Originally published at ictfax.com
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Quick answer: In late June 2026 federal health officials announced that the TEFCA network had crossed one billion health records exchanged, up from about ten million a year earlier, alongside tighter oversight of the networks that connect to it. That is real progress, but roughly three quarters of medical communication still moves by fax, because not every provider sits on a shared digital exchange. A HIPAA-compliant fax server remains the fallback that bridges the gap, especially for small practices and cross-organization sends where TEFCA connectivity does not yet reach.
On June 26, 2026, federal health officials shared a milestone: the national exchange framework known as TEFCA had passed one billion records exchanged, a jump from roughly ten million in under a year. They also rolled out stronger oversight and compliance reviews for the networks that plug into it. The direction is clear, the country is wiring health data together at scale.
And yet fax has not gone anywhere. Industry estimates still put around 75 percent of medical communication on fax, because exchange networks only help when both sides are connected. A HIPAA-compliant fax server is what covers the providers and sends that the digital network has not reached yet.
Why Fax Survives a Billion-Record Network
The headline number is impressive, but it hides a coverage problem. A national exchange works when both the sender and the receiver are on a connected network. A large hospital system might be. The rural clinic, the small specialty practice, or the cross-state referral often is not. When one side is offline from the exchange, the record still has to move, and fax is the path that always works.
Tighter oversight of the connecting networks also raises the bar for joining. That is good for security, but it means the on-ramp is not instant for smaller providers. During that gap, the compliant fallback carries the load.
TEFCA
exchange hub
Health system A
Health system B
Fax server bridge
T.38 FoIP
Small clinic
not on network
Figure 1: When one side is not on the exchange, the fax server bridges the record to the provider the digital network has not reached.
What Makes a Fax Server the Right Bridge
Not every fax setup is built for healthcare. The fallback only works if it is compliant, reliable, and under your control. ICTFax is a FreeSWITCH-based fax server, and a few features make it suited to this role.
Self-hosted, so the data stays yours
Because you run the server, protected health information stays on infrastructure you control rather than passing through a third-party cloud you cannot audit. That is a meaningful difference when the data is patient records.
FoIP and T.38 for reliable delivery
Fax over IP with T.38 handles the real-time timing that fax needs, so transmissions complete cleanly over modern networks. The same engine supports gateway and PSTN faxing, which keeps you compatible with whatever the receiving side uses.
Email-to-fax and an API for workflow
Email-to-fax and fax-to-email let staff send and receive without a physical machine, and the REST fax API lets you wire faxing into an EHR or intake system. Multi-tenant and white-label support mean a service provider can offer this to many practices from one platform.
Self-hosted fax server
ePHI
T.38 server
on-prem
Stays inside your boundary
Third-party cloud fax
ePHI
vendor cloud
offsite
Leaves your control
Figure 2: With a self-hosted server, protected health information never leaves the boundary you audit.
Planning for the Gap Years
TEFCA will keep growing, and that is good. The realistic plan treats fax as the dependable bridge while coverage fills in.
Keep a compliant fax path for any partner not yet on a shared exchange.
Prefer self-hosting so patient data stays on infrastructure you control.
Use email-to-fax and the API to remove manual steps and reduce errors.
Confirm T.38 and gateway support so you stay compatible with every receiver.
Revisit coverage periodically and shift partners to digital exchange as they connect.
Related reading:
The 2026 prior authorization rule and HIPAA fax · Open source communications and IP telephony
Frequently Asked Questions
If TEFCA is growing, why keep fax at all?
Because a national exchange only helps when both sides are connected. Many smaller and cross-organization providers are not yet on the network, and during that gap fax is the reliable, compliant way to move the record.
Is fax still HIPAA-compliant in 2026?
Yes, when handled properly. A self-hosted fax server keeps protected health information on infrastructure you control and audit, which supports the safeguards HIPAA expects, unlike routing data through a cloud you cannot inspect.
What does FoIP with T.38 give me?
Reliable fax delivery over IP networks. T.38 manages the timing fax transmission needs so pages complete cleanly, and the same engine supports gateway and PSTN faxing for compatibility with any receiver.
Can a service provider offer this to many clinics?
Yes. Multi-tenant and white-label support let one platform serve many practices, each with its own faxing, while the provider manages it centrally.
How does the API help a healthcare workflow?
The REST fax API lets you send and receive faxes directly from an EHR or intake system, so faxing becomes part of the workflow rather than a separate manual step. Email-to-fax covers the simpler cases without any code.
Get Started
Want a compliant fax bridge that keeps patient data on your own infrastructure? Contact our team and we will help you plan it.
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