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Cloud vs. traditional: What’s the future of healthcare faxing?

Sep 22, 2022

Healthcare is a prime example of an industry for which faxing still serves a vital purpose. Given faxing proven track-record, easy implementation, and lower total costs of ownership, faxing remains one of healthcare’s most reliable and secure means of exchanging large quantities of clinical information.

Although the need for healthcare faxing isn’t predicted to change, the requirements have. Modern faxing software has come a long way with EHR integration, automated deliveries, and additional delivery options like email or secure text for real-time clinical alerts. In addition, most healthcare facilities have exceptionally high fax volumes unique to the industry. Fax volumes can run into the tens of thousands of pages per month. This can present a real issue when paired with limited phone lines and technical incompatibilities.

Cloud-based faxing has risen in popularity to bypass these challenges, but is it for everyone? Read below to explore the pros and cons of various faxing deployments and transmission methods including traditional phone lines, FoIP (internet faxing), and cloud-based faxing.

Healthcare faxing options at-a-glance

Traditional phone lines

Pros - Familiar, simple, and reliable

Cons - Potential costs for telephony, hardware maintenance, point-to-point transmissions, limited flexibility for remote employees

Fax over IP (FoIP)

Pros - Eliminates phone lines, cost savings, flexible faxing options for remote employees

Cons - Transmission can be unreliable, point-to-point transmissions

Cloud Faxing

Pros - Highly reliable, Scalable to handle volume increases, marketed to eliminate on-prem fax servers

Cons - Only one transmission option, may be missing advanced features

Hybrid Faxing

Pros - Combines server-based faxing with cloud delivery, includes advanced faxing functionality, highly reliable with on-demand scalability

Cons - Price, no flexibility to use cloud and FoIP

Hybrid Faxing with Cloud and/or FoIP

Pros - Combines server-based faxing with optional cloud delivery, flexibility to use cloud and/or FoIP, includes advanced functionalities, highly reliable with on-demand scalability

Cons - A newer model of faxing with limited availability, price (but can be mitigated by choosing the deliveries sent via cloud)

Traditional phone lines

Faxing via traditional phone lines, using analog or digital, is a familiar method for many. Familiar can go a long way, especially when it’s as reliable as faxing using phone lines. Despite this reliability, there are negatives associated with traditional phone lines that are impossible to ignore. There’s a steep cost associated with telecom vendors and maintaining on-premises hardware. Additionally, faxing via a traditional phone line is typically one-to-one (or point-to-point), whereas other methods, like cloud faxing, have many end points. Lastly, this type of fax transmission doesn’t offer the flexibility of remote faxing for employees outside the enterprise if you are still using physical fax machines.


  • Familiar

  • Reliable


  • Potentially higher costs associated with telecom vendors for digital telephony

  • Hardware maintenance

  • Point-to-point transmissions

  • Limited flexibility for remote employees needing to fax


Faxing over Internet Protocol (FoIP) gained traction in healthcare by eliminating phone lines and hardware for valuable cost savings. Additionally, FoIP (often called internet faxing) provides more freedom for the end user to send and receive faxes from anywhere in the healthcare enterprise. This is a perfectly acceptable means for many healthcare organizations that use the technology without issue.

However, there are other organizations that struggle with unreliable faxing using FoIP. Our experts refer to this as FoIP incompatibility. FoIP is also known as virtual fax or sending faxes over the Internet via IP. This method relies on TCP (transmission control protocol) and does not use a telephone line, but it still has restrictions on volume. Information is broken down into “packets” when transmitted, and there are often packet delays or losses when the packets aren’t reassembled. These issues don’t affect everyone, but they are prevalent enough for many to seek out cloud-based faxing solutions.


  • Eliminates phone lines

  • Cost savings

  • Flexible faxing options for remote employees


  • Transmissions can be unreliable

  • Point-to-point transmissions

Cloud Faxing

Cloud faxing sends faxes over a cloud infrastructure or network that can expand and handle volume as needed. It doesn’t use phone lines or packets as with FoIP so solves most of the limitations of other faxing methods previously discussed. However, it’s important to note that healthcare organizations are somewhat limited with their cloud-based choices. Many popular cloud faxing solutions use a SaaS model marketed as eliminating on-premises faxing servers by moving everything to the cloud. However, these faxing solutions may not offer sophisticated EHR integration and may be missing advanced features such as automated routing.


  • Highly reliable

  • Scalable to handle volume increases

  • Marketed as eliminating on-premises faxing servers


  • May or may not be EHR-integrated

  • Only one transmission option

  • May be missing advanced features

Hybrid Faxing

There are options that offer a hybrid solution by combining a server-based faxing solution with a cloud delivery option. These hybrid solutions can offer advanced faxing functionality plus the added benefits of reliability and on-demand scalability. A hybrid solution can be more difficult to find as it’s a newer model of faxing.


  • Combines a server-based faxing solution with cloud delivery

  • Includes advanced faxing functionality

  • Highly reliable with on-demand scalability


  • Price

  • No flexibility to use Cloud and FoIP

Hybrid faxing with Cloud and/or FoIP Deliveries

This option is similar to the hybrid faxing model described above but with added benefits and flexibility. It’s a server-based faxing solution with the flexibility of cloud fax delivery and/or FoIP/traditional faxing. It’s not the typical way most people think of cloud faxing. However, this type of faxing offers the most options and mitigates the need to move all deliveries to the cloud, while providing the EHR integration and advanced faxing features healthcare organizations rely on.


  • Combines server-based faxing solution with optional cloud delivery

  • Flexibility to use cloud and/or FoIP

  • Includes advanced functionalities

  • Highly reliable with on-demand scalability


  • A newer model of faxing with limited availability

  • Price, but can be mitigated by choosing which deliveries are sent through cloud

Find the best option for your organization

Finding a faxing solution can be complicated with all the options available. However, from working with customers, we’ve identified the following key criteria to use when evaluating faxing solutions:

  • Flexible transmission options to meet departmental and financial needs

  • Removes the need for physical fax machines

  • Provides both automated and electronic desktop faxing

  • Includes additional delivery modalities like email, file drop, etc.

  • Has inbound routing capabilities

  • Is EHR integrated

  • Deployed and serviced by a vendor experienced in healthcare and with the EHR

The takeaway

No matter what type of faxing is right for your organization, it pays to look at all the options. After many conversations with customers, we’ve found that offering a variety of options and features provides the flexibility that most healthcare organizations need.

Forward Advantage has developed a hybrid solution by adding cloud faxing to our robust and trusted Communication Director solution, solving issues like problem numbers for increased reliability and saving time on resending failed faxes. Additionally, Communication Director stands apart from other hybrid fax offerings with the added benefit of sending faxes through:

  • Traditional phone lines

  • FoIP

  • Cloud fax

  • A combination of the above

Communication Director is a great option for organizations wanting to maintain EHR connections and utilize advanced, automated faxing. Plus, it offers the flexibility of adding cloud-based deliveries to solve transmission issues or allow for increased demand without adding fax channels. For more information about the benefits of cloud faxing, watch our on-demand webinar featuring Carl Smith, Former CIO at King’s Daughters Medical Center.

“We went from a 40% failure rate to less than 1% with the cloud-based solution [from Forward Advantage]. From an efficiency and productivity standpoint, those numbers are huge.” – Carl Smith, Former CIO at King’s Daughters Medical Center
“I spent at least two or three hours each day looking at the faxes coming in and going out just to make sure they were delivered. I’d then have to resend them if they failed or use a regular fax machine. Cloud faxing [with Communication Director] frees up a huge portion of my day.” – Tammy Means, Telecommunications Specialist at King’s Daughters Medical Center

Which type of faxing fits your needs?

Let us help you determine what faxing solution would best benefit your company.

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