Healthcare providers, payers, and suppliers increasingly rely on email communication for a wide variety of purposes pertaining to their patients’ and customer’s healthcare journeys. However, ensuring email messaging is both effective and HIPAA compliant requires the right infrastructure, including dedicated environments, high throughput and low latency, end-to-end encryption, scalability and compliance monitoring.

The Health Insurance Portability and Accountability Act’s (HIPAA) regulations mandate a series of data security and privacy requirements to safeguard the electronic protected health information (ePHI) contained in emails, which is a good place to start. At the same time, however, healthcare organizations must also consider deliverability best practices to ensure their messages successfully reach the intended recipients. 

With all this in mind, this post discusses the infrastructure requirements for HIPAA compliant email. We’ll explore the differences between transactional and marketing emails, as well as infrastructure and compliance considerations for each. 

What Are Transactional Emails?

Transactional emails are messages that correspond to a previous interaction between a healthcare organization and an individual. A patient or customer will trigger the delivery of a transactional email by taking a specific action – with the transaction email being confirmation of the action.  

Examples of transactional emails include:

• Explanation of Benefits
• Billing statements
• Invoices
• Appointment confirmations and reminders
• Order updates and shipping notifications
• Password resets and security notifications
• Plan renewal confirmation 
• Payment failure notifications
• In-home care communications

Healthcare companies can also use transactional emails to communicate relevant instructions, next steps, or follow-up actions.

What Are Marketing Emails?

Marketing emails contain content designed to influence the recipient into taking a particular action, usch as ordering a new product or sign up for a new service. Subsequently, they often contain informational materials intended to educate the individual so they can make a more informed decision. 

Examples of marketing emails include:

• New product or service launches
• Promotional offers
• Loyalty reward notifications 
• Customer reviews and testimonials 
• Educational materials or campaigns 
• Preventative care outreach
• Event Invitations
• Re-engagement messages (e.g., “We Miss You!..”)

With the proper data safeguards and the effective use of ePHI, marketing emails can be personalized to be made more relevant to the recipient. This then allows patients or customers to be segmented into subgroups according to particular commonalities, e.g., age, gender, lifestyle factors, medical conditions, etc.

Opt-in Rules for HIPAA-Compliant Email Communication 

One significant difference between marketing and transactional emails is that recipients must explicitly opt-in to receive marketing emails. 

HIPAA requires explicit patient consent for marketing emails if they contain ePHI, requiring individuals to opt-in to receive email marketing communications from a healthcare organization. Neglecting to allow people to opt-in to your marketing communications leaves your company open to the consequences of HIPAA non-compliance, which include financial penalties and reputational damage. 

Conversely, healthcare organizations aren’t required to obtain opt-ins to send transactional emails, but these communications are still subject to other HIPAA regulations, such as encryption and audit logging. 

Additionally, marketing emails must comply with the CAN-SPAM Act: US legislation that governs commercial email communication and protects individuals from deceptive sales and marketing practices. The CAN-SPAM Act requires healthcare organizations to provide an opt-out mechanism in the event they no longer wish to receive marketing emails. Subsequently, you must always allow individuals to opt out of marketing emails to stay compliant.

Email Infrastructure Requirements For HIPPA-Compliance

As the vast majority of healthcare organizations need to send marketing and transactional emails, they must have the appropriate infrastructure to facilitate the optimal delivery of both types of emails. Consequently, for HIPAA compliant email, they need to establish the appropriate infrastructure configurations for each, according to their differing purposes, sending patterns, and compliance considerations. 

Let’s look at the infrastructure requirements for each email type in turn, before looking at considerations that pertain to both types of email.

Key Transactional Email Infrastructure Considerations

Transactional emails are sent to a sole patient or customer, with the information therein only intended for that specific individual. Additionally, they can be highly time-sensitive: for example, a password reset or similar emails related to logins and service use must be immediate, while order confirmations need to be delivered ASAP to reassure clients of a company’s reliability and trustworthiness. 

Accounting for this, the infrastructure requirements for transactional emails include: 

• High Speed and Low Latency: servers that are optimized  for high IOPS (input/output operations per second) and minimal processing delays to ensure near-instant delivery
• Dedicated IPs: this helps healthcare companies maintain a strong sender reputation to avoid blacklisting, being labelled as spam, etc. This is crucial for reliable, fast delivery. 
• High Availability and Redundancy: this includes load balancers, failover servers, and geographically distributed data centers to ensure comprehensive disaster recovery and more robust business continuity protocols.  

Key Marketing Email Infrastructure Considerations

In contrast to transactional messages, marketing emails must often be sent out in high volumes, which could be as many as hundreds of thousands or millions per month. As a result, marketing email campaigns have different computational demands, i.e., CPU and storage, than transactional messages intended for a single person. 

Subsequently, the infrastructure requirements for marketing emails include: 

• High Volume and Scalability: marketing messages require a larger throughput to facilitate the bulk delivery of email. Additionally, servers should scale easily to accommodate increasingly larger campaigns without suffering bottlenecks.
• Queueing and Throttling: marketing email infrastructure must prevent sending surges that could trigger spam filters or overload recipient servers, which often results in blacklisting. 
• Dedicated vs. Shared Infrastructure: it’s important to consider whether to opt for private versus shared infrastructure, depending on the size of your organization and the scale of your campaigns. Large senders often use dedicated IPs for better control, while smaller companies or campaigns might use shared pools with strict sender reputation management.

Key Infrastructure Considerations for Both Types of Email

Lastly, there are infrastructure requirements that apply to both types of email that will help facilitate their fast and reliable delivery, respectively. These include:     

• Separate Infrastructure: consider hosting your transactional and marketing emails on separate servers. This benefits transactional emails in particular, as there are several factors inherent to marketing email campaigns, such as bounced emails and being flagged as spam, that affect an email IP’s reputation. Separate infrastructure maintains the integrity of a healthcare company’s IP address for transactional emails, ensuring they are delivered unimpeded. 
• Encryption: the ePHI in all email communications must be encrypted in transit, i.e., when sent to individuals, and at rest, i.e., when stored in a database. This helps safeguard the patient data within the message, regardless of its nature. 
• HIPAA Compliance Monitoring: remaining aware of what ePHI is included in email communications. This keeps data exposure to a minimum and mitigates the unintentional inclusion of patient data in email communications. 
• Logging and Auditing: this not only allows you to track email activity, but you also can measure the efficacy of your email communications, who accessed ePHI, and what they did with it. This is an essential part of HIPAA compliance and will be subject to tighter regulation when the updates to HIPAA’s Security Rule come into effect in late 2025. 

HIPAA-Complaint Email Solutions From LuxSci

LuxSci offers HIPAA compliant email solutions designed to optimize the reliability and deliverability of both transactional and marketing emails.

LuxSci’s Secure High Volume Email solution offers:

• Dedicated, high-performance infrastructure to ensure fast and reliable delivery.
• Scalable infrastructure for high-volume email campaigns, ensuring reliability even as sent emails venture into the hundreds of thousands or millions.
• Dedicated IPs and reputation management tools to prevent blacklisting and deliverability issues.
• Logging, tracking, and audit trails for HIPAA compliance and security monitoring.

LuxSci’s Secure Email Marketing platform provides: 

• Hypersegmentation for personalized patient and customer engagement.
• Detailed tracking and reporting capabilities for performance monitoring and compliance auditing.
• Automated campaign scheduling for reduced administrative overhead.
• Opt-in and list management tools to ensure compliance with HIPAA and CAN-SPAM.

Discover how our solutions can meet your evolving email infrastructure requirements today.

HIPAA compliant email hosting provides secure email infrastructure that meets HIPAA Security Rule requirements for protecting electronic protected health information (ePHI). These hosting services implement administrative, physical, and technical protections while offering business associate agreements to healthcare organizations that need to transmit patient data via email communications. Healthcare providers rely heavily on email for patient communications, care coordination, and administrative tasks. Standard email hosting services lack the security controls and compliance features needed to protect PHI, making specialized HIPAA hosting solutions necessary for organizations handling sensitive health information.

Security Infrastructure Requirements

HIPAA compliant email hosting requires a security architecture that protects data at rest and in transit. Hosting providers must implement encryption protocols, access controls, and network security measures that meet or exceed HIPAA technical safeguards specifications. Data center facilities housing HIPAA compliant email servers need physical security controls including biometric access systems, surveillance cameras, and environmental protections. These facilities maintain certifications like SOC 2 Type II to show their commitment to security and operational excellence.

Network infrastructure must include firewalls, intrusion detection systems, and secure communication channels that prevent unauthorized access to email data. Hosting providers regularly implement network segmentation to isolate healthcare client data from other customers and security threats.

Business Associate Agreement Obligations

Healthcare organizations using third-party email hosting services must establish business associate agreements (BAAs) with their hosting providers. These contracts outline how the hosting company will protect PHI and comply with HIPAA regulations on behalf of the healthcare organization. Hosting providers accepting BAA responsibilities agree to implement appropriate security measures, report potential breaches, and allow healthcare organizations to audit their compliance practices. The BAA also limits how hosting companies can use or disclose PHI beyond the services specified in the agreement.

Liability provisions within BAAs help protect healthcare organizations from compliance violations caused by hosting provider security failures. Healthcare organizations remain responsible for ensuring their hosting providers maintain adequate security controls and comply with HIPAA requirements.

Data Backup and Recovery Capabilities

HIPAA compliant email hosting services must provide reliable backup and disaster recovery systems that protect against data loss while maintaining security controls. These systems ensure healthcare organizations can restore email communications and maintain business continuity after technical failures or security incidents. Backup procedures need encryption and access controls that match the security standards applied to primary email data. Hosting providers typically maintain multiple backup copies across geographically distributed facilities to protect against localized disasters or system failures.

Recovery time objectives and recovery point objectives help healthcare organizations evaluate hosting provider capabilities and ensure service levels meet their operational needs. Many providers offer guaranteed recovery times and service level agreements that include financial penalties for failing to meet performance commitments.

Email Server Administration and Maintenance

Managed email hosting services handle server administration tasks including software updates, security patches, and performance optimization. This approach helps healthcare organizations maintain HIPAA compliance without requiring internal technical expertise for email infrastructure management. Server maintenance activities must follow change control procedures that document modifications and assess potential security impacts. Hosting providers schedule maintenance during off-peak hours to minimize disruptions to healthcare operations and patient communications.

Performance tracking helps ensure email systems can handle healthcare organization communication volumes without delays that might impact patient care. Hosting providers monitor server resources, email delivery rates, and system availability to identify potential issues before they affect service quality.

Integration with Healthcare Applications

HIPAA compliant email hosting platforms often provide APIs and integration capabilities that connect with electronic health record systems, practice management software, and other healthcare applications. These integrations enable automated email communications while maintaining security and compliance controls. Directory services allow healthcare organizations to manage user accounts and access permissions centrally. Integration with existing authentication systems like Active Directory helps maintain consistent security policies across all organizational technology resources.

Email archiving features help healthcare organizations meet record retention requirements while providing search capabilities for compliance audits and legal discovery requests. These archives maintain the same security controls as active email data and provide long-term storage for regulatory compliance.

Cost Structure and Service Models

HIPAA compliant email hosting services typically use subscription-based pricing models that scale with the number of users or email volumes. Pricing often includes security features, compliance support, and administrative services that would require significant internal resources to implement independently. Hosted solutions eliminate the capital expenses associated with purchasing and maintaining email server hardware. Healthcare organizations can redirect IT budget from infrastructure costs toward other patient care priorities while ensuring email communications remain secure and compliant.

Service level agreements define hosting provider responsibilities and performance guarantees. These agreements generally include uptime commitments, support response times, and security incident response procedures that help healthcare organizations plan their operations and ensure reliable email communications.