The fax machine dates back to the 1840s. The CD arrived in the early 1980s. Both remain strangely central to how healthcare information still moves today.
That reality sat quietly underneath nearly every conversation at the Axios Future of Health Summit in Washington, D.C. this week. Whether the topic was artificial intelligence, prior authorization, maternal health, transplant coordination or healthcare affordability, conversations that began around modernization eventually collided with the same hard limit: the underlying architecture of American healthcare still struggles to move information reliably between people, platforms and institutions.
This became especially visible during a discussion with CMS Administrator Mehmet Oz, M.D., who announced a new expansion of the CMS initiative colloquially called “Axe the Fax” alongside major health systems including Cleveland Clinic, Ochsner Health, Sanford Health, Providence and others, as well as EHR vendors including Epic Systems, Oracle and athenahealth. Dr. Oz described a system where nearly half of prior authorization communications still move through fax machines, creating delays, lost documentation and enormous administrative drag across care delivery.
He joked that physicians collectively spend enough time managing prior authorization each year to rewatch every episode of The Simpsons twice (69 days!). The line landed because everyone in the room understood the workflow underneath it. The comment triggered knowing laughs and head nods around the ballroom, the kind that usually happens when people have grown resigned to a problem that feels permanent.
Healthcare spent the last two decades digitizing records, building portals, implementing EHRs, moving infrastructure to the cloud and layering on increasingly sophisticated AI systems. Yet much of the actual exchange of clinical data between institutions still depends on faxes, manual outreach, disconnected systems, mismatched governance rules and patients physically carrying the data themselves.
Patients, clinicians, schedulers, radiology departments, referral coordinators, insurers and medical records teams now spend enormous amounts of time compensating for systems that never fully learned how to communicate with one another despite decades of modernization efforts and billions of dollars invested in digitization.
The System Still Moves At Human Speed
That disconnect surfaced again during a discussion with Caryn Seidman Becker, chairman and CEO of CLEAR, who described navigating the healthcare system during her husband’s battle with stage 4 pancreatic cancer. Even while speaking about identity infrastructure, interoperability and fraud reduction, she returned repeatedly to the reality many patients already know well: moving scans between hospitals still often revolves around carrying CDs from one hospital to another.
That detail resonated deeply with me, both as a patient with my own growing collection of MRI discs and as the spouse of a wife whose cancer journey created an expanding library of imaging CDs scattered across institutions. Some are in paper sleeves from radiology departments. Others are loose in drawers at home because at some point the stack simply became too difficult to organize. The burden of stitching together siloed environments still falls heavily on the people least equipped to coordinate it: patients and families already dealing with illness.
Becker described a healthcare experience where patients still arrive at appointments filling out repetitive clipboard forms while providers struggle to retrieve prior imaging, outside records or basic historical context that already exists somewhere else. The technology to solve much of this already exists, but alignment between systems often does not.
The contradiction becomes harder to ignore as healthcare increasingly asks patients to take an active role in their care while limiting their ability to retrieve, verify or meaningfully control the records required to coordinate it across institutions.
The Problem Does Not Stay Administrative
Even conversations that appeared unrelated to interoperability eventually circled back to coordination failures.
Charles Johnson, founder of 4Kira4Moms, described repeatedly pleading for intervention while his wife, Kira, was bleeding internally after a scheduled C-section. The room got noticeably quieter during that portion of the discussion. Not performatively quiet. The kind of quiet where people stop checking their phones because the stakes suddenly feel less theoretical.
Later, HRSA Administrator Tom Engels described modernization efforts inside the national organ transplant system and compared the desired future state to the kind of package tracking consumers already expect from Amazon.
That comparison lingered because it exposed how uneven healthcare modernization still is. Consumers can track a package or rideshare driver in real time, yet hospitals still struggle to reliably exchange imaging studies, authorization records and clinical documentation without delays, duplication or manual intervention.
Infrastructure Determines Outcomes
Senator Peter Welch framed the same tension through affordability, arguing that the system increasingly shifts costs, complexity and administrative burden across institutions while patients experience rising anxiety and diminishing visibility into how care decisions are made.
One small moment from the summit that probably won’t make any official recap captured the mood in the room quite well.
After his session, Senator Welch accidentally left his phone behind in the chair that Dr. Oz had just walked up to for the next panel. Dr. Oz picked it up and joked, “What do I do with the senator’s phone?” while Senator Welch laughed, reached his hand out and then pretended to call someone after getting it back.
For a few seconds the room stopped feeling like a polished healthcare summit and started feeling more like healthcare itself: improvised, messy and dependent on people trying to piece information back together after it failed to move where it was supposed to. And in some ways that felt like the clearest metaphor of the entire day.
Healthcare has spent decades building increasingly sophisticated technology on top of infrastructure that still struggles to reliably move records, imaging and clinical context between institutions without faxes, CDs and manual coordination.
Eventually every conversation about the future of healthcare runs into the same uncomfortable question: if information still does not reliably follow the patient, what exactly are we modernizing on top of?
