Among the retro symbols on the iPhone’s emoji keyboard is the humble facsimile machine. But the fax machine holds a different place than the transistor radio, the floppy disk, and the vintage picture tube: It is both outdated and yet, for those who have to interact with the U.S. medical system, not an ancient relic at all.

Right now in medical facilities across the country, surgeons, obstetricians, GPs, nurses, and staff are placing physical medical records in a tray, dialing in a number, pressing send, and hoping to avoid a paper jam. If you’ve ever watched a medical drama, you’d be forgiven for thinking that hospitals are full of cutting-edge technology, but the system is still reliant on paper and fax, technologies that were cutting-edge 2,000 and 50 years ago, respectively.

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