Fax is still core infrastructure in healthcare and other regulated industries because it securely bridges organizations at different stages of technical sophistication.
What’s changing is the tolerance for weak architecture. By 2026, fax platforms will be judged not simply by whether they can send a document, but by how they enforce security, support auditability, and integrate with core systems.
Three models dominate enterprise fax today:
Each model carries different implications for control, compliance, integration depth, and scalability.
An on-prem fax server offers maximum configurability and 100% data ownership and control. It runs on customer-managed resources, integrates with virtually every EHR and business system on the market, and supports complex routing and automation. The trade-off is operational responsibility: hardware refreshes, patching, telephony, monitoring, and disaster recovery all remain internal obligations.
Generic public cloud fax removes infrastructure management entirely. Deployment is fast, and basic send/receive workflows work well for low-complexity use cases. However, these platforms usually rely on email and portals, provide limited workflow control, and may offer less visibility into security, retry behavior, and audit detail (but potentially enough to support HIPAA compliance).
A managed service like Private Fax Cloud® occupies the middle ground. It’s built on the OpenText Fax engine, with all the integrations, routing logic, and audit capabilities that entails. But its deployment and day-to-day management are offloaded to a specialized provider. The result is reduced operational burden without limiting workflow sophistication or transparency.
Decision criteria usually come down to:
Compliance in 2026 requires not just assurance, but evidence. Organizations must show how fax systems enforce access controls, retain data, log activity, and recover from failure—then proactively review these records for signs of inappropriate PHI management.
(As noted in a major 2017 enforcement action, the responsibility of proactive review is where many fall short.)
An on-prem fax server provides full control, but also full responsibility for the creation and maintenance of logs.
Generic public cloud fax simplifies infrastructure but often introduces visibility gaps. Multi-tenant designs, opaque retry behavior, limited audit trails, and email-centric delivery models might be perfectly compliant, but can also make it harder to prove.
With a managed service like Private Fax Cloud, the provider is responsible for maintaining the platform, including continuous availability of all logs. The client is still responsible for review and interpretation of audit logs, but the architecture supports regular review without requiring manual reconstruction or vendor involvement in day-to-day oversight.
A more detailed breakdown of auditability, access control, retry behavior, and security is available in our Private Fax Cloud FAQ.
The real differentiator is not the ability to send a fax, but how well fax integrates with core systems and adapts as workflows evolve.
Generic public cloud fax typically offers email-to-fax, portals, and basic APIs. Large, enterprise-ready vendors also offer several integrations with EHRs and other major applications. Deeper clinical integrations are generally limited, requiring either custom development (for newer applications that support REST APIs) or more complicated workarounds for legacy desktop applications.
On-prem RightFax and Private Fax Cloud support the deepest integrations: EHR connectors, dozens of back-office and line-of-business applications, print workflows, MFPs, directory services, and complex routing rules. The difference is who implements, customizes, and maintains the integrations.
Fax reliability depends on how well the fax platform and the underlying carrier environment work together. Architecture determines whether delivery issues are easy to see and resolve, or hidden behind layers of abstraction.
On-prem deployments give organizations direct control over telephony and routing. That control comes with responsibility: users need to provide internal expertise, own ongoing maintenance, and develop the ability to diagnose issues across both fax and carrier layers.
Generic cloud fax services abstract telephony details from customers. This simplifies setup but limits visibility into delivery behavior and failure modes. Mature vendors generally offer higher SLAs at their higher service tiers, and may offer custom agreements for major customers. However, if issues do arise, the customer is fully reliant on the provider to investigate and resolve them.
Private fax cloud shifts telephony and platform operations to a managed, single-tenant environment. The service provider is primarily responsible for troubleshooting both the fax and telephony layers, so clients can reduce their operational burden while improving predictability and accountability.
Cost decisions increasingly reflect what an organization can operate reliably at scale.
On-premises RightFax carries high ownership costs: servers, storage, telephony hardware, patching, backups, monitoring, and specialized staff. Scaling requires planning and capital investment.
Generic public cloud fax minimizes upfront cost but introduces variable expenses tied to pages, numbers, or retries. The ease of setup and lack of admin overhead are cost-effective for lower volume, but higher per-page costs may undermine savings at higher volumes.
Private fax cloud uses a stable subscription model that covers infrastructure, patching, monitoring, and potentially failover and even full HA/DR. Scaling is elastic within a dedicated environment, and operational responsibility shifts off internal IT while preserving integration control.
The key to reliable, scalable faxing (in 2026 and beyond) is to treat fax as a deliberate architectural decision, no matter which deployment model you choose.
The Paperless Productivity® team has successfully implemented all three models, at large scale, for major healthcare orgs and other regulated firms. For helping weighing your options and finding the straightest path to stability, please reach out today.