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In the eyes of the law, a fax is a secure way to send personal information. An email, even an encrypted one, is not. We need to fix the law, but lawmakers as a rule do not understand technology.
Speaking as someone who works directly in the field: this is just plain factually incorrect. Encrypted email is compliant with patient privacy regulations in the US.
The issue is entirely cultural. Faxes are embedded in many workflows across the industry and people are resistant to change in general. They use faxes because it's what they're used to. Faxes are worse in nearly every way than other regulatory-compliant means of communication outside of "this is what we're used to and already setup to do."
I am actively working on projects that involve taking fax machines away from clinicians and backend administrators. There are literally zero technical or regulatory hurdles; the difficulty is entirely political.
And just try to get regular people to use email encryption. Yes, it could be signed to show that it hasn't been altered, but then most users can't even figure out where a file has been saved.
So they use faxes.
Here (not US) they've tried implementing a dedicated "secure email platform" for medical professionals so that they can exchange patient data. It's both progress and kind of idiotic, but it's not very widely used (because now, they have yet another email address to manage, on top of the six they already have to use).
Secure email is nearly always implemented as a portal-based system in practice. It's also typically only used for one-off exchanges. It's not our first-line method of communication, but it gets used within the facility literally every day.
HIE portals are more commonly used for provider-to-provider exchange that doesn't justify full data integration.
At any rate, the fundamental point stands: regulatory compliance has absolutely nothing to do with why faxes are still in use in the industry.