Roger,
My nurse and I are the only ones in my office that manage my Updox, although I have a third user who will help on occasion with sending records to and fro.
I use the assigned 888 fax # Updox gave me for everything, and if a fax comes in through the old fax #, my nurse will contact the entity and not respond until they send to our 888 fax #.
So with that being said, I have not seen missed faxes or unsent faxes occurring, nor has my nurse had an issue. We did have a situation where a local cardiologist's faxes came across on half pages, but after several days back and forth I think Meg at Updox tracked it down and got it figured out as a problem with the cardiologist's fax machine.
I have found emailing Meg at Updox is the best way to get things done through the help button on the main page.
However, the intersection of the e-faxing, 727 active portal users, scheduling, AC, telephone at one person's fingertips is fantastic as long as she is good and not sick a lot. It could be disastrous with a sub optimal employee.
So, my point is, I have not seen any recurring issues impacting my practice negatively with Updox, but in fact the opposite is the case. I think if you asked my nurse the last application she would do without would be Updox.
I do not have any suggestions on alternatives to Updox. Sorry.