Enhanced Security: AES-256 Encryption for SSL and TLS

Business Solutions, HIPAA Compliant Email
LuxSci
December 1, 2020

SSL and TLS play critical roles in securing data transmission over the internet, and AES-256 is integral in their most secure configurations. The original standard was known as Secure Sockets Layer (SSL). Although it was replaced by Transport Layer Security (TLS), many in the industry still refer to TLS by its predecessor’s acronym. While TLS can be relied on for securing information at a high level—such as US Government TOP SECRET data—improper or outdated implementations of the standard may not provide much security.

Variations in which cipher is used in TLS impact how secure TLS ultimately is. Some ciphers are fast but insecure, while others are slower, require a greater amount of computational resources, and can provide a higher degree of security. Weaker ciphers—such as the early export-grade ciphers—still exist, but they should no longer be used.

The Advanced Encryption Standard (AES) is an encryption specification that succeeded the Data Encryption Standard (DES). AES was standardized in 2001 after a five-year review and is currently one of the most popular algorithms used in symmetric-key cryptography. It is often seen as the gold standard symmetric-key encryption technique, with many security-conscious organizations requiring employees to use AES-256 for all communications. It is also used prominently in TLS.

AES has been available in most cryptographic libraries for a long time. It became available in OpenSSL in 2002 with v0.9.7. OpenSSL is the foundation of most SSL services in UNIX and Linux environments, such as that used by LuxSci. GPG, the open source implementation of PGP, also includes an AES-256 option.

This article discusses AES, its role in TLS, which web browsers and email programs support it, and how you can ensure that you only use 256-bit AES encryption for communications that require a high level of security.

How secure are AES-256 and AES-128?

AES is Federal Information Processing Standard (FIPS) certified, and there are currently no known non-brute force attacks that work directly against AES. However, there are some side-channel timing attacks on the processing of AES. These are not feasible over a network environment and don’t apply to SSL in general. Because of this, AES is considered robust enough to protect secret government information:

The design and strength of all key lengths of the AES algorithm (i.e., 128, 192 and 256) are sufficient to protect classified information up to the SECRET level. TOP SECRET information will require use of either the 192 or 256 key lengths. The implementation of AES in products intended to protect national security systems and/or information must be reviewed and certified by NSA prior to their acquisition and use.”

Out of the three different key lengths, AES-256 offers a higher degree of security than the 128-bit and 192-bit versions of the standard.

The Beast Attack and TLS-secured websites

When TLS is used to protect website traffic (as opposed to IMAP, SMTP, encryption of files, etc.), an attack against it is known as The Beast. This attack makes it possible for people with access to a trusted location on your network to break into your TLS session and eavesdrop on your communications.

Thankfully, The Beast attack can easily be prevented. All you have to do is use TLS v1.1+ ciphers. This is why The Beast is no longer considered a critical attack vector. See also:

Mitigating The Beast attack.

Is the beast still a threat?

How long will AES-256 remain suitable for security?

The rise of quantum computing has caused a stir in the security community, with fears that it will render many of our security algorithms useless. While quantum computing looks like it will change the landscape regarding public-key algorithms, it is not believed to have significant impacts on algorithms like AES-256 soon.

The biggest quantum computing threat against AES is currently considered to be Grover’s algorithm. It is theorized to be able to perform a brute-force key search using quadratically fewer steps than required in classical computing. The implication is that an attacker with access to a quantum computer may be able to successfully attack a cipher with a key twice the length of what would generally be possible in classical computing.

However, the expense of quantum hardware and real-world complications of using Grover’s algorithm mitigate the threat of these attacks. NIST states that “… AES 128 will remain secure for decades to come. Furthermore, even if quantum computers turn out to be much less expensive than anticipated, the known difficulty of parallelizing Grover’s algorithm suggests that both AES 192 and AES 256 will still be safe for a very long time.”

Currently, there is no great rush to move away from AES to other symmetric key algorithms.

How is the cipher chosen in an SSL or TLS session?

Generally, when an SSL client, such as an email program or web browser, connects to a server and wishes to use SSL or TLS, the client sends the server a list of encryption ciphers it supports. The server then goes through the list and chooses the first match it supports. Usually, the client orders the list with the most secure methods first so that the most secure method supported by both the client and server is selected. Sometimes, the client orders the list based on other criteria to make a compromise between security and speed. This can result in a sub-optimal cipher being chosen.

Most modern web and email servers that support TLS encryption will have a wide range of different encryption techniques that they support. These can vary from 128-bit RC4, to 256-bit AES, to others. This range of options allows users with old or broken software to still take advantage of encryption, even if it is weaker than what is considered ideal in many situations.

Additionally, most companies that provide security services do not permit techniques that are deemed weak and can be broken easily. If you are connecting to a reputable service provided over TLS, the type of encryption will almost certainly be determined by your client program (i.e., email program or web browser), based on the options listed by the server.

What encryption techniques are supported by modern web browsers?

The latest versions of most modern browsers should support appropriate encryption algorithms.

You can check out whether your web browser uses up-to-date security practices by visiting:

https://www.howsmyssl.com/

If it says “Probably Okay,” it means that no security problems could be detected. If it says “Improvable” or “Bad,” your browser may be using an outdated version of TLS or have other security issues. In this case, you need to update to the latest version of your browser or switch to a browser like Firefox or Chrome that is actively being developed.

What encryption techniques were supported by legacy web browsers?

Before AES support became universal for older web browsers, we analyzed cipher support to see which ones supported AES. For posterity, we include this information here:

Web Browser	Operating System	Best Cipher	Verdict?
Native Android Browser (LG G3)	Android v4.4.2+	AES 256-bit	Good!
Chrome v39+	Android v4.4.2+	AES 256-bit	Good!
Firefox Mobile v8+	Android	AES 256-bit	Good!
Safari	iOS v8+ (iPhone/iPad/etc.)	AES 256-bit	Good
Safari	iOS v5.0.1	AES 128-bit	Good
Safari	iOS v2.2	AES 128-bit	Good
Silk	Kindle Fire	RC4 128-bit	Terrible
Firefox v35+	Windows XP & Vista, Mac OSX	AES 256-bit	Good!
Firefox v8+	Windows XP & Vista, Mac OSX	AES 256-bit	Good!
Firefox v3.0.5	Windows XP & Vista, Mac OSX	AES 256-bit	Good!
Safari v8+	Windows Vista/7, Mac OSX	AES 256-bit	Good
Safari v5.1.2	Windows Vista/7, Mac OSX	AES 128-bit	Good
Safari v3.2.1	Windows Vista, Mac OSX	AES 128-bit	Good
Safari v3.2.1	Windows XP	RC4 128-bit	Terrible
Chrome v40+	Windows Vista/7, Mac OSX	AES 256-bit	Good!
Chrome v15+	Windows Vista/7, Mac OSX	AES 256-bit	Good!
Chrome v1.x	Windows Vista	AES 128-bit	Good
Chrome v1.x	Windows XP	RC4 128-bit	Terrible
Internet Explorer v11	Windows 7	AES 256-bit	Good
Internet Explorer v9	Windows 7	AES 128-bit	Good
Internet Explorer v9	Windows Vista	RC4 128-bit	Terrible
Internet Explorer v7 & v8	Windows Vista	AES 128-bit	Good
Internet Explorer v8	Windows XP	RC4 128-bit	Terrible
Internet Explorer v7	Windows XP	RC4 128-bit	Terrible
Internet Explorer v6	Windows XP	RC4 128-bit	Terrible
Opera v26+	Mac OSX	AES 256-bit	Good!
Opera v11.10+	Windows Vista	AES 256-bit	Good!
Opera v9.62	Windows XP & Vista	AES 256-bit	Good!

So, by default, legacy browsers will take advantage of AES encryption when available. We also found that any program that uses old windows default SSL libraries will use RC4 in Windows XP and 128-bit AES in Windows Vista.

What encryption techniques are supported by modern email programs?

Asking this question about web browsers asks what is supported by the various email programs out there. If you are using a WebMail interface to access your email, the answer depends on your web browser. The latest versions of well-known email programs will use suitable encryption techniques, including AES-256. If you are using outdated/legacy email software, you should immediately update it to the latest version.

What encryption techniques were supported by legacy email programs?

We tested several popular legacy email programs on legacy operating systems to see the best encryption cipher they could use. This was done before AES usage became essentially universal. Here are the results (for posterity):

Email Program	Operating System	Verdict?	Results
Mozilla Thunderbird v2+	Windows XP & Vista	Good!	256-bit AES
Thunderbird v2+	Mac OSX v10.4.11	Good!	256-bit AES
Outlook 2010	Windows 7	Good!	256-bit AES
Outlook 2007	Windows XP	Terrible	128-bit RC4 is the best supported
Outlook 2007	Windows Vista	Good	128-bit AES chosen (though 256-bit is there, it is not listed 1st in the program and thus not used)
Outlook 2003	Windows XP	Terrible	128-bit RC4 is the best supported
Mail.app	Mac OSX v10.10	Good	256-bit AES
Mail.app	Mac OSX v10.5.5	Good	128-bit AES chosen (though 256-bit is there, it is not listed 1st in the program and thus not used)
Mail.app	Mac OSX v10.4.11	Good	128-bit AES chosen (though 256-bit is there, it is not listed 1st in the program and thus not used)
Mail.app	iPhone v2.2	Good	128-bit AES chosen (though 256-bit is there, it is not listed 1st in the program and thus not used)
Eudora v7	Windows XP	Good	256-bit AES
Eudora v8	Mac OSX v10.4	Good	256-bit AES
Entourage v12	Mac OSX v10.4	Terrible	DES

We see a similar pattern here. In most cases, the cipher used depended on the Operating System and not the program. Some programs roll their own SSL (i.e., Thunderbird/Eudora), and some use the OS built-in libraries. So, from this, we can infer that any newer version of Outlook on Vista or Windows 7+ will go for at least 128-bit AES; most things on Windows XP would use 128-bit RC4, etc.

How to force the use of AES-256 on secure web browsers and email programs

Web browsing clients like Mozilla Firefox or Opera and email clients like Thunderbird use AES-256 by default, as long as the server supports it.

However, it’s also possible to force the use of 256-bit AES encryption. This can be useful if your organization mandates that secure connections use 256-bit AES or if you do not trust that the servers you wish to connect to will have secure ciphers.

You can ensure that AES-256 is always used by following the instructions below. If the server does not support AES-256, the connection will fail.

Mozilla Firefox:

Type “about:config” in the address bar to open up the detailed list of configuration parameters.
Scroll down to “tls.version.min”, and ensure that it is set to “1” as an absolute minimum. This will turn off support for SSLv2 and SSLv3.
Search for “ssl3.”
Look for the ciphers that do not include “aes_256” in their names. If any of these say “true,” double click on them to change them to “false.” This will make them no longer available for use.
You will be left with various versions of AES-256 with TLS v1.0+.
You don’t have to restart Firefox for this to take effect.

Mozilla Thunderbird:

From Thunderbird’s home screen, click on the three horizontal lines in the top right corner.
Click Preferences, then Preferences once more in the menu that comes up.
Click Advanced, then scroll to the bottom right where it says Config Editor. Click on Config Editor.
Be aware that configuration changes can affect the program’s stability, and only proceed if you know what you are doing. Click I Accept the risk.
Scroll down to “tls.version.min”, and ensure that it is set to “1” as an absolute minimum. This will turn off support for SSLv2 and SSLv3.
Search for “ssl3 “
Look for the ciphers that do not include “aes_256” in their names. If any of these say “true,” double click on them to change them to “false.” This will make them no longer available for use.
Restart Thunderbird so that any persistent connections are broken and re-opened.
Make sure that your email accounts are all configured to use SSL or TLS (not “if available,” but “always”).
If possible, go to your email provider and disallow insecure connections to your account. This will make the connection fail even if the email program is accidentally configured to make a secure connection. (LuxSci allows this to be set on the user-level or enforced by policy account-wide).

Skype:

It’s off-topic, but Skype uses 256-bit AES encryption, so if you use it for chat or voice calls, your data is also being encrypted in this fashion.

Locking down your website (in Apache)

If you are a website owner and have TLS security on it, you can lock it down so that the only cipher your website supports is 256-bit AES. This takes the choice out of the end user’s hands. They can either use AES-256, or they won’t be able to connect to the website. However, this also means that some users may not be able to access your site unless they change to a more secure browser.

To lock your site down so that it only supports 128-bit and 256-bit AES, add the following to your Apache httpd.conf file:

SSLCipherSuite AES256-SHA:AES128-SHA

This can be added globally, in a virtual host, or even in your .htaccess file. It will ensure that any successful connection to your site will use one of these ciphers. Be sure to add it to the secure settings for your site and not just the insecure site area. More information is available at Apache.

You will generally want only to support TLS v1.2+ and NIST-recommended cipher suites. See: what level of TLS is required for HIPAA.

AES encryption is still reliable

AES encryption is still the preferred standard for TLS. Modern machines don’t noticeably affect performance, providing an adequate security level.

However, it’s important to note that TLS only protects data sent between you and the server. When you send and receive an email, the message data travels in the clear, so TLS does not protect it throughout the entire journey. The Case for Email Security explains this in more detail.

Thankfully, services like LuxSci’s SecureLine provide email encryption, which can safeguard your email the whole way. Contact our team for more information on how to protect your organization’s data.

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Why is High Email Deliverability Essential for Healthcare Companies?

June 30, 2025
Pete Wermter

With email communication playing a critical role in the customer engagement strategies of virtually every organization, high email deliverability rates are vital to success across all industries. In the healthcare sector, however, the stakes can be far higher. An undelivered email isn’t merely an inconvenience or a lost sales opportunity; it could mean a missed appointment, a delay in a prescription refill, or a failure to get a patient critical healthcare information. Or worse, the email could end up in the hands of an unintended recipient, including bad actors and cybercriminals.

With this in mind, this post details why high email deliverability is essential for healthcare companies, as well as how your organization benefits from reliable and rapid email delivery.

Speed and Efficiency

The primary reason that high email deliverability is crucially important to healthcare organizations is to best guarantee essential communications that directly impact an individual’s healthcare journey reach them promptly. These transactional emails can include appointment reminders, prescription renewals, product order confirmations, test results, explanation of benefits notices, payment reminders, and invoices. Administrative notifications related to software or systems that a patient might use, such as a password reset for an online portal, also fall under the category of transactional emails.

When transactional emails are delayed or fail to reach people altogether, they can compromise a patient’s ability to access care, adhere to treatment plans, stay informed on key facets of their healthcare journey, and, ultimately, achieve optimal health outcomes.

When a patient fails to receive an expected email, such as a prescription confirmation, for example, it can leave them feeling confused and unsure of what to do next. For individuals who are sick, elderly, or managing chronic conditions, this can cause unnecessary stress, anxiety, and even compromise adherence to care plans.

In contrast, high email delivery rates create the opposite effect, helping patients get the communications and information they need. This increases their trust in your company and gives them a firmer sense of control over their healthcare journey.

Compliance with HIPAA Regulations

While the above point stresses the importance of reliable email delivery for the patient’s and customer’s benefit, healthcare companies also have a vested interest in ensuring communications reach the intended recipient for regulatory and patient privacy reasons.

To comply with the Health Insurance Portability and Accountability Act (HIPAA), emails that contain sensitive patient data, i.e., electronic protected health information (ePHI), must be securely delivered to the intended recipient. If, on the other hand, a communication containing ePHI fails to reach the intended recipient patient, that represents a failure in secure communications and a potential HIPAA violation for your organization.

After all, where did the patient’s data go? Was it delivered to the wrong person? Was it blocked by a spam filter and is left sitting unencrypted on a server somewhere?

If you can’t answer these questions, you could be exposed to a data breach, and it could result in a HIPAA violation, meaning your organization incurrs the associated consequences, including financial penalties and reputational damage. Conversely, deploying a fully HIPAA compliant email solution, such as LuxSci, supported by a dedicated infrastructure and designed for high email delivery enables your organization to include patient data in communications with confidence and ensure you messages land in the recipient’s inbox.

Greater Levels of Personalization and Engagement

Finally, high email deliverability rates are essential for healthcare organizations because they help drive greater levels of engagement with patients and customers. Higher email deliverability means better inbox placement, leading to more emails being opened, more links being clicked, and more conversions for your communications and campaigns.

In the case of healthcare retailers, for example, this equates to converting more prospects into customers and, consequently, maximizing the ROI of email marketing campaigns, in some cases with up to 80% better results.

While healthcare marketers, understandably, focus most of their efforts on crafting attention-grabbing headlines, personalizing the message content, and the email’s design elements, these factors are rendered irrelevant if the message fails to reach the recipient in the first place! When you take this into account, high email deliverability is a crucial component in optimizing the ROI of email communications and campaigns, and an all too often overlooked component at that.

Get Your Copy LuxSci’s Achieving High Email Deliverability Best Practices Paper

To learn more about the importance and value of high email deliverability for healthcare companies, download your copy of LuxSci’s latest Best Practices Paper: How to Achieve High Email Deliverability in Healthcare. You’ll discover:

How to opitmize performance for the different types of healthcare emails.
Powerful strategies for increasing your company’s email deliverability rates.
How small increases in email deliverability can have considerable effects on your marketing ROI

Grab your copy of the report here, and learn how to enhance your email deliverability rates today.

What is a HIPAA Email API?

June 25, 2025
Ian Snipper

A HIPAA email API is a programming interface that allows healthcare applications to send secure emails containing protected health information while maintaining compliance with HIPAA regulations. These APIs provide developers with tools to integrate encrypted email functionality into healthcare software systems while automatically handling security requirements, audit logging, and PHI protection measures. Healthcare software development increasingly requires email capabilities for patient notifications, care coordination, and administrative communications. Standard email APIs lack the security controls and compliance features necessary for healthcare applications that handle sensitive patient data.

Technical Architecture and Security Framework

REST and SOAP protocols provide the foundation for most HIPAA email APIs, enabling healthcare applications to integrate email functionality through standard web service interfaces. These protocols support secure authentication and encrypted data transmission while maintaining compatibility with diverse healthcare technology environments. Message queuing systems help manage email delivery during high-volume periods while maintaining security controls throughout the transmission process. Healthcare applications can submit emails to secure queues where they receive encryption and compliance validation before delivery to recipients. Error handling mechanisms ensure that failed email transmissions do not compromise PHI security or leave sensitive data exposed in log files. HIPAA email APIs must provide detailed error information to developers while protecting patient information from unauthorized disclosure.

Authentication and Authorization Protocols

API key management provides secure access control for healthcare applications using email services. These keys must include appropriate permissions and expiration policies that prevent unauthorized access while enabling legitimate healthcare communications, allowing healthcare applications to authenticate users and obtain appropriate permissions for sending emails on their behalf. These protocols help ensure that only authorized personnel can trigger email communications containing PHI.

LuxSci supports three industry-standard authentication methods—alongside its proprietary LuxSci Secure option. These include:

OAuth 2.0 – The modern standard. Secure, flexible, and ideal for enterprise-scale integrations.
API Key – Simple and efficient. Ideal for server-to-server use when convenience matters most.
Basic Authentication – Straightforward, widely supported. Good for internal systems and quick testing.

For those who want the tightest possible control over API sessions—including HMAC signatures and session revocation—LuxSci Secure authentication remains the best option for customers.

Message Formatting, Template Management, and Security

MIME and S/MIME encoding support enables healthcare applications to send rich-text emails with attachments while maintaining encryption and security controls. These capabilities allow inclusion of medical images, test results, and formatted reports within compliant email communications. Template engines help healthcare developers create standardized email formats that include dynamic patient data while preventing inappropriate PHI disclosure. These systems can validate content against organizational policies before message transmission. Attachment handling procedures ensure that medical documents and images receive appropriate encryption and access controls when included in email communications. HIPAA email APIs must provide secure upload and transmission capabilities for healthcare file attachments.

Delivery Tracking and Status Reporting

Real-time delivery status updates help healthcare applications track email transmission progress and identify potential delivery issues. These status reports must provide actionable information without exposing PHI to unauthorized systems or personnel. Read receipt capabilities enable healthcare applications to confirm that recipients have accessed important medical communications. These features help care coordination while maintaining appropriate privacy protections for patient email interactions. Bounce management systems handle failed email deliveries appropriately while protecting PHI from exposure through error messages or automated responses. Healthcare applications need visibility into delivery problems without compromising patient privacy.

Compliance Logging and Audit Features

Automated audit trails capture detailed information about all email activities initiated through HIPAA email APIs. These logs must include sender identification, recipient information, transmission timestamps, and delivery status while protecting actual message content from unauthorized access. Compliance reporting features help healthcare organizations track their email usage patterns and identify potential policy violations. These reports can highlight unusual sending volumes, unauthorized recipient addresses, or messages that might violate PHI handling policies. Data retention controls ensure that API logs and message metadata comply with healthcare record-keeping requirements while managing storage costs and system performance. Healthcare organizations can configure retention periods based on their regulatory and operational needs.

Integration Patterns for Healthcare Applications

Electronic health record system (EHR), customer data platform (CDP), and Revenue Capture Management (RCM) platform integrations can enable automatic email messages and notifications to be sent based on clinical events like lab result availability or appointment scheduling changes. These integrations must respect minimum necessary standards while providing timely patient communications. Workflow automation allows healthcare applications to trigger email sequences based on patient care milestones or administrative requirements, tailoring communications based on user actions taken with each email. For example, healthcare organizations might send automated email reminders about upcoming appointments or medication refills. Batch processing capabilities enable healthcare organizations to send large volumes of patient communications efficiently while maintaining security controls and HIPAA compliance. These features support activities like appointment reminders, wellness newsletters, or billing notifications that affect many patients simultaneously.

Performance Optimization and Scalability

Rate limiting controls help healthcare organizations manage email volumes while preventing abuse or accidental bulk sending that might violate patient communication policies and damage your IP reputation. These controls can be customized based on organizational needs and user roles. Caching mechanisms improve API performance by storing frequently used templates and configuration data while maintaining appropriate security controls. These optimizations help reduce response times for healthcare applications without compromising PHI protection. Load balancing systems ensure reliable email delivery during peak usage periods when healthcare organizations send high volumes of patient communications. These systems must maintain security controls while distributing processing loads across multiple servers.

Testing and Development Support

Sandbox environments enable healthcare developers to test email functionality without exposing real patient data or sending communications to actual patients. These testing systems provide realistic API responses while using protected data that supports thorough integration testing. Documentation and code samples help healthcare development teams implement HIPAA email API functionality correctly while understanding security requirements and compliance obligations. These resources should include examples for common healthcare use cases and integration scenarios.

Finally, support services provide healthcare developers with technical assistance and compliance guidance during implementation and ongoing operations. API providers should offer expertise in both technical integration and healthcare regulatory requirements to ensure successful deployments.

On-Demand Webinar: HIPAA Compliant Email Marketing – 20 Tips in 20 Minutes

June 24, 2025
Pete Wermter

Healthcare marketers and compliance professionals—this one’s for you.

LuxSci’s latest on-demand webinar, HIPAA Compliant Email Marketing: 20 Tips in 20 Minutes, delivers practical, fast-paced guidance to help you run secure, compliant, and results-driven healthcare email marketing campaigns.

Watch the Webinar

What You’ll Learn

The session is packed with actionable insights to help you safely navigate the world of HIPAA compliant email marketing, including:

How to leverage PHI safely and effectively for email personalization
Best practices for email messaging and content
Tips for segmenting and targeting audiences to boost engagement
How to stay HIPAA compliant
Automation and list-building strategies for smarter workflows
How to avoid common compliance pitfalls and reduce regulatory risk
Technical tips for email encryption, access protocols, and email retention and storage

Whether you’re leading digital strategy, building campaigns, or ensuring HIPAA compliance for your healthcare marketing efforts, this webinar provides timely and useful information on secure healthcare communications and what you need to know to keep you business safe and your patient data secure.

At LuxSci, we empower healthcare providers, payers, and suppliers to personalize their healthcare engagement efforts and better connect with patients and customers—securely, compliantly, and effectively.

Watch the Webinar

What Is a HIPAA Compliant Email API?

June 23, 2025
Ian Snipper

HIPAA compliant email API enables healthcare applications to send automated emails containing protected health information through secure programming interfaces that meet HIPAA Security Rule requirements. These APIs provide encryption, access controls, and audit logging capabilities while allowing developers to integrate email functionality into healthcare software without compromising patient privacy or regulatory compliance. Healthcare software applications increasingly need automated email capabilities for appointment reminders, test results, billing notifications, and care coordination communications. Standard email APIs lack the security features and compliance controls necessary for transmitting PHI, requiring specialized solutions designed for healthcare use cases.

API Authentication and Access Controls

HIPAA compliant email APIs implement robust authentication mechanisms that verify the identity of applications and users before allowing access to email services. These systems typically use API keys, OAuth tokens, or digital certificates to establish secure communication channels between healthcare applications and email services. Role-based access controls allow healthcare organizations to limit API functionality based on user privileges and business needs. Appointment scheduling systems might have permission to send calendar reminders while being restricted from accessing patient medical records or billing information. Rate limiting and usage tracking help prevent unauthorized bulk email sending and detect potential security threats. API providers monitor usage patterns and can automatically restrict access when they detect unusual activity that might indicate compromised credentials or malicious use.

Message Encryption and Security Features

Email messages sent through HIPAA compliant APIs receive automatic encryption during transmission and storage. These systems typically support multiple encryption standards including TLS for transport security and end-to-end encryption for message content protection. Message validation features help ensure that emails containing PHI meet compliance requirements before transmission. APIs can check for proper authorization, validate recipient addresses, and verify that message content follows organizational policies for PHI disclosure.

Secure message delivery tracking provides confirmation when recipients receive and access encrypted emails. This audit trail helps healthcare organizations demonstrate compliance with HIPAA requirements and provides documentation for potential breach investigations or regulatory audits.

Integration with Healthcare Workflows

HIPAA compliant email APIs connect seamlessly with electronic health record systems, practice management platforms, and other healthcare applications. These integrations enable automated patient communications that trigger based on clinical events, scheduling changes, or administrative milestones. Template management systems allow healthcare organizations to create standardized email formats that ensure consistent messaging while maintaining compliance controls. Templates can include dynamic content from patient records while preventing unauthorized PHI disclosure through automated formatting rules. Event-driven messaging capabilities enable real-time communications based on healthcare system activities. Laboratory systems can automatically send encrypted test results to ordering physicians immediately after completion, improving care coordination and reducing manual data entry requirements.

Audit Logging and Compliance Tracking

HIPAA compliant email APIs maintain detailed logs of all messaging activities including sender identification, recipient information, message content summaries, and delivery status. These logs provide the documentation necessary for compliance audits and breach investigations. Automated compliance reporting features help healthcare organizations track email usage patterns and identify potential policy violations. Reports can highlight unusual sending volumes, unauthorized recipient addresses, or messages that might contain inappropriate PHI disclosures.

Data retention policies ensure that API logs and message archives meet HIPAA requirements while managing storage costs and system performance. Healthcare organizations can configure retention periods based on their compliance needs and operational requirements.

Developer Tools and Documentation

API documentation provides healthcare software developers with detailed technical specifications, code samples, and integration guides for implementing HIPAA compliant email functionality. These resources help development teams understand security requirements and implement proper PHI handling procedures. Software development kits (SDKs) simplify API integration by providing pre-built libraries for common programming languages and frameworks. These tools handle encryption, authentication, and compliance features automatically, reducing the risk of implementation errors that could compromise PHI security. Testing environments allow developers to validate their integrations without exposing real patient data. Sandbox systems provide realistic API responses while using synthetic data that enables thorough testing of email functionality and error handling procedures.

Scalability and Performance Considerations

HIPAA compliant email APIs must handle varying message volumes without compromising security or compliance controls. Healthcare organizations experience different email patterns based on patient schedules, clinical activities, and administrative cycles that require flexible capacity management. Load balancing and redundancy features ensure reliable email delivery even during peak usage periods or system maintenance activities. API providers typically maintain multiple data centers and failover systems that prevent service disruptions from affecting patient communications.

Performance analytics help healthcare organizations optimize their email communications and identify potential bottlenecks in their workflows. Metrics include delivery speeds, error rates, and system response times that enable proactive performance management and capacity planning.

Is Office 365 HIPAA Compliant?

October 18, 2024
Erik Kangas

Microsoft Office 365 can be HIPAA compliant when properly configured and covered under a Business Associate Agreement (BAA) with Microsoft. The platform includes security features, access controls, and encryption capabilities that support HIPAA requirements when implemented correctly. Healthcare organizations must enable specific security settings, configure appropriate access permissions, and train staff on proper usage to maintain compliance within the Office 365 environment.

Microsoft BAA Coverage

Microsoft offers a Business Associate Agreement covering Office 365 services when used by healthcare organizations. This agreement establishes Microsoft as a business associate under HIPAA regulations and outlines their responsibilities for protecting health information. Not all Office 365 services fall under BAA coverage – Microsoft provides documentation specifying which services qualify for healthcare data. Core services like Exchange Online, SharePoint Online, OneDrive for Business, and Microsoft Teams typically qualify with proper configuration. Organizations must execute this agreement before storing any protected health information in Office 365.

Email Protection Capabilities

Exchange Online includes several features supporting HIPAA compliant status for healthcare email. Transport Layer Security (TLS) encrypts email during transmission between systems. Data Loss Prevention policies can identify and protect messages containing patient information. Rights Management Services allows message encryption for sensitive healthcare communications. Organizations can implement archiving and retention policies that maintain healthcare records according to regulatory requirements. These capabilities help protect patient information sent through email while maintaining appropriate documentation for becoming HIPAA compliant.

Document Storage Safeguards

SharePoint Online and OneDrive for Business provide document storage with security features supporting HIPAA compliance. Encryption protects stored healthcare documents from unauthorized access. Permission controls restrict document viewing based on user roles and responsibilities. Audit logging tracks document access and modifications for HIPAA compliant documentation. Version history maintains records of document changes. Organizations can implement information barriers that prevent inappropriate sharing between departments. These features allow healthcare organizations to store and collaborate on patient information while maintaining appropriate security controls.

Collaborative Healthcare Communication

Microsoft Teams offers collaboration capabilities that support HIPAA compliant communication when properly configured. Private channels allow secure discussions about patient cases between authorized healthcare providers. Meeting recordings and chat logs maintain appropriate documentation of clinical consultations. Guest access controls allow external providers to participate in care discussions with proper security boundaries. Organizations can implement retention policies that maintain records according to healthcare requirements. These features enable healthcare teams to collaborate effectively while protecting patient information confidentiality.

Platform Management Tools

Office 365 includes administrative tools that help maintain HIPAA compliance across the platform. Multi-factor authentication adds security beyond passwords for accessing healthcare information. Conditional access policies can restrict system access based on device status, location, and risk factors. Mobile device management enforces security requirements on smartphones and tablets accessing patient data. Security monitoring identifies potential threats and suspicious activities across the environment. These administrative capabilities help organizations implement security programs that protect healthcare information throughout the Office 365 environment.

Workforce Readiness Elements

Achieving HIPAA compliance with Office 365 requires proper implementation and staff training beyond technical configuration. Organizations must develop policies governing appropriate use of Office 365 services for healthcare information. Staff need training on security features and compliance requirements specific to the platform. Regular security assessments help identify potential vulnerabilities in Office 365 implementations. Documentation should include Office 365 security configurations as part of overall compliance planning. These implementation practices help organizations maintain HIPAA compliance while leveraging Office 365 productivity benefits.

What is Email Deliverability?

June 3, 2025
Erik Kangas

Email deliverability refers to the ability of emails to reach recipients’ inboxes successfully without being filtered into spam folders or blocked entirely by email service providers. This metric involves the entire journey an email takes from sender to recipient, including authentication protocols, sender reputation, content quality, and recipient engagement patterns. For healthcare organizations managing patient communications, provider networks, and supplier relationships, understanding email deliverability is highly important given the sensitive nature of healthcare data and the need for reliable communication channels.

How Email Service Providers Filter Messages

Email service providers use sophisticated algorithms to evaluate incoming messages and determine their appropriate destination. These systems analyze multiple factors simultaneously, including sender authentication records, message content, sending patterns, and recipient behavior. The filtering process occurs in real-time, with providers like Gmail, Outlook, and Yahoo applying machine learning models trained on billions of email interactions to identify potential spam or malicious content. Authentication plays a large role in this filtering process. Providers verify sender identity through SPF (Sender Policy Framework), DKIM (DomainKeys Identified Mail), and DMARC (Domain-based Message Authentication, Reporting, and Conformance) records. Healthcare organizations without properly configured authentication often find their appointment reminders, lab results, or billing communications relegated to spam folders, disrupting patient care workflows and administrative processes.

Sender Reputation and Its Impact on Healthcare Communications

Sender reputation functions as a digital credit score for email domains and IP addresses, influencing whether healthcare organizations can reliably reach patients, providers, and business partners. Email service providers maintain reputation databases that track sending behavior, bounce rates, spam complaints, and recipient engagement over time. A single domain or IP address with poor reputation can affect email deliverability across an entire healthcare network. Healthcare entities take on reputation challenges due to the nature of their communications. Patient appointment reminders sent to outdated email addresses generate high bounce rates, while automated billing notifications may receive spam complaints from recipients who forgot they subscribed to such communications. These factors can gradually erode sender reputation, making it increasingly difficult to reach patients with time-sensitive medical information.

Protocols for Healthcare Email Deliverability Security

Modern email deliverability depends heavily on proper implementation of authentication protocols that verify sender identity and prevent email spoofing. SPF records specify which mail servers are authorized to send emails on behalf of a domain, while DKIM adds cryptographic signatures to verify message integrity. DMARC ties these protocols together by instructing receiving servers how to handle emails that fail authentication checks. Healthcare organizations must configure these protocols carefully to avoid authentication failures that could block legitimate patient communications. A misconfigured SPF record might prevent appointment confirmation emails from reaching patients, while improper DKIM setup could cause lab result notifications to be filtered as spam. These authentication failures can have serious implications for patient care, particularly when dealing with urgent medical communications or time-sensitive treatment instructions.

Content Quality and Compliance Considerations

Email content quality directly affects email deliverability, with providers using advanced algorithms to evaluate message structure, language patterns, and formatting for spam indicators. Healthcare organizations must balance informative content with deliverability requirements, ensuring that medical communications reach their intended recipients without triggering spam filters. This balance becomes particularly challenging when dealing with complex medical terminology, prescription information, or insurance-related content that may resemble spam to automated filtering systems. HIPAA compliance adds another element of complexity to healthcare email content, as organizations must protect patient information while maintaining effective communication channels. Emails containing protected health information require extra security measures and careful content formatting to avoid both compliance violations and deliverability issues. The challenge is in creating compliant, informative communications that also pass through increasingly sophisticated spam filters.

Email Deliverability Performance

Tracking email deliverability metrics provides healthcare organizations with the data needed to identify and address communication issues before they impact patient care or administrative operations. Key metrics include delivery rates, bounce rates, spam complaint rates, and inbox placement percentages across different email providers. These metrics help organizations understand how their communications perform across various platforms and identify potential problems with specific communication types or recipient segments.

Healthcare organizations should establish monitoring systems that track deliverability performance across different communication channels, including patient portal notifications, appointment reminders, billing communications, and provider-to-provider messages. This approach helps identify patterns that might indicate authentication issues, content problems, or reputation concerns that could affect the organization’s ability to communicate effectively with patients and business partners.

The Risks of Third-Party Email Integrations for Healthcare Companies

March 10, 2025
Pete Wermter

Today’s healthcare organizations heavily rely on a variety of third-party organizations for a range of services and products. This includes applications (i.e., SaaS solutions), suppliers, partners, and other companies depended upon to serve their patients and customers.

As the healthcare industry evolves, companies will need to increasingly collaborate with external parties, or business associates, which creates several dependencies and risks.

In particular, third-party email platforms are integral to the operations of healthcare companies, and the sensitive nature of protected health information (PHI) contained in email communications raises the stakes exponentially.

This post analyzes the main risks associated with third-party email integrations. From there, we detail the most effective measures for safeguarding your company from the dangers of an insecure integration with an email delivery platform.

What Are The Risks of Third-Party Email Integrations?

Email applications are a pillar of the modern workplace, enabling companies to communicate almost instantly and facilitating greater productivity and efficiency. Email has transformed the speed at which transactions can take place and individuals receive the product or service they’ve purchased.

Consequently, the importance of email communication and the vast amounts of sensitive data it encompasses, makes it a contrast target – or “attack vector” for cybercriminals. Hackers and other malicious actors know that if they can infiltrate an organization’s email system, they have the potential to steal vast amounts of private or proprietary data. Just as alarmingly, they may simply use an insecure email platform as a backdoor into a company’s wider network, assuming greater control over their systems in an effort to maximize their financial gain or inflict maximum damage to an organization.

For healthcare companies with ambitious patient engagement goals, sharing protected health information (PHI) with a reliable third-party email provider is mandatory. Unfortunately, this comes with a litany of risks, which include:

Data Breaches: weak security features in third-party email providers can expose PHI.
Misconfigured Permissions: misconfigurations and a lack of oversight control can result in personnel at third parties having excessive access to PHI.
HIPAA Non-Compliance – if the integration does not support encryption, audit logs and other features mandated by HIPAA, you may drift into non-compliant territory.
Financial Implications: violating HIPAA regulations can result in financial penalties, including fines and compensation to affected parties.
Reputational Damage: companies that fall victim to cyber attacks, especially through negligence, become cautionary tales and case studies for cybersecurity solution vendors. Data exposure that comes from an insecure email platform integration can have disastrous effects on your company’s reputation.

Therefore, mitigating the risks of integrating a third-party email platform into your IT infrastructure, platforms and systems is crucial. This includes customer data platforms (CDP), electronic health record systems (EHR) and revenue cycle management platforms (RCM). Let’s move on to specific strategies on how to do so and, subsequently, better safeguard your organization’s PHI.

How To Mitigate Email Integration Risk

Now that you have a better understanding of the potential risks that come with integrating an insecure third-party email solution into your IT ecosystem, let’s look at risk prevention. Fortunately, several strategies will significantly lower the risk of malicious actors getting their hands on the sensitive patient data under your care. Let’s take a look:

Verify A Third-Party Vendor’s Security Practices

Before sharing PHI with a vendor, ensure they have a strong cybersecurity posture. This makes sure they have measures such as encryption, access control (or identity access management (IAM), and continuous monitoring solutions in place, in addition to conducting regular risk assessments.

Similarly, it’s crucial to research an email provider’s reputation, including how long they’ve been in operation, the companies they count among their clients, and their overall standing within the industry.

Business Associate Agreements (BAAs)

A business associate agreement (BAA) is a legal document that’s required for HIPAA compliance, when sharing PHI with third-party vendors, such as email services. It ensures that both you and the vendor formally agree to comply with HIPAA regulations and your respective responsibilities in protecting patient data.

Without a BAA, the above point about verifying a vendor’s security practices is moot. If they’re not willing to sign a BAA, their security stance is irrelevant, as your organization would have violated HIPAA regulations by not signing a BAA. More to the point, a HIPAA compliant email vendor will be eager to highlight their willingness to sign a BAA, as it advertises their ability to safeguard PHI and aid companies in achieving compliance.

Encrypting PHI

Encryption needs to be a major consideration when it comes to integrating a third-party email services provider. Adequate encryption measures ensure that sensitive data is protected even in the event of its exfiltration or interception. Sure, the hackers now have hold of the PHI, but with proper encryption policies and controls, it will be unreadable, preserving the privacy of the individuals affected by the data leak.

With this in mind, encryption measures that mitigate third-party email integrations include automated encryption, which ensures PHI is always encrypted without the need for manual configuration, and flexible encryption, which matches the encryption level with the security standards of your recipients.

Threat Intelligence

Unfortunately, cybersecurity never stands still. With the ever-evolving nature of cyber threats, healthcare organizations must keep up with the latest dangers to patient data. This means creating a process for discovering, and acting upon, the latest threat intelligence.

This could entail signing up for a threat intelligence service, or retaining the periodic services of an external threat intelligence expert.

Developing An Incident Response Plan For Vendor-Related Breaches

The alarming reality of securing PHI is that, even with robust safeguards in place, such as continuous monitoring, a process for acquiring the latest threat intelligence, and generally following the advice outlined in this post, data breaches are still a stark reality. Cyber criminals will always target healthcare organizations, due to the value and sensitivity of their data and systems. Worse, even as security measures grow more effective, the tools that malicious actors have at their disposal become more sophisticated. It’s an arms race, and one that’s only been exacerbated by the introduction of AI, with both security professionals and cyber criminals honing their use of it for their respective purposes.

Taking all this into consideration, having a comprehensive incident response plan in place ensures your organization responds quickly and effectively to cyber threats, or even suspicious activity. Your incident response plan should:

Detail what employees should do if they suspect malicious activity.
Outline steps for investigation and containment.
When and how to notify affected parties.
Processes for disaster recovery and retaining operational continuity.

While it’s vital to develop a general incident response plan, having a specific set of protocols for security breaches caused by third-party vendors is especially prudent.

Choose a HIPAA-Compliant Email Provider

An efficient and convenient way of mitigating the risks of third-party email integrations is to deploy a HIPAA compliant email delivery platform for communicating with patients and customers.

Being well-versed with the safety requirements of healthcare organizations, HIPAA compliant email software features all the security required to safeguard PHI. In deploying a HIPAA compliant email provider, you also implement several of the strategies outlined above, such as encryption and signing a BAA (as a HIPAA compliant will offer a BAA). Accounting for this, taking the time to select the right HIPAA compliant email provider for your organization’s needs and goals should be a key part of your overall cyber threat defense strategy.

Train Staff on Secure Email Communication Practices

Your staff is a considerable part of securing third-party email communications, so they must know the best practices for email security and safeguarding PHI. Comprehensive cyber threat awareness training ensures your personnel understand the risks of HIPAA non-compliance and follow the procedures you’ve set in place. Furthermore, the more responsibility an employee has in regards to PHI, the more comprehensive and regular their training needs to be.

Additionally, training, or “drilling”, if you will, on their roles in the incident response process increases its efficacy considerably and optimizes your response to attempts at unauthorized access to data.

How LuxSci Mitigates the Risks of Third-Party Integrations

At LuxSci, we specialize in providing secure, HIPAA compliant solutions that enable healthcare organizations to execute effective email communications and marketing campaigns.

With more than 20 years of experience, and helping close to 2000 healthcare organizations with HIPAA compliant email services, LuxSci has developed powerful, proven tools that sidestep the vulnerabilities often associated with third-party email integration. To learn more about how LuxSci can help your organization address the risks of third-party email integration, contact us today.

What is a Secure Email Gateway?

April 2, 2025
Pete Wermter

Email communication is indispensable in today’s fast-paced, digitally-driven healthcare world. Unfortunately, for healthcare organizations, cyber criminals are aware of this too, which is why email-based cyber threats, such as unauthorized access, PHI exposure, phishing and ransomware, remain as prevalent as ever. A Secure Email Gateway can help, providing a security solution that sits between an organization’s email server and the outside world to monitor, filter, and control all incoming and outgoing email traffic.

As healthcare companies learn to recognize and mitigate email security threats, malicious actors grow more sophisticated, developing new ways of breaching organizations’ email security measures. In light of this, healthcare companies must find ways to better safeguard the electronic protected health information (ePHI) within their IT infrastructure, especially for email. Not only will this help maintain operational consistency, delivering high-quality and expedient service to their patients and customers, but it helps them comply with the regulatory guidelines mandated by the Health Insurance Portability and Accountability Act (HIPAA).

A secure email gateway provides an excellent solution to the problem of an evolving email cyber threat landscape, without a healthcare company having to make significant changes to their IT infrastructure. So, with this in mind, this post explores the concept of secure email gateways, how they better safeguard sensitive patient data, and how they support HIPAA compliance efforts.

What Is a Secure Email Gateway?

A secure email gateway is a security tool that filters inbound and outbound email communications to mitigate a variety of email-based cyber threats, including phishing, malware (e.g., ransomware, viruses, etc), PHI exposure, and spam mail.

Effectively providing an additional security layer for your organization’s email accounts, a secure email gateway acts as a checkpoint between its email systems and the internet, enforcing your healthcare company’s security policies and ensuring HIPAA compliance.

How Do Secure Email Gateways Work?

A secure email gateway sits between a company’s email platform (e.g., Microsoft 365, Google Workspace) and external email traffic, scanning messages for potential malicious activity and security policy violations.

When sending an outbound email, the message is encrypted before being passed onto the recipient. This prevents the exposure of any ePHI contained in the email, in the event of its interception. Without the encryption key, the email is rendered unreadable by cyber criminals, ensuring data privacy and regulatory compliance. By the same token, depending on its nature, the secure email gateway may automatically archive the email to help satisfy compliance requirements for message retention – something that will be all the more important when the updated HIPAA Security Rule comes into effect in later 2025.

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Conversely, for incoming traffic, a secure email gateway utilizes filtering tools to identify and quarantine suspicious messages. By preventing potentially malicious messages from reaching employee inboxes, a gateway reduces instances of phishing, malware installation, credential compromise – and any email cyber threat that requires human error or negligence.

When Should You Opt For a Secure Email Gateway?

The key reason to opt for a secure email gateway solution is that you want to enhance your company’s email security without replacing your existing email infrastructure.

A key advantage offered by secure email gateways is that they’re easy to install, manage, and use. This keeps the administrative burden on a company’s IT and operations departments to a minimum while still achieving the key objectives of boosting email security and aiding compliance efforts.

More specifically, installing a secure email gateway can be an easy solution for healthcare care companies looking to quickly achieve HIPAA compliance for email. By simply sitting on top of a company’s existing email service, like Microsoft 365 or Google Workspace, a secure email gateway can be easier for IT teams to install and maintain, especially for smaller companies and organizations. Additionally, employees won’t require additional training or have to make any adjustments: they can simply keep using their existing email accounts without interruption.

Enhance Your Email Security Posture With Luxsci’s Secure Email Gateway

LuxSci’s Secure Email Gateway can be easily integrated with Microsoft 365, Google Workspace, or your on-premise email client to better safeguard ePHI and ensure HIPAA compliance – with zero disruption to your current systems, employees, or your quality of service.

Using LuxSci’s proprietary SecureLine encryption technology, our Secure Email Gateway solution automatically encrypts every email, protecting sensitive patient data without the need for explicit employee intervention before sending the message.

Want to know more about how HIPAA compliant email will boost your security and compliance? Contact us to learn more and get started!