Not Just Faxes

By Kim Bellard, October 21, 2020

I missed it when it was first announced in Japan, but fortunately the U.S. mainstream media has finally picked up on the story, with articles in both The Washington Post and The Wall Street Journal: Japan’s new Administrative Reform Minister Taro Kono has “declared war” on fax machines, among other paper-based traditions.

Wait, what? “Administrative Reform Minister?” The U.S., or at least the U.S. healthcare system, has to hear about this.

Mr. Kono set up a hotline for people to report government red tape, which was quickly overwhelmed with thousands of examples. It soon reopened.

It didn’t take long for Mr. Kono to start calling for significant changes. “To be honest, I don’t think there are many administrative procedures that actually need printing out paper and faxing,” he said in a press conference in late September. “

Part of the problem in Japan is the hanko, a personal stamp that is routinely used for authentication (and which thus requires paper.)

If you’ve ever envied Japan for its bullet trains, its early adoption of robots, or its broad use of consumer electronics, you may be surprised to hear that more than 95% of Japanese businesses still use faxes, and 34% of Japanese households have a fax. Mr. Kawaguchi admitted: “It may be 1970s technology, but it is extremely secure and very difficult for someone on the outside to hack…Digitisation may make things more efficient, but there is clearly a trade-off when it comes to security.”

Not surprisingly, the COVID-19 pandemic has been a big driver in the anti-fax initiative. Health care professionals were overwhelmed by the amount of reports that had to be prepared by hand and then faxed. “Come on, let’s stop this already,” one physician tweeted. “Even with corona, we’re handwriting and faxing.” Mr. Kono quickly retweeted it, even though he was still in his former position as Defense Minister — and within a week the health ministry announced a system of online filing (which, not surprisingly, has not entirely succeeded).

An independent report on Japan’s response to the pandemic found that their system “made it difficult to grasp the spread of infection in real time nationwide, and exhausted health center staff. The new coronavirus crisis was also Japan’s ‘digital defeat.’”

We don’t have hankos in the U.S., and we’re not as reliant on faxes as Japan is, even in our healthcare system. But red tape, inefficiencies, and antiquated technology? Yeah, we’ve got all that, especially in healthcare. But where’s our Secretary of Administrative Reform? Where are our Chief Administrative Reform Officers?

Heck, where are our hotlines to report red tape?

Even now, well over six months into our pandemic response, we have a slapdash, state-by-state (or even county-by-county) system of reporting, with hospitals and HHS still struggling to figure out what and how to report.

Yoshimitsu Kobayashi, chairman of Mitsubishi Chemical Holdings, sees the pandemic as an opportunity: “The very negative damage it has inflicted on Japan has in turn served as a powerful accelerator. If we miss this chance, we won’t be able to do it next time.”

Economist Paul Romer is usually credited with the quote, “A crisis is a terrible thing to waste.” Well, we certainly have a crisis, and I’m worried we’re going to waste it. Using it to just get rid of faxes would be a waste. We’re already using it to streamline development of therapeutics and vaccines, although not without problems. But will we use it to solve fundamental problems in our healthcare system, such as inequities, inefficiencies, and infrastructure?

Maybe we could recruit Mr. Kono to do the job.

This post is an abridged version of the original posting in Medium. Please follow Kim on Medium and on Twitter (@kimbbellard)