The eClinicalWorks Fax Server, How to allow for more faxing throughput

What is the eClinicalWorks fax server?

Similar to a fax machine, the eClinicalWorks (ECW) fax server can receive faxes. However, unlike a fax machine, a fax server can store those faxes electronically. This avoids the tedious task of scanning files into eClinicalWorks. Faxing, is that still a thing? With EHR and EMR software, faxing is still the primary means of sharing data in a HIPAA compliant manner. With faxing, there's no encryption, but since it's a peer-to-peer connection over the plain old telephone service (POTS), it's considered an acceptable method of transmitting Protected Health Information (PHI).

eClinicalWorks uses a fax server to handle both incoming and outgoing faxes. This fax server can be an ordinary workstation with Windows 10 Professional. A fax modem is required along with a telephone line.

What faxing options are available: Fax Machine or On-premise Fax Server

A fax machine is the simplest and least expensive option. You receive faxes in paper form and scan them into eClinicalWorks. However, you're unable to send and receive faxes simultaneously. Remote senders may complain about not being able to send you faxes due to the line being busy.

With a fax server, you would have all the features of a traditional fax machine but with the added benefit of storing the faxes digitally and injecting them into eClinicalWorks. In addition, faxes can be sent directly from eClinicalWorks without the need to print the documents and fax them manually.

However, both a Fax Machine and a Fax Server will bottleneck if you've got a single fax line in place. With either solution, the document may have a hard time getting to you on busy days. If your fax line is busy, there is a delay in getting needed documentation and information for your patients. While a fax server with a single telephone line works well for small practices, it quickly becomes a bottleneck when higher volumes of faxes are being sent and received. Think of a single telephone line like a single-lane highway. Additional faxes won't be sent or received while the modem is busy with another fax.

Cloud Fax Service

eClinicalWorks offers a cloud faxing service that allows for sending and receiving faxes simultaneously without senders receiving busy tones. However, this option is the most expensive as there's a high per page charge.

What If You Want to Allow for More Traffic?

An alternative and more robust solution would be to utilize an internet faxing platform. This solution handles all faxes sent while the single MainPine IQ Express modem handles all faxes sent. This solution would free up the modem to solely focus on outgoing traffic. Many internet faxing services allow you to receive multiple faxes at once, effectively giving you multiple incoming fax lines. With several incoming lines, faxes would be received on the first attempt--something senders will very much appreciate. You don't want to waste time sending the same fax over and over again, and neither does anyone else. Unfortunately, however, most internet faxing solutions don't integrate with eClinicalWorks and require an added solution--ideally one that won't create further issues.

NEXpbx eCW Fax Connect

A hybrid solution that's compatible with the eClinicalWorks fax server is the NexPBX ECW Fax Connect. NexPBX eCW Fax Connect allows receiving faxes through the internet and frees up your modem for sending outgoing faxes. With NEXpbx eCW Fax Connect, you'll notice a significant performance increase and less frustration.

The NEXpbx eCW Fax Connect solution works by rerouting all inbound faxes through the cloud, freeing up your modem for outbound faxes. You'll still need an eClinicalWorks fax server for sending faxes if you don't already have a fax server.


1-2 Providers $75 a month (up to 10,000 minutes)

3-4 Providers $99 a month (up to 15,000 minutes)

5-6 Providers $129 a month (up to 20,000 minutes)

How can I set up my Fax Server?

If you are thinking of setting up your on-premise fax server, you'll need a workstation with a PCI Express slot available for the required Fax Modem. Keep in mind that eClinicalWorks only supports Modems manufactured by Mainpine. They recommend the Mainpine IQ Express device, which comes in either a single or two-line configuration. With Windows Professional, you'll only be able to utilize a single-line fax modem. Therefore, the RF5118 is the single line configuration that works well and meets eClinicalWorks requirements.

We’d also highly recommend using Windows 10 for this setup. Windows 7 has been phased out and is no longer HIPAA compliant as of January 14th, 2020. As such, while you're making upgrades to your infrastructure, this is something you'll want to explore further regardless if the eCW Fax Server is the right option for your business.

A solution with two modems and two phone lines can help manage traffic. In this scenario, one modem is dedicated to incoming faxes while the other handles outgoing faxes. With two modems, your single-lane highway now becomes a two-lane highway with traffic flowing in both directions simultaneously. While this solution is ideal, Microsoft doesn't allow multiple modems to be installed on Windows 10 Professional. If several modems are a must-have, you'd need to purchase a Windows Server License to utilize multiple fax modems on a single machine.


eClinicalworks fax server