Austin's COVID-19 Case Count Is Slow, Making Contract Tracing Ineffective. Blame The Fax Machine.

Jun 23, 2020

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As Texas sees record spikes in new coronavirus cases, Austin and Travis County's accounting for infections is lagging. A record-breaking surge in cases is partly to blame, but there's another culprit: the fax machine.

Austin Public Health's interim Medical Authority Dr. Mark Escott told county commissioners Tuesday that the current system of inputting data is reliant on "archaic" tools like the fax.

"This is a very manual and archaic process of getting information out, and we're struggling with that," he said, "and we had a call this weekend with jurisdictions across the state who are struggling with that."

While some testing providers have migrated to a digital system, many still fax each test record over, and it is then manually inputted into APH's database. Escott said staff enter more than 1,000 faxed test results a day.

If there's a question about positivity or other circumstances, there's a back-and-forth and, usually, another fax.

That back-and-forth has hamstrung contact-tracing efforts, delaying some results by as long as 10 days – which is particularly problematic if a patient doesn't have COVID-19 symptoms. That, in turn, further impacts the health authority's ability to bolster testing at hotspots like construction sites or among Latino communities, Escott said, which are experiencing an outsized impact of the coronavirus.

"It is causing a backlog, which is impacting people's notification that they're positive and it's impacting our ability to contact trace in a timely fashion," he said. "Right now, it is not uncommon for us to have a week to 10 days between when a person is tested and when their case is entered into the system so they can be called."

Escott said that lag amounts to a "wasted investment" in contact tracing statewide, as the system doesn't allow for efficient notification or investigation on the part of the health authority.

"My sense is [other jurisdictions are] all in the same boat," he said.

On Monday, Austin saw 129 new COVID-19 cases – a number Escott said "is not reflective of the cases we have" because of the slow system.

Escott told Precinct 2 Commissioner Brigid Shea that he and other APH staffers inputted data all day Sunday. 

"That's like a third-world technology. Most young people don't even know what a fax machine is anymore. It's like a teletype or something. It's archaic," Shea said. "Seriously, it is so crude, I am horrified to hear this."

Escott said while the state requires a digital database, testing providers and doctors offices haven't migrated en masse to a digital system.

"The state has required digital reporting," he said. "Unfortunately, that hasn't translated into it happening."

Escott noted APH has developed its own digital accounting for local outbreaks at nursing homes and long-term care facilities, however.

A provision of the Affordable Care Act attempted to drastically expand electronic health care records and put $30 billion toward that effort. A number of hospitals and providers ultimately set up their own, siloed record-keeping systems, but the use of fax machines to share data with other providers persisted.

Got a tip? Email Andrew Weber at aweber@kut.org. Follow him on Twitter @England_Weber.

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