Everyone Uses Email. So Why Does Fax Still Dominate Healthcare?
It’s 2025. Most industries have gone fully digital—but fax is still alive and well in healthcare. And while it’s easy to write this off as outdated or stubborn, there’s a very real reason why fax continues to hold legal ground that email often doesn’t:
HIPAA doesn’t forbid email, but it places far more restrictions on it than it does on fax.
Understanding that distinction can mean the difference between safe communication—and a compliance nightmare.
HIPAA Doesn’t Ban Email. But It Doesn’t Trust It, Either.
Let’s be clear: You can send PHI over email under HIPAA—but only if:
- It’s properly encrypted (TLS in transit, sometimes end-to-end)
- The recipient is verified and trusted
- The message is logged and auditable
- Users are trained to handle it securely
If any of those things are missing, you’re at risk of violating HIPAA. This makes email compliance-dependent. That is: it’s only compliant if you’ve configured it properly, trained staff, and set strict controls.
Fax Is Still Treated Differently
In contrast, fax is often considered secure by default—especially when it’s direct-dialed to a known number. HIPAA doesn’t require encryption for analog phone lines, and many regulators see fax as:
- Point-to-point (sender knows recipient device)
- Not traversing the open internet
- Less prone to interception or human error
Even cloud fax, when properly configured, maintains that compliance profile through:
- TLS encryption in transit
- Strict access controls
- Centralized audit logs
- System-generated delivery confirmations
In short, fax has a baked-in security model, while email requires bolting one on.
Email Is Not “Direct” (Even If It Feels That Way)
Most users think email is like fax—type it, send it, done.
But what actually happens:
- The message routes through multiple mail servers and DNS lookups
- It’s stored temporarily (sometimes indefinitely) at each stop
- If encryption isn’t enforced, it may travel in plaintext
Even with TLS, you can’t always guarantee end-to-end encryption unless both parties use the same secure mail system—or an overlay like ProtonMail or Virtru. And once a message arrives? It can be:
- Forwarded
- Printed
- Accessed on a personal phone
- Synced to cloud storage
This creates a sprawling risk surface.
Even Encrypted Email Isn’t Automatically Compliant
HIPAA isn’t just about encryption. It’s about:
- Access controls
- Auditability
- User behavior
- Intentionality
A secure channel means little if staff don’t know how (or when) to use it.
By contrast, cloud fax platforms usually require:
- Authentication
- Role-based permissions
- Delivery receipts
- Centralized logging
That makes fax easier to manage from a compliance standpoint—especially for organizations without large IT teams.
The Reality for Most Healthcare Orgs
Many small clinics, solo practitioners, and therapists don’t have:
- Secure email gateways
- Managed devices
- Staff training programs
- HIPAA audit teams
But they do have fax numbers. And cloud fax services offer these providers an affordable, ready-to-go solution that meets HIPAA’s requirements without needing to build infrastructure from scratch.
Even for large hospitals and health systems, fax is often the lowest common denominator that allows them to exchange data with smaller providers.
The Bottom Line
Email has its place—but it’s not trusted by default under HIPAA. Fax is still trusted because it’s direct, limited in scope, and harder to misuse—especially when cloud fax is involved.
You can make email compliant… but fax usually already is.