Why healthcare can’t break up with fax
For most of my time in healthcare, there’s always been some sort of push from someone to end the role of fax in the ecosystem. Really praying for its ruination.
In 2024, the world thrives on instant communication: Slack threads, real-time data syncs, and cloud platforms connecting us in the blink of an eye. And yet, in healthcare, a relic of the 1980s still reigns supreme: the fax machine.
Most industries—finance, retail, legal—have long moved from fax in favor of faster, safer, and more digital solutions. But healthcare just can’t quit it. Why? To understand healthcare’s stubborn relationship with fax, we need to look at its history, its role as a crutch for outdated systems, and the unique challenges that keep it alive.
A brief history: Fax and healthcare’s unlikely bond
The fax machine—originally patented in the 1840s (yeah, you read that right) and commercialized in the 20th century—hit its stride in the 1980s and 1990s as offices across industries adopted it for quick document transmission. At the time, fax was revolutionary; send images and text instantly over phone lines instead of waiting for snail mail.
In healthcare, it became indispensable. As paper-based charts dominated workflows and hospitals struggled to coordinate across facilities, fax machines allowed documents like lab results, prescriptions, and referrals to be sent quickly and securely—critical in an environment where delays could affect patient care.
While other industries moved on with the rise of email, cloud storage, and integrated software systems in the 2000s, healthcare clung to fax for several reasons:
HIPAA: Fax was deemed a “safe” method for transmitting protected health information (PHI) under HIPAA standards
Interoperability gaps: Digital systems never fully replaced fax as healthcare digitized unevenly
Fragmentation: Healthcare systems and payers developed siloed systems that couldn’t talk to one another. Fax remained the only common denominator
Why other industries moved on—and healthcare didn’t
In finance, banking, and legal industries, the shift to digital alternatives was driven by a combination of pressure to modernize, cost-saving incentives, and tighter regulatory oversight. Secure email, digital signatures, and online verification tools made fax obsolete as organizations adopted interoperable systems that streamlined communication.
Healthcare, however, has been held back by unique challenges:
Fragmented systems: No universal data standards exist to connect the thousands of EHRs, labs, insurers, and clinics
Risk aversion: In a life-or-death field, introducing new workflows feels risky, and fax’s familiarity provides comfort
Regulatory complexity: HIPAA introduced stringent requirements that made fax “safe,” while digital tools faced slower adoption due to security concerns
Workflow entrenchment: Fax became so embedded in daily processes—submitting prior authorizations, claims, and referrals—that replacing it feels monumental
Why fax is still “good enough” for healthcare
Ironically, fax persists not because it’s good, but because it’s good enough:
It works across old and new systems
It doesn’t require costly technology overhauls
It’s a bridge between digital-forward hospitals and rural clinics still relying on paper charts
Other industries solved their inefficiencies by standardizing systems and embracing digital transformation. Healthcare hasn’t—because modernizing such a vast, siloed, and heavily regulated ecosystem is harder than it sounds.
What will it take to break up with fax?
To finally move on, healthcare needs:
Universal interoperability: A commitment to standards like FHIR (Fast Healthcare Interoperability Resources) to connect EHRs, labs, and insurers
Policy-driven incentives: Mandates or financial incentives to encourage digital adoption over fax
Cultural change: Leadership across hospitals, clinics, and insurers must prioritize innovation, recognizing that better solutions exist
Patient demand: As patients expect real-time access across their health data, healthcare will face pressure to modernize
Tools leading the charge against fax
While fax still lingers, several emerging tools and technologies are gaining traction and chipping away at its dominance:
-
What it is: A secure, HIPAA-compliant alternative to fax that allows healthcare organizations to send encrypted messages and documents over standardized protocols.
Who’s behind it: Platforms like DirectTrust enable this technology, and it’s already being integrated into many EHRs.
Why it matters: Direct Secure Messaging bridges the gap between systems, providing a familiar “email-like” experience while maintaining compliance with HIPAA standards.
-
What it is: Fast Healthcare Interoperability Resources (FHIR) is a modern standard for sharing healthcare data through APIs (application programming interfaces). It allows systems to talk to each other in real-time without relying on clunky workarounds like fax.
Who’s behind it: Organizations like HL7 are pushing FHIR adoption, and major players like Epic, Cerner, and Apple are embracing API-driven data sharing.
Why it matters: APIs enable true interoperability—making it easier to securely exchange patient records, lab results, and referrals without physical paperwork.
-
What it is: Platforms like Redox, Intersystems, and Particle Health act as intermediaries, connecting disparate systems (EHRs, payors, labs) to enable seamless data exchange.
Why it matters: By acting as a universal bridge, these tools reduce the reliance on fax as a stopgap for sharing records.
-
What it is: Tools like ReferWell, Klinix, and Updox digitize and streamline referrals between providers, replacing the need for faxed documents.
Why it matters: Referrals are one of the most common faxed documents in healthcare. Automating this process significantly reduces fax reliance and improves patient care.
-
What it is: Platforms like eFax and RightFax digitize fax workflows, allowing healthcare organizations to send and receive faxes via email or cloud-based systems.
Why it matters: While these tools don’t eliminate fax altogether, they reduce physical fax machine reliance and create a pathway toward fully digital workflows.
-
What it is: Regional and national networks that enable healthcare organizations to share patient data electronically.
Why it matters: HIEs provide a secure, standardized way to share data without needing fax as the fallback method.
Final thoughts
The fax machine isn’t just a symbol of a bygone era; it’s a symptom of systemic inertia in healthcare. Breaking up with fax will require more than swapping out machines (so much more)—it’ll take a coordinated effort to modernize systems, connect data, and redesign workflows that prioritize speed, security, and patient outcomes.
In the meantime, while we roll our eyes at the sound of a fax machine or the mention of its name, it’s worth asking: Is healthcare stuck with fax because it’s hard to change, or because we’ve accepted that change is too hard?