Obsolete communications technology

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"Choke Point for U.S. Coronavirus Response: The Fax Machine", NYT 7/13/2020:

The machine at the Harris County Public Health department recently became overwhelmed when one laboratory sent a large batch of test results, spraying hundreds of pages all over the floor.

“Picture the image of hundreds of faxes coming through, and the machine just shooting out paper,” said Dr. Umair Shah, executive director of the department. The county has so far recorded more than 40,000 coronavirus cases.

Some doctors fax coronavirus tests to Dr. Shah’s personal number, too. Those papers are put in an envelope marked “confidential” and walked to the epidemiology department. […]

Health departments track the virus’s spread with a distinctly American patchwork: a reporting system in which some test results arrive via smooth data feeds but others come by phone, email, physical mail or fax, a technology retained because it complies with digital privacy standards for health information. These reports often come in duplicate, go to the wrong health department, or are missing crucial information such as a patient’s phone number or address.

This is one of many ways in which the biomedical area is decades behind the times. And the excuse that this "complies with digital privacy standards for health information" is an increasingly feeble one, given the existence of various modern HIPAA-compliant storage and transfer technologies, which have been technically feasible for many years, but are well documented and easy to use now.

I'm reminded of the punchline of this recent Questionable Content strip:

Or the various university administrative apps where the "save" button (which you need to press or all your work will be lost) is a 16×16 image intended to represent a floppy disk…



41 Comments

  1. Philip Taylor said,

    July 13, 2020 @ 8:41 am

    You mean something like this ? That is the "save" icon from Adobe Acrobat DC (as up-to-date as possible), and I would not regard Acrobat as solely "an administrative app" …

  2. Joe said,

    July 13, 2020 @ 9:04 am

    As technical feasibility of digitalization grows, so does the risk of cyber attacks. The AWS link you provided was the result of the myriad ways AWS can be attacked – and, very definitely, the medical industry has been a href="https://www.beckershospitalreview.com/healthcare-information-technology/hospitals-are-hit-with-88-of-all-ransomware-attacks.html">a major target.

    FAX, as an archaic form of technology, is not vulnerable to the attacks mentioned above – that's why it is still being used.

  3. Joe said,

    July 13, 2020 @ 9:06 am

    As technical feasibility of digitalization grows, so does the risk of cyber attacks. The AWS link you provided was the result of the myriad ways AWS can be attacked – and, very definitely, the medical industry has been a major target.

    FAX, as an archaic form of technology, is not vulnerable to the attacks mentioned above – that's why it is still being used.

  4. Don said,

    July 13, 2020 @ 9:31 am

    Expanding on Philip Taylor's comment, the floppy disk icon is still definitely the universal save icon, even in software with very modern design sensibilities, despite the obsoletion of the technology it depicts. (I remember seeing an article discussing how kids nowadays are familiar with the "save icon" but don't know what it's actually supposed to be a picture of.)

  5. Dwight Williams said,

    July 13, 2020 @ 9:43 am

    The lesson here is that if it's still useful to people, it isn't obsolete. Hence the survival of faxes and PDFs.

  6. Gregory Kusnick said,

    July 13, 2020 @ 10:12 am

    On my mobile phone, the phone app icon looks like a 1950s-era telephone handset, the voicemail icon looks like spools of tape, the email icon like a paper envelope, the password app like a key, the GPS app like a magnetic compass, and so on for about half the icons on the home screen.

    A determined attacker could presumably intercept faxes by wiretapping. If there wasn't a Mission: Impossible episode about that, there should have been.

  7. Philip Taylor said,

    July 13, 2020 @ 10:23 am

    Is there any suggestion that PDFs are absolute ? OK, in many respects I am a dinosaur (no laptop, no tablet, no smart'phone, no "Internet of Things", …) but not a day goes by when I do not read or generate a dozen or more PDFs. By what have PDFs been replaced, in the view of those who think them obsolete ?

  8. John from Cincinnati said,

    July 13, 2020 @ 11:07 am

    Fax machines are physical objects while computer icons are metaphors. Metaphors do persist usefully even after their referents become obsolete. While the group of "desktop" icons may be based on objects lifted from a 1970s physical office space (file, file folder, sheet of paper, trashcan, inbox, paper clips, analog clock, wall calendar), the icons have become idiomatic and remain useful. Not so for physical objects such as fax machines, perhaps. Personally I'm OK with either a floppy disc, or a cylinder, representing storage, even though my laptop uses non-rotating solid state technology. I'd be less happy to see a picture of a cloud, which to me suggests going up in smoke. With regards to the cartoon in the OP, in an web search I found a save-as icon consisting of a down arrow over a sheet bearing the label pdf. Heh.

  9. mg said,

    July 13, 2020 @ 11:11 am

    @Philip Taylor – this comic takes place in the future. There's no reason to think that PDFs won't eventually become as obsolete as anything else technological.

  10. David L said,

    July 13, 2020 @ 11:46 am

    My doctor's office as as well as a specialist I see regularly both enable me to see test results by logging into their websites. If that kind of procedure suffices for doctor-patient communications it's hard to see why it can't be used for other purposes.

    Faxes may be immune to hacking but I would hardly call them secure — not when you end up with sheets of paper lying around in offices here, there and everywhere.

  11. Stephen Hart said,

    July 13, 2020 @ 2:11 pm

    Most offices use computers and printers for "faxing" and have done for decades. The computer or printer just converts the data to sounds to send over a phone line.
    Our local medical community uses a computer-based database and if a doctor's office sends a fax, it's printed, scanned (maybe OCRed) and stored in the database.

    I would think that anyone with the knowledge and motivation (and lack of ethics) to hack a computer could hack a fax.

  12. Doug said,

    July 13, 2020 @ 2:38 pm

    @Philip Taylor.

    I deal with a lot of PDFs too — but then I'm in the insurance industry, and we may not be on the cutting edge.

    An earlier Language Log entry discussed an XKCD comic that said PDF is a "ridiculous format" not used by any "normal human trying to communicate in 2020."

    https://languagelog.ldc.upenn.edu/nll/?p=47038#comments

    And here's someone explaining that PDFs are in fact obsolete (for most purposes):

    https://emilymaier.net/words/why-pdfs-are-obsolete-for-most-purposes/

  13. wanda said,

    July 13, 2020 @ 3:11 pm

    A conversation my friend A related that she had with someone:

    A: I'm sorry, I cannot receive a fax because of where I live.
    Other: Where do you live?
    A: In the 21st century!

  14. Philip Taylor said,

    July 13, 2020 @ 5:01 pm

    I think that Emily Maier should try expressing a complex scientific paper using MathML for the mathematical parts; she might then better appreciate the many benefits of staticising mathematical expressions into an immutable format such as Adobe PDF, although of course this has the very unhelpful side-effect of disenfranchising the blind and partially sighted.

  15. Julian said,

    July 13, 2020 @ 7:00 pm

    One of my amusements is noting anachronistic icons. Apart from those already mentioned: the level crossing warning sign with a picture of a steam locomotive. The 'no camping' sign which is a picture of a tent with a red line through it – but the tent is a silhouette of an A-frame japara job from 1950. Others?

  16. Rick Rubenstein said,

    July 13, 2020 @ 7:30 pm

    Anachronistic icons may be amusing, but consider an alternate world in which "take a picture", "make a phone call", "make a video call", "check email" etc. are each represented by a featureless rounded rectangle, i.e. a picture of a smartphone. Not so useful.

  17. Michael Watts said,

    July 13, 2020 @ 8:26 pm

    And here's someone explaining that PDFs are in fact obsolete (for most purposes):

    https://emilymaier.net/words/why-pdfs-are-obsolete-for-most-purposes/

    And from the linked essay:

    A similar problem used to occur – but has been mostly solved – in web design. For many years professional websites were created from fixed-pixel layout templates. The site would be designed to be exactly 800px in width perhaps. This let the designer attempt to control every pixel, but ran into problems from the start since different computers had different resolutions. The problem became insurmountable with the advent of smartphones and tablets, and modern web design is intended so that the same page can be seen beautifully at many different screen sizes and resolutions.

    This is pretty surreal; modern web design involves having one page for desktops and a basically unrelated page for phones and tablets, and serving one or the other according to one of a few discriminators (user-agent, URL, size of the browser window, or what have you). We looked at the problem of having the same page render beautifully at many different screen sizes and resolutions, and we roundly rejected it as an option.

  18. Globules said,

    July 14, 2020 @ 12:39 am

    Regarding the longevity of digital documents, there's a standardized variant of PDF, called PDF/A, intended to be "specialized for use in the archiving and long-term preservation of electronic documents." We'll see…

  19. Hans Adler said,

    July 14, 2020 @ 1:45 am

    The discussion has moved in a direction where it seems appropriate to point out the following problem: http://www.dkriesel.com/en/blog/2013/0802_xerox-workcentres_are_switching_written_numbers_when_scanning

    Since faxing is often handled by a computer nowadays, or by a relatively recent all-in-one device, faxes are just as susceptible to this problem of randomly changing glyphs in small print as scanned PDF documents are.

  20. Philip Taylor said,

    July 14, 2020 @ 2:20 am

    Not unless the fax encoding uses JBIG2, a derivative, or a related technology Hans. The problem lies in the compression software chosen by Xerox.

  21. rosie said,

    July 14, 2020 @ 4:24 am

    A difference is that floppy disks have long since ceased to be the most popular medium to save to, whereas we still use phones with handsets, envelopes, keys and compasses.

  22. Philip Taylor said,

    July 14, 2020 @ 4:58 am

    Although I am no fan of icons as a means of presenting important information, and will always use either "File / Save" or "Ctrl+S" to save my work rather than trying to locate a small and cryptic icon, I nonetheless do not think that it matters that "floppy disks have long since ceased to be the most popular medium to [which to] save". Consider this image — I seriously doubt whether one in a thousand could explain the significance of the pie-crust segments, central circle, etc., yet most if not all would know that it indicates a potential danger from radiation. The same is true, I would argue, for the floppy-disc icon — it has embedded itself almost universally as representing the action of saving something, and the fact that it is now anachronistic in no way detracts from its intelligibility.

  23. Jonathan Silk said,

    July 14, 2020 @ 7:35 am

    And not a single remark about the snarky reference to Sanskrit?

  24. Nick Montfort said,

    July 14, 2020 @ 8:34 am

    What's really hard to come by these days, particularly in a modern office context, is an analog phone line, not hardware that functions as a fax machine. VOIP isn't designed to carry a fax signal.

  25. Rose Eneri said,

    July 14, 2020 @ 9:07 am

    Philip Taylor, can you please tell us the significance of the radiation danger trefoil? The only information I could find is that the symbol is intentionally symmetrical so that it is recognizable when viewed from any direction.

  26. Rodger C said,

    July 14, 2020 @ 9:14 am

    No one seems to have noted that already the 2.5" "floppy disk," unlike the 4" which I vaguely remember, didn't actually flop.

  27. Philip Taylor said,

    July 14, 2020 @ 9:27 am

    Personally I cannot, Rose (I am not one of the "fewer than one in a thousand !). But Nathan Thompson can, far better than I. In brief, the design was meant to represent "activity radiating from an atom".

  28. Nathan said,

    July 14, 2020 @ 9:57 am

    I guess the people who think PDF already obsolete believe it can be replaced by ePub or something. Those people have no need for mathematical typesetting.

  29. Timothy Rowe said,

    July 14, 2020 @ 10:06 am

    Philip Taylor: Epub3 supports MathML, and is vastly superior to PDF because it will adapt to varying display and text sizes, so those with a degree of visual impairment can increase the text size and it will re-flow the text, rather than having to zoom in on a PDF so it's like reading through a letterbox.

  30. Philip Taylor said,

    July 14, 2020 @ 10:27 am

    I think (with the greatest respect) that "is vastly superior to" is in the nature of a value judgement. For the uses to which I put PDF, it is difficult to imagine anything "vastly superior", but I can also fully understand the frustration of blind and partially sighted people who cannot (for example) study a PDF of The TeXbook because their screen-reader software cannot present the PDF in an intelligible way. As with all things, we need horses for courses — for some applications (those with which I deal on a daily basis), PDF is perfect; for others, Epub3 may well be infinitely superior. If you could point me at a mathematically and scientifically complex document expressed on Epub3, and at a Windows-compatible reader that can display it, I would be extremely interested to experiment.

  31. OvV said,

    July 14, 2020 @ 11:39 am

    Indeed Jonathan Silk, I too wondered about Sanskrit in the comic.
    IS there actually a dictionary Sanskrit to Ancient Greek in existence? Does anybody know?
    Or Sanskrit – Latin?
    Wait, there is a Sanskrit – Latin dict. See:
    https://www.sanskrit-lexicon.uni-koeln.de/

  32. Terry Hunt said,

    July 14, 2020 @ 4:49 pm

    A minor point of irony in the QC comic under discussion that may elude those not following the story, is that the hard copy and PDF have been sent from a very large orbiting space station by an eccentric human scientist, while the recipients are all Artificial Intelligences in humaniform (Nelson less so than the others) robot "chassis", who are permanently online via WiFi and can send & receive emails mentally (so to speak).

  33. Chester Draws said,

    July 14, 2020 @ 5:15 pm

    I have my output to the web in pdf so it cannot be easily stolen. I give it away under Creative Commons, but I seriously object when people take my work and pass it off as their own.

    PDFs allow me to lock in a watermark in a universally readable format for free from a range of different origins (I generate some from spreadsheets).

    If you are happy for your work to be stolen, then by all means put it up in formats that don't protect it.

  34. maidhc said,

    July 14, 2020 @ 7:40 pm

    One use of PDF format was a student who submitted a PDF of a paper to turnitin (a program that checks for plagiarism) instead of the required Word format. Because a PDF is a picture of text instead of being text, turnitin would regard it as having no content to check, and hence detect no plagiarism.

    The flaw in this plan is that turnitin normally finds small amounts of plagiarism even in non-plagiarized papers, just because of the use of common phrases. Actually seeing 0% correlation immediately looks suspicious.

    Also, if you have Acrobat Pro, it's usually pretty easy to extract the text from a PDF.

  35. Chester Draws said,

    July 14, 2020 @ 11:35 pm

    Also, if you have Acrobat Pro, it's usually pretty easy to extract the text from a PDF.

    Not if password protected.

  36. Thomas Lumley said,

    July 15, 2020 @ 12:55 am

    The other canonical fax-machine comic: http://www.achewood.com/index.php?date=11222006

    "No, I aint' got a fax machine. I also ain't got an Applie IIc, polio, or a falcon"

  37. Chas Belov said,

    July 15, 2020 @ 2:07 am

    Also, if you have Acrobat Pro, it's usually pretty easy to extract the text from a PDF.

    Not if password protected.

    If it's read-password-protected, then nobody can even read it without the password.

    If it's edit-password-protected, there is at least one, possibly several, non-Adobe programs that don't respect that.

    Even if you render the contents as an image, someone can run optical character recognition (OCR) on it – which has been getting shockingly better in the past few years – although a watermark may well grunge that up. But any watermark that can reliably grunge OCR will make the document hard for the intended recipient to read, and rendering the contents as an image will likely run afoul of any accessibility requirements.

    If it's on the web, someone can copy and edit it.

  38. monscampus said,

    July 17, 2020 @ 11:01 am

    @Nick Montfort

    What's really hard to come by these days, particularly in a modern office context, is an analog phone line, not hardware that functions as a fax machine. VOIP isn't designed to carry a fax signal.
    – – –
    Is that so? Obviously not in my case.

  39. David Marjanović said,

    July 19, 2020 @ 6:39 am

    Science publishing is entirely in PDF. The immutability of the layout that imitates a printed page is not a bug, it's a feature.

    a PDF is a picture of text instead of being text

    It can be a picture, but usually it's not.

  40. Andrew Usher said,

    July 19, 2020 @ 8:56 am

    The one problem with PDF is its relative slowness; there used to be (?) an alternative free format for books called DejaVu that was much faster, and I preferred it for that reason.

    k_over_hbarc at yahoo.com

  41. Avery said,

    July 25, 2020 @ 10:04 am

    The suggestion in an article that was linked in the comments claiming that EPUBs are somehow immune to the typesetting problems that plague PDFs is kind of laughable in my experience. They can be converted to something I can read on my Kindle, but doing so often creates a document that is unreadable in practice because many EPUBs actually do have baked in formatting information. In addition the eBook format Amazon (MOBI, I believe) uses is broadly the same (HTML) but incompatible in a myriad of ways, and that's before the problem of DRM. On my computer, they're usually readable, but not in an optimal format. The experience is basically the same as using PDF except the EPUBs usually look worse.

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