LetterAgent

Mail physical letters by just asking your AI assistant.

Status: LetterAgent is currently in private testing ahead of public launch. Everything on this page describes the service as it works today.

Home > Guides > Why doctors still fax

Why do doctors still use fax in 2026?

Three reasons: regulation, workflow, and the failure of the alternatives. Fax is grandfathered into health privacy practice on both sides of the border, it plugs straight into hospital fax servers that file faxes into patient records, and every clinic already has a fax workflow the replacements never managed to displace.

This is general information, not legal advice.

Most large hospitals do not use a machine on a desk anymore. They run fax servers: software that receives faxes over digital lines and routes them into the electronic health record, often matched to the patient automatically.
Insurance companies, pharmacies, and government health programs still list fax numbers as the primary way to submit forms, referrals, and prior authorizations.
Fax persists because it is the lowest common denominator: any two providers can exchange documents even if their record systems cannot talk to each other at all.

Is faxing actually allowed under health privacy law?

Yes, and this surprises people. Under HIPAA in the US, fax is treated as an acceptable way to share protected health information when reasonable safeguards are in place, like verifying the number before sending and using a cover sheet. The law was written in the fax era and never took fax away. In Canada, provincial health privacy laws take a similar stance: the method matters less than the safeguards around it. That legal comfort is a huge reason clinics never felt forced to switch.

There is a wrinkle most people miss: the security argument for fax is weaker than its reputation. A fax traveling over internet-based phone lines can be intercepted like any other data, and a misdialed fax number sends patient records to a stranger with no recall button. Regulators tolerate fax; they do not endorse it as the safest option.

What does a fax actually plug into at a hospital?

Not a machine. A modern hospital's fax number terminates at a fax server, which converts incoming faxes into documents and files them into patient charts, sometimes with optical character recognition pulling out the patient name and date of birth for matching. Outgoing, staff "print to fax" from inside the records system the same way you would print to a printer. The fax number on the hospital's letterhead hides an entirely digital pipeline.

Channel	How it works at a hospital	Why it stuck or stalled
Fax	Fax server files documents into the patient record	Universal: works with every outside provider regardless of their system
Secure email / Direct messaging	Encrypted provider-to-provider messaging	Stalled: both ends need compatible systems, and many clinics never set it up
Patient portals	Patient uploads or messages documents	Works for patient-submitted items, useless for provider-to-provider referrals
Health information exchanges	Regional networks sharing records	Patchy coverage; many regions have nothing usable

Why haven't email or portals replaced fax?

Because healthcare has a coordination problem, not a technology problem. Replacing fax requires every participant to adopt the same replacement at the same time: the specialist, the family doctor, the pharmacy, the insurer, and the lab. Fax requires none of that. It is the only channel where a clinic running a 15-year-old records system can send a referral to a hospital running a brand-new one, with zero setup on either side.

Then there is the form problem. Huge parts of healthcare run on specific forms: prior authorization forms, referral templates, workers' compensation paperwork. Those forms were designed around fax, with fax numbers printed on them and fax-based workflows behind them. Redesigning the form means redesigning the workflow of every office that uses it, and nobody volunteers for that job.

Is faxing in healthcare finally declining?

Slowly, and unevenly. Large health systems are routing more traffic through internal messaging and quietly retiring fax for communications inside their own networks, where both ends share the same records system. But the traffic between organizations, which is where fax earned its keep, is barely moving. As long as insurers and government programs accept faxes as the default submission method, clinics will keep a fax workflow. The fax machine on the desk may be gone, replaced by a server and a "print to fax" button, but the fax itself is not going anywhere soon.

Related guides

Ready to fax it? Fax with LetterAgent: describe it to your AI assistant, approve the exact quoted price, and it is sent.

LetterAgent is a working name. Prices include print, postage, and our service fee. US prices in USD, Canadian prices in CAD (Canadian prices exclude applicable sales tax, added at checkout). Currently in private testing.

Need help? Ask your assistant: it can check a job's status any time. If it ever can't handle something: hello@getletteragent.com