The documents that often initiate and conclude a business cycle are often sent or received by fax. Everything from processing a referral in healthcare, confirming a purchase to signing an NFL contract. If your fax service is down, your business is down to some extent. Making sure your fax service is reliable and offers 99.999% up time is imperative.
What Are Patient Referrals in Healthcare?
A patient referral is a formal recommendation or order from one healthcare provider (usually a primary care physician, or PCP) to another provider, typically a specialist, for evaluation, diagnosis, treatment, or specific services. It ensures coordinated care when a patient’s condition requires expertise beyond the PCP’s scope.
Fax persists strongly, particularly for external referrals (between unrelated practices or systems with incompatible EHRs). Reasons include:
- Proven HIPAA compliance and perceived security.
- Familiarity and legacy workflows.
- Lack of full interoperability across all EHR vendors.
- Around 56% of referrals are still faxed (per 2025 industry reports), down from higher percentages in prior years but far from eliminated.
Many “faxes” today are digital/cloud-based (sent via internet, integrated with EHRs, often with AI for data extraction), not traditional paper machines. This modernizes fax while retaining its reliability. It’s important that fax services offer ‘five-nines’ of uptime due to the critical nature of securing new patients in a timely manner.
Trends and Future
The shift to fully electronic is accelerating due to value-based care, AI automation, and regulations pushing interoperability. However, fax (especially digital) acts as a reliable fallback. In many cases, providers use a mix: electronic when possible, fax when needed.
If your experience involves frequent faxes, it’s common—especially in smaller practices or cross-system referrals.
Faxing for Order Placement
Numerous industries continue to rely on fax (often digital or cloud-based) for confirming order placement or processing orders as of 2025. This persistence stems from regulatory requirements, perceived security, legal validity of faxed signatures, audit trails, and legacy systems—despite shifts toward electronic alternatives.
Key Industries and Reasons
| Industry | Common Use of Fax for Orders/Confirmation | Why Fax Persists |
|---|---|---|
| Healthcare (including hospitals, clinics, pharmacies, and medical suppliers) | Physician orders, referrals, prescription transfers, durable medical equipment (DME) orders, supply requests, and insurance forms. | HIPAA compliance favors fax for secure transmission of protected health information (PHI); provides delivery confirmation and audit trails. Many systems still route orders/referrals via fax. |
| Pharmaceuticals & Pharmacy | Prescription orders, transfers between pharmacies (including mail-order), prior authorizations, and specialty drug orders. | Regulatory allowances for faxed prescriptions; secure and verifiable for controlled substances; common in transfers and mail-order processes. |
| Food Service & Restaurants | Orders from delivery services or suppliers; automatic printing of incoming orders. | Immediate printed confirmation for kitchen workflow; habit in supplier-buyer relationships. |
| Manufacturing & Wholesale (e.g., lumber, lawn/garden, craft beer) | Purchase orders, invoices, quote requests. | Legacy B2B processes; reliable confirmation without needing advanced digital integration. |
| Logistics & Supply Chain | Order confirmations, shipping documents. | Need for verifiable transmission in regulated or high-volume environments. |
Additional Notes
- Legal, Finance, Government, Insurance, and Real Estate — heavily use fax overall (e.g., for signed contracts, claims, permits), but more for document transmission than routine order placement.
- Japan — stands out with widespread fax use across business, including orders.
- Modern faxing often occurs digitally (e.g., fax-to-email or integrated with EHR systems), providing the same confirmation receipts without physical machines.
While fax usage declines with electronic health records, EDI (electronic data interchange), and portals, it remains a requirement or preferred method in these areas for compliance and reliability. If your specific context involves a particular sector, details may vary by region or company.
The Famous (Or Infamous) Incident in NFL History, Often Called the “Faxgate” Fiasco
On March 15, 2013, the Denver Broncos were trying to restructure the contract of star pass rusher Elvis Dumervil (nicknamed “Doom”) to reduce his $12 million salary for the 2013 season and create salary cap space. Dumervil agreed to a pay cut that would have kept him in Denver on a restructured deal worth about $8 million for that year.
However, the signed paperwork needed to be submitted to the league by a strict 4:00 p.m. ET (2:00 p.m. MT) deadline, or his original $12 million salary would become fully guaranteed. Due to logistical issues—Dumervil was in Miami, his agent Marty Magid in Philadelphia, and communication delays—the signed contract pages were faxed to the Broncos’ headquarters, but they arrived at approximately 4:06–4:07 p.m. ET, just six or seven minutes late.
To avoid guaranteeing the higher salary, the Broncos had no choice but to release Dumervil, making him an unrestricted free agent. He fired his agent shortly after and ended up signing with the Baltimore Ravens.
This bizarre event, relying on outdated fax technology in 2013, is still remembered as one of the biggest paperwork blunders in NFL history.
How Faxcore Has Built a Resilient On-Line Fax Service Using Microsoft Azure and Etherfax
Key Pillars: Focus on infrastructure (e.g., redundant resources), operations (e.g., monitoring), and application design (e.g., handling failures gracefully). Resilience combines HA for ongoing operations and DR for major incidents.
Multi-Region and Multi-AZ Deployment: Distribute resources across availability zones (AZs) and regions to avoid single points of failure. For example, use global load balancers to route traffic to healthy regions.
Auto-Scaling and Load Balancing: Implement auto-scaling groups to handle traffic spikes and elastic load balancers to distribute requests evenly. This ensures the system scales horizontally without manual intervention.
Redundant Storage and Databases: Use replicated storage (e.g., object stores with cross-region replication) and multi-master databases for failover.
Test and Iterate
- Regularly conduct failover tests, load testing, and security audits.
- Monitor key metrics like uptime (aim for 99.99% or higher), mean time to recovery (MTTR), and error rates.
- Evolve based on lessons learned—cloud resilience is iterative.
Microsoft Azure provides a resilient cloud environment through a combination of global infrastructure design, redundancy features, and built-in services that protect against failures ranging from hardware issues to full datacenter or regional outages.
Global Infrastructure and Regions
Azure operates over 60 regions worldwide, each consisting of one or more datacenters. This extensive footprint allows workloads to be distributed geographically for low latency, compliance with data residency requirements, and enhanced resilience.
Availability Zones (AZs)
Within many regions, Azure uses Availability Zones—physically separate datacenters with independent power, cooling, and networking. Each zone is designed to isolate failures, ensuring that an issue in one zone (e.g., power outage or hardware failure) doesn’t affect others.
- Deploying resources across multiple AZs (zone-redundant configuration) provides automatic resilience for services like VMs, storage, and databases.
- This supports high availability SLAs up to 99.99% for VMs and higher for zone-redundant services.
FaxCore has been built on Microsoft products (Windows Server, SQL and .net) since its inception over twenty years ago. And now the Azure datacenters provide the backbone of our cloud-based fax service. Leveraging best of breed technology and datacenter infrastructure results in highly available fax services.
