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Ontario’s finance minister says he will phase out fax machines in government — a long-overdue move to bring public services into the 21st century. He should be commended for pulling the plug, as our reliance on cumbersome devices is both archaic and expensive.
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Now, it’s time to take the next logical step and extend that mandate to health-care systems across the province and across Canada.
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Millions of medical records are faxed in Ontario every month, and approximately 20 percent of faxes sent to traditional fax machines fail daily due to outdated technology. Not only does this eat up hours of administrative work—a waste of healthcare spending—but it also leads to errors, lost patient information, and slows down the process of connecting patients to the health care they need. What is particularly troubling is that most of Ontario’s cancer screening programs rely on fax machines.
There is a huge gap between the technologies we use to treat patients and how we transmit health information. Doctors’ offices and hospitals use various electronic medical record systems to document medical history, but if they want to send a patient a prescription to a specialist or pharmacy, they often need to print and fax the paperwork.
This is the equivalent of drafting an email, printing it, and then mailing it to the recipient. The fact that so much vital health information is being spread like this is dangerous, and frankly, embarrassing.
Doctors have seen how inefficient fax machines are and many are vocal advocates for axing faxes in healthcare. Some integrated primary care clinics, like our own, are digital-first and work with other digital-first health-care providers, including online pharmacies. This means that when a patient needs a prescription, it is sent electronically to pharmacy partners through a secure software system. No fax cord required.
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However, the problem won’t be fully solved until all providers — including hospital systems — phase out fax machines and are able to send documents to each other electronically, even if they use different computer systems.
Large-scale software solutions that let health systems “talk” to each other. This technology already exists, we have also developed a solution.
Think of it this way: it doesn’t matter if you send an email through Gmail and the recipient uses Hotmail; They can still read your message. If we are able to email someone through our own servers, there is no logical reason why our health-care system should still rely on an outdated method of communication.
The pandemic has accelerated the adoption of many health technologies, such as telemedicine. It’s time to ax fax in healthcare once and for all, and fax machines where they belong – in the past.
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Dr. Parminder Singh is co-founder of Healthcare Plus, a network of digital-first clinics in Toronto, and managing director of clinical services at health technology company Think Research. Sachin Aggarwal is the CEO of Think Research.
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With Alexander Bain’s synchronization of two moving pendulums by means of a clock in 1846 and later Frederick Bakewell’s construction of synchronized rotating cylinders, the Italian physicist, Giovanni Caselli, was able to solve one of the biggest problems in image transmission – how to synchronize two machines at different locations. His result, the Pantelegraph, was an invention believed by many to be the ancestor of today’s modern fax machine.
A fax machine? Standing on the other side of the time scale in this age of AI, IoT and other high-tech acronyms, you’d be forgiven for thinking that fax machines are a relic of the 90s. However, this ‘old technology’ should not be overlooked in today’s modern IT environment, especially from a security perspective.
In a new discovery dubbed ‘Faxploit,’ Check Point researchers describe how organizations of all sizes, as well as consumers, could face intrusions by hackers seeking to exploit weaknesses in fax machine communication protocols. Furthermore, and perhaps more worryingly, the only information needed to do this is the organization’s fax number – which is often publicly available on any employee’s business card or company website.
This alarming investigation was conducted on HP fax machines, although the same fax communication protocols are used by other fax machine vendors and our team of analysts has every reason to believe that a similar exploit could be applied to other vendors’ fax machines as well. Our research team worked closely with HP to help deliver the patch, which has already been rolled out to most of their customers as an automatic update. Other fax and all-in-one printer-fax manufacturers, however, may still be exposed.
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Compared to the past, when fax machines were standalone devices, today they are one of the components in all-in-one office equipment to combine faxes, printers and photocopiers together. In fact, these multi-functional devices are part of the internal IT network of almost every organization, company or home, and even if they are used primarily as printers, their fax functionality is still capable.
With just one fax number as the only piece of information, however, our team of researchers was able to find inherent vulnerabilities in the fax protocol to gain access to the entire IT network. This introduces an entirely new attack vector to the fifth generation of the cyber threat landscape from which cybercriminals can target industries that hold the most secure data.
While this research focuses on all-in-one printer fax machines, all fax machines from all vendors implement the same communication protocols, and these devices may have the same vulnerabilities. Additionally, since popular online fax services, such as fax2email, are using the same protocol, the same risk may apply there as well.
Looking at a corporation’s basic network layout, it’s clear how exploiting a printer-fax device can lead to the conquest of the rest of your IT network. In fact, unfortunately, many organizations set up their IT infrastructure based on business and operational needs rather than security considerations and requirements. It is important to note, however, that our research also holds true for networks that are completely disconnected from the Internet. This is because the attack leverages telephone lines instead of the Internet.
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To explain, if all the printer-fax machines are connected, and, consequently, they are all connected to each other, then the attacker needs to enter one access point (in this case the printer-fax). Access the entire corporation’s network. From this point, through a process of lateral movement, the attacker will be able to hop from one part of the network to another, infecting a wider part of it as he moves. In such an attack, it would be a matter of seconds before the entire network was compromised and you had an intruder well embedded in your systems.
The diagram below shows the Faxploit attack flow, following which a threat actor can move laterally across your network to access your organization’s most confidential information. An important element to note is that most attacks today penetrate through a
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