Short answer: in 2026, a medical practice can still send and receive faxes, but no longer over an analogue line — the shutdown of the PSTN means you have to go through VoIP (the T.38 protocol) or, far more simply, through fax-to-email. For personal health data, faxing must comply with the GDPR, and France's secure health messaging system (MSSanté) is the recommended route for exchanges between professionals.
It's a paradox we see every week in the messages that reach us through our contact form: while French healthcare is digitising at full speed — Mon espace santé, digital prescriptions, e-prescribing — the fax remains ubiquitous in medical practices, testing laboratories, community pharmacies and hospital administrative departments. A transport authorisation to send to an ambulance service, a report to forward to a colleague, a purchase order for a medical device supplier: faxing survives wherever the person on the other end still expects it.
The problem is that the technical foundation it has relied on for forty years has disappeared. Let's take stock, without scaremongering, of what still works, what has stopped working, and what you should be moving to.
Why the medical fax is living on borrowed time
The end of the PSTN is not a rumour
The public switched telephone network — the good old analogue copper pair — stopped being sold by Orange in November 2018 for new lines. Since then, the incumbent operator has been shutting it down in successive geographical batches, under the supervision of Arcep. In parallel, the shutdown of the copper network itself (the one that also carries ADSL) is being rolled out municipality by municipality, with timetables that are regularly readjusted: in early 2026, Orange announced a postponement of the schedule for some of the households still connected via copper.
For a medical practice, the consequence is very concrete: the day your line switches over, the fax machine sitting on top of the filing cabinet stops working reliably. Not necessarily overnight with a blank screen: more insidiously, with transmissions that fail one time in three, truncated pages, and confirmation reports that never arrive.
Why VoIP breaks fax
Group 3 fax (the T.30 standard) was designed for a continuous analogue channel. It carries the image of your page as modulated audio tones, with a speed negotiation that is highly sensitive to timing.
VoIP, on the other hand, chops the voice into packets, compresses them (G.729, G.722 codecs, etc.) and tolerates the loss of a few milliseconds — inaudible in a human conversation, fatal for fax modulation. The result: dropped calls, blackened pages, repeated failures.
There are two workarounds:
- The G.711 codec in passthrough mode: the fax is carried as uncompressed audio. It works… when the network is perfect. A jitter of a few tens of milliseconds is enough to make everything fail.
- The T.38 protocol: this is the real technical answer. The fax is demodulated, carried in dedicated IP packets with redundancy, then remodulated on arrival. It's the standard used by operators and serious platforms.
One detail many practices discover too late: T.38 must be supported on both ends, as well as by any intermediate operators. A T.38-equipped practice sending to a laboratory still running G.711 behind a consumer-grade router will still get failures.
Hence the value of leaving the "machine + line" logic behind entirely and moving to fax-to-email.
Fax-to-email: the most realistic solution for a practice
Our readers know the principle: you send a fax from your email client or a web interface, and the platform handles the conversion and transmission to the recipient's fax number. Conversely, an incoming fax reaches you as a PDF in your inbox.
For a practice, the benefits are immediate:
| Criterion | Analogue fax machine | Fax-to-email |
|---|---|---|
| Dependence on the PSTN | Total | None |
| Dedicated line to pay for | Yes | No |
| Consumables (toner, paper) | Yes | No |
| Sending from outside the practice | No | Yes (home visits, on-call duty) |
| Archiving of sent items | Paper activity log roll | Time-stamped digital history |
| Reception outside opening hours | Paper left lying around the room | Time-stamped PDF in the inbox |
| Traceability in the event of a dispute | Weak | Transmission receipt kept on file |
The point we systematically highlight to healthcare professionals is the fifth one: no more incoming faxes sitting for hours in the output tray, freely accessible, in a corridor where patients, medical reps and cleaning staff walk past. It is probably the main confidentiality gain of going digital.
Fax and health data: what the legal framework actually says
The GDPR is not satisfied with "we've always done it this way"
Health data is sensitive data within the meaning of Article 9 of the GDPR. Its processing — including its transmission — is subject to reinforced obligations: minimisation, appropriate security (Article 32), traceability, and the obligation to notify data breaches to the CNIL within 72 hours.
Yet traditional faxing combines several well-documented weaknesses:
- Dialling the wrong number is the number one risk. One transposed digit and a pathology report ends up with a stranger. The CNIL has repeatedly pointed out that this kind of incident constitutes a personal data breach that may require notification.
- The absence of end-to-end encryption: along the way, the content travels in the clear in the cryptographic sense of the term.
- Residual storage: modern multifunction fax machines have an internal hard drive that retains images of documents. A device resold or returned at the end of a lease without secure erasure is a data leak waiting to happen.
- Physical exposure of the document on arrival.
The CNIL has also published specific recommendations on health data exchanges, insisting on the use of secure messaging systems rather than fax or ordinary email to transmit medical information identifying individuals.
Evidential value: a point that is often misunderstood
A fax is not an authenticated legal instrument. Under French law, an electronic document has the same evidential weight as a paper document as long as its author can be identified and the integrity of the document guaranteed (Articles 1366 and 1367 of the Civil Code). A fax, on the other hand, is generally accepted as prima facie written evidence: it holds up if nobody challenges it, and wobbles if the other party denies having received it.
In practice, for a medical practice, this means: always keep the transmission receipt and, ideally, the signed original. The transmission report from an online fax platform, time-stamped and stored server-side, is infinitely more usable than a thermal-paper slip that has faded at the back of a drawer.
We covered this subject in detail in our article on the legal value of the fax in 2026; the healthcare professions are a particularly sensitive use case there.
MSSanté: the official alternative between professionals
It's impossible to talk about medical faxing without mentioning MSSanté, the secure health messaging system run by the Agence du numérique en santé (ANS). It is a trusted space: only professionals and organisations identified in the health directory (via the CPS or e-CPS card) can exchange messages there, and messages travel encrypted within that space.
Since MSSanté was opened up to citizens and linked to Mon espace santé, a doctor can also send a document directly to the patient in their personal space.
The key points for making a decision:
- Professional-to-professional exchanges (GP, specialist, laboratory, hospital, pharmacist): MSSanté is the option to favour. It's the expected, secure channel, and there is no longer any reason to fax a report to a colleague who is equipped with it too.
- Exchanges with a non-healthcare party (insurer, employer, government body, medical transport provider, supplier, court registry, bailiff): these recipients are not part of the MSSanté trusted space. The fax often remains the only accepted channel — and that is precisely where fax-to-email comes into its own.
- International exchanges: a colleague abroad, a care centre outside France, a foreign insurance company. MSSanté does not cover these cases; international faxing remains operational.
Five habits to adopt in a practice in 2026
1. Check the actual status of your line
Before buying or cancelling anything, contact your operator to find out whether your premises are affected by a PSTN or copper shutdown batch in the near future. A practice that invests in a brand-new fax machine six months before the switchover is making a very bad deal.
2. Stop faxing anything that can go through MSSanté
The safest fax is the one you don't send. Every report moved over to secure messaging is one fewer opportunity for a wrong-number error.
3. Put systematic number-checking in place
For everything that still has to go out by fax:
- Build a shared address book validated by the medical secretary, rather than re-keying a number by hand for every transmission.
- Check the country code for international destinations (+33 for France, +32 Belgium, +41 Switzerland, +1 Canada, +351 Portugal, +34 Spain, +49 Germany).
- Add a cover page explicitly stating the confidential nature of the document and what to do if it is received in error.
- Read the transmission receipt before filing the case away.
4. Reduce what appears on the document
The minimisation principle: a report intended for a medical transport provider does not need the patient's entire medical history. Anonymise or trim anything that isn't necessary for the purpose of the transmission.
5. Secure reception
A dedicated fax number that lands in a professional inbox protected by two-factor authentication is a thousand times better than an output tray accessible from the waiting room. And when the practice closes for the holidays, documents no longer pile up on a tray.
Real-world cases from medical practices
The testing laboratory. Many laboratories have moved to results servers and to MSSanté. Faxing is now only used there for urgent requests to organisations that aren't equipped, particularly care homes for the elderly or isolated private practices.
The community pharmacist. Digital prescribing is rolling out, but pharmacies continue to receive repeat-prescription faxes, particularly from medical and social care facilities. Receiving faxes as PDFs avoids the build-up of paper at the counter here.
The locum doctor or doctor on home visits. This is the use case that suits fax-to-email best: sending a prescription from a smartphone between two visits, without going back to the practice. Our guide on sending a fax from a smartphone explains the procedure in detail.
The outsourced medical secretariat. A virtual fax number makes it possible to route documents to the right person, with no duplicate physical hardware across two sites.
Frequently asked questions
Can a medical practice still receive faxes after the end of the PSTN?
Yes, provided it no longer depends on an analogue line. There are two routes: a T.38-compatible VoIP adapter connected to an existing fax machine, or — simpler and hardware-free — a virtual fax number that delivers incoming documents as PDFs by email.
Is faxing GDPR-compliant for health data?
It isn't prohibited, but it is considered weak. The GDPR requires security measures proportionate to the risk: for health data, the CNIL and the Agence du numérique en santé clearly point towards secure messaging systems. Faxing remains acceptable when no other channel is available at the recipient's end, provided the procedure is properly framed (validated address book, cover page, minimisation, retention of receipts).
What should you do if you send a fax to the wrong number?
Treat it as a personal data breach: record it in the breach register, assess the risk to the individuals concerned, contact the unintended recipient to request destruction of the document, and notify the CNIL within 72 hours if the risk is established. Inform the individual concerned if the risk is high.
Does MSSanté fully replace the fax?
No, not yet. MSSanté only works between parties listed in the health directory and, now, towards patients via Mon espace santé. All exchanges with contacts outside the healthcare sphere — insurers, government bodies, transport providers, suppliers, foreign correspondents — remain out of scope.
Should you keep the physical fax machine?
Rarely. If it's still working and already paid off, you can keep it behind a T.38 adapter. But as soon as the hardware needs replacing, the calculation is quickly made: no more dedicated line subscription, no more consumables, no more maintenance. Be careful, though, to wipe the internal hard drive of a multifunction device before parting with it.
Is a fax admissible in court?
It generally constitutes prima facie written evidence, which must be corroborated. Always keep the time-stamped transmission receipt and the signed original. For an important commitment, prefer an electronic signature compliant with the eIDAS regulation.
In summary
- The PSTN is closing down gradually: a fax machine plugged into an analogue line is doomed in the short to medium term.
- VoIP breaks fax except with T.38 — and even then the recipient must also be correctly configured.
- Fax-to-email is the simplest way out for a practice: no hardware, no dedicated line, the ability to send from outside, and reception as time-stamped PDFs.
- Health data is sensitive within the meaning of the GDPR: wrong numbers, lack of encryption and physical exposure of the document are the three major risks.
- MSSanté is the channel to favour between listed professionals and towards patients via Mon espace santé.
- The fax retains its usefulness for all contacts outside the healthcare sphere and for international destinations.
- Five habits: check your line, move whatever can be moved to MSSanté, verify numbers using a shared address book, minimise the data transmitted, and secure the inbox.
The fax isn't dead in the world of healthcare; it is simply changing medium. At MondialFax, we continue to make it possible to send faxes to France, Spain, Portugal, Germany and Canada, and we remain attentive to your feedback so we can open up new destinations.
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