eCW Fax Server Setup Guide

The eClinicalWorks fax server allows medical practices to send and receive faxes electronically, eliminating manual scanning into your EHR system. This guide covers setup requirements, hardware specifications, and solutions for common bottlenecks. It reflects eCW v12 as deployed in our clients' practices.

Why Faxing Still Matters in Healthcare

Despite modern technology, faxing remains the primary means of sharing data in a HIPAA-compliant manner. Unlike email, faxing operates as a peer-to-peer connection over standard telephone lines without requiring additional encryption—making it inherently secure for protected health information (PHI).

Faxing Options Compared

Hardware Requirements

For an on-premise eClinicalWorks fax server, you'll need:

The Bottleneck Problem

With a single-line on-premise fax server, your practice faces a common challenge:

• When sending an outbound fax, the line is busy
• Inbound faxes get a busy signal and may fail
• High-volume periods create backlogs
• Staff waste time re-sending failed faxes

The obvious solution—adding a second modem—isn't straightforward. Windows 11 Professional doesn't support multiple fax modems on one machine. You'd need to upgrade to Windows Server, adding significant cost and complexity.

The NEXpbx eCW Fax Connect Solution

NEXpbx eCW Fax Connect takes a hybrid approach that eliminates the bottleneck without requiring a server upgrade:

1. Inbound faxes are routed through the internet rather than down your phone line
2. Outbound faxes continue to use your existing modem and phone line, or go out through the portal
3. Your single phone line is freed up for outgoing traffic only
4. No more busy signals for incoming faxes

That solves the bottleneck without a second modem, a Windows Server licence, or a second analog line.

What Happens to an Inbound Fax

This is where having a fax server pays off, and it's worth being precise about the difference:

Either way, every fax is archived in the portal and tagged as an automatic delivery, so your audit trail distinguishes it from one someone filed by hand. If you don't have a fax server today and the hands-off path is what you're after, the hardware above is what it takes—and it's a one-time build, not a subscription.

Sending: Portal Access and the Fax Printer

Outbound faxing doesn't stay tied to the fax server workstation. Every plan includes access to the NEXpbx Fax Portal, which gives staff two ways to send:

• From the browser — sign in on desktop or mobile, pick the line, enter the number, attach the PDF. Multiple files merge into one fax, and cover pages are generated rather than retyped.
• New Straight from eClinicalWorks — add the fax as a printer on Windows 10, Windows 11, or macOS using the operating system's built-in printing standard, then print to it from eCW or any other application. No client software, no special driver. The print job arrives as a draft in that person's Drafts folder, where they add the cover page and confirm the number before sending.

Accounts are per-person with two-factor sign-in and per-line permissions, so every outbound fax is attributable to the staff member who sent it. Transmission receipts and 13 months of searchable history come with it.

Pricing

Plans are priced on pages per month. There are no per-page overage charges—a line pauses at its allowance and resumes next month, or immediately if you move up a plan. eCW Fax Connect is included on Fax 12000 ($89.99/month) and above:

Lower-volume plans start at $9.99 for 300 pages a month if you don't need the eClinicalWorks integration. See our full cost comparison against eCW Cloud Fax.

Setup Checklist

1. Verify Windows 11 Professional is installed
2. Install Mainpine fax modem in available PCI-E slot
3. Connect dedicated phone line to modem
4. Install Mainpine drivers
5. Configure Windows Fax and Scan service
6. Set up eClinicalWorks fax integration
7. Test send/receive functionality
8. (Optional) Add NEXpbx eCW Fax Connect to move inbound traffic off the phone line