone numbers but do not mandate it.

This type of information often gets lost, as the typical test data take a journey from doctor’s office to laboratory to public health authority and back to the original doctor, not necessarily in that order. At each stage, technological failures can slow or disrupt the flow of vital information. Doctor’s offices don’t always have digital systems capable of talking to the lab that analyzes the result. Laboratory software often omits information that public health authorities will later need. And transmissions by fax or spreadsheet can require workers to manually re-enter information into their computer systems, increasing the risk of errors or duplicate entries.

Some public health officials say they’ve been especially vexed by the ubiquity of fax machines, with their blurry printouts and analog data.

Large, national laboratories typically have software that allows them to communicate electronically with a wide range of hospitals and public health systems. But smaller labs, drawn to coronavirus testing by high payment rates, often don’t invest in expensive software packages when they can simply send data by fax instead.