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Creating Secure Web Forms: What You Need to Know

person filling out a secure web form on a laptop

Creating secure web forms starts with creating a secure website. This process is more complex than creating web pages and adding an SSL Certificate. A certificate is a solid first step, but it only goes so far as to protect whatever sensitive data necessitates security in the first place.

Naive attempts at security can ultimately make the data less secure and more likely to be compromised by creating an appetizing target for the unscrupulous.

So, what do you do beyond hiring a developer with significant security expertise? Start with this article. Its purpose is to shed light on many of the most significant factors in creating secure web forms and how to address them. At a minimum, reading this article will help you intelligently discuss website security with the developers you hire.

person filling out a secure web form on a laptop

What Is Involved In Creating Secure Web Forms?

If you want to add a secure web form to your website, first, you must understand how to securely configure the website. Website security is a serious and complex topic; this article only discusses the high points. Check out some of our other articles and eBooks for more detailed information on website security.

Here are some of the critical issues that need to be considered:

  1. SSL – Is the website and form secured to transmit data from the end user safely? Is your website form page protected with SSL to prevent tampering with its contents?
  2. Web page content – Is the HTML content sent to the end-user protected from Cross-Site Scripting (XSS) issues, and does it avoid loading objects insecurely or from third parties?
  3. Script Security – Are the scripts or programs that process the submitted data written with security in mind? Do they have any vulnerabilities?
  4. Infrastructure – Is the website hosting provider trusted and known for good security? Are you on a shared server when you should be on a dedicated one?
  5. Data Flows – What do you do with the data once submitted? Is that data secured?
  6. Tracking – Do you track events such as data access and submission?
  7. Archival and Backup – Are there processes to make backups and permanent archives of important data?

SSL – Web Security Starts Here

SSL certificates are required for creating a secure website and form. The SSL certificate allows:

  1. The encryption of data sent to and from your web server and users to prevent eavesdropping or tampering.
  2. Your users trust that they are connecting to your website securely.

An SSL certificates on a properly configured web server encrypts your website data as it flows to and from your end users.

To get an SSL certificate, you can order one directly from a third party, or your web hosting provider will handle it for you. In either case, the web host will need to install the certificate on the server where the website is hosted, and then you will need to make changes to your site to take full advantage of the secure channel you have added.

SSL and Encryption

The most significant reason people use SSL is to encrypt the data transmitted from their website and the end-user. When an end-user visits a page protected by SSL, their web browser communicates over a secure channel with the web server so that all data transmitted is sent over this encrypted channel. This helps prevent eavesdropping and man-in-the-middle attacks on the data (more on these below).

Without SSL encryption, there is little or no protection of the data.

SSL and Trust

The most overlooked and misunderstood aspect of SSL is the establishment of trust. That is, enabling your end-users to trust and feel confident that they are connecting to your website. What else could they be connecting to, you may ask?

  1. Someone with access to the network between the end-user and website could be trying to intercept and read all the web traffic or altering your website pages themselves (e.g., changing your forms to submit the data to them instead of you). This is called a man-in-the-middle attack. Even with SSL security, a man-in-the-middle can present the end-user with an SSL Certificate for your domain name that looks legitimate, like a forged ID card.
  2. The user could be visiting another website that is pretending to be yours. This phishing website could collect information from your users for malicious purposes. Unless your users identify this site as illegitimate, they could be duped into revealing personal information. How could they end up at a phishing website like this? This can happen by clicking on a link emailed to them or by visiting a misspelled version of your URL. No site is immune from such attacks, but you can work to mitigate them.

SSL Certificates and Cybersecurity

As mentioned above, SSL certificates are not the sole website and form security solution, but they can help! To understand how it’s worth looking at how certificates are awarded. SSL certificates are signed by a third-party authority, the “Certificate Authority.” This can be:

  1. You, if you sign your certificates.
  2. A respected third-party issuing:
    1. A cheap or free certificate validating only your domain.
    2. A more expensive “Extended Validation” certificate which also validates your organization.

If you sign your own certificates, your website will generate warnings when anyone visits it. Users can choose to dismiss them, but more commonly, they will be more likely to navigate away from the website. For this reason, self-signed certificates are never recommended for a public website. Self-signed certificates provide no inherent trust that they are legitimate (anyone can generate one and pose as your site). They look amateurish and are annoying to the end user. Self-signed certificates should only be used in internal or test environments.

When ordering a certificate from a trusted third-party authority, there are various types that you can order. The cheapest ones are called domain-validated certificates. These work by emailing your domain administrator a validation link. Once verified, the certificate is awarded. These domain-validated certificates are acceptable and provide excellent security; however, as no humans are directly involved in the validation process, it may be easier for an attacker to get an illegitimate certificate by gaining control of the admin’s inbox or via other methods.

You can also order Extended Validation certificates. They cost more because real people validate the organization and your domain ownership. They make phone calls and ensure that everything looks right. If you have one of these certificates, your browser’s address bar turns green (or displays a lock symbol) when visitors come there to indicate that this site is trusted. If you want to maximize trust and make it easy for your end-users to identify your site as legitimate, you should use an Extended Validation certificate. These cost more but are well worth it in terms of security and trust. If EV certificates are outside your budget, you should still use an SSL certificate from some trusted third party.

Securing Web Forms with SSL

Once your website has an SSL certificate installed by a web host, your web pages can be accessed with addresses that start with “https://” instead of just “http://.” The “s” in “https” means “secure.” Note:

  1. When connected to a web page using a secure address like “https://yourdomain.com,” the web browser will show a lock icon to inform you that the connection is secure.
  2. Web pages that end in “.shtml” are not necessarily secure. The “s” means “server” (i.e., server-parsed page) and not “secure.” So, for example, “http://yourdomain.com/index.shtml” is not a secure page, but “https://yourdomain.com/index.html” is a secure page.
  3. With SSL enabled, you can access the same page securely and insecurely in many default web server configurations. Both “http://yourdomain.com/form.html” and “https://yourdomain.com/form.html” work and show the form — the only difference is the use of SSL or not.

So, let’s say that you have a web form located at “http://yourdomain.com/form.html.” You have an SSL certificate, and your web host has installed it. Next, you want to:

  1. Make sure people connect securely to the form page.
  2. Make sure that no one can connect to the form page insecurely.

These two goals might sound the same, but they are not.

Enforce Secure Connections to Form Pages

Since regular website pages may be insecure, you need to ensure that the links to the secure form page are absolute links starting with the prefix “https://.” This will ensure that anyone clicking these links will be taken to the form page on a secure connection.

The best solution is to use an HSTS (HTTP Strict Transport Security), which tells browsers that they should always use the secure version of your website. If you choose to have both the insecure (http) and secure (https) versions of your site running at the same time (not recommended), then you need to be careful with linking so that sensitive pages are secured:

Wrong Links: Relative links are not recommended because, if the user is on an insecure page, relative links will always take them to insecure versions of the destination page. So relative links like the following should be avoided:

Fill out my form!

Correct Links: Absolute links will ensure a secure connection by specifying that SSL must be used via the link prefix “https://.”

For example: <a href=”https://yourdomain.com/form.html”>Fill out my form!

Be sure that all links to all secure pages of the site use this secure format with the “https://” prefix.

Side Note: These days, it is recommended that you use SSL for all website pages, not just ones that process sensitive information. This is good for user trust, security, and privacy. It is also good for Search Engine Optimization (as Google will reward you for securing your site). If you set up your site so all pages are always secure, relative links are safe.

Ensure No One Can Connect to Form Pages Insecurely

Using the above suggestions, all the links on your website will take users to the secure version of the form. However, most web hosts leave the insecure version of the form there, and users can still access it if they enter the insecure address directly (or if links are directed to the insecure page). As a next step, you should ensure that accessing the form page via an insecure connection is impossible.

There are several different ways that this can be done. Some of these include:

Separate space for SSL pages: If your web host has this feature, you can configure the website to store web pages for secure (SSL) connections in a different directory from those for insecure pages. If this feature is enabled, the form page is placed in the secure directory and no copies are in the insecure directory. Thus, any insecure requests for these pages would result in a “page not found” error. You could then implement server-side redirection rules where if someone requests the insecure page, they are automatically redirected to the secure version (this can be done using .htaccess files and the “Redirect” directive). If you did this, secure and insecure requests for the page would take the user to the secure version with no errors, warnings, or issues for the end user.

Scripted pages: If the form page is generated by a server-side script (i.e., PHP, Perl, Python, or JAVA), then the script itself can determine if the request is secure or not (e.g., by looking at the server environment variables). For secure requests, it can render the form as usual. The user receives an error for insecure requests or is redirected to the proper secure location. 

Securing all pages: (Recommended) The site can be configured to automatically redirect all requests for insecure pages to the respective secure page. All pages will be secure, and any accidental/incorrect requests for the insecure pages will still get people to the right place. Security is greatly improved if you have set this up.

If my form is posted to a secure form processing script, why does it need to be secured?

This question is usually asked when a third-party manages the form processing. Is securing the form itself with SSL needed?

The answer is based on the following facts:

  1. The data sent from end-users to the server will be secure and encrypted during transmission. This is critical for creating secure websites and forms that require HIPAA compliance.
  2. Non-technical end-users will only know if their data is securely submitted once it is done. Many end-users will refrain from submitting sensitive data to an insecure form on your site.
  3. End-users cannot know if they are viewing your website or a phishing site or if eavesdropping and modification are happening. Many users will not trust the connection and will not want to submit their data through your site if it appears insecure.
  4. If your form page is insecure, it is straightforward for any malicious party to perform a man-in-the-middle attack to eavesdrop on connections, modify your form in transit to change what is collected and where the data is sent, and set up phishing sites. Your end-users can’t tell if this is going on.

If you do not secure your web form with SSL, it is vulnerable to attack. If nothing is going on, you can rely on transmission security. However, that minimal level of security is not recommended for production websites or anywhere that compliance is required.

Other Aspects of Creating Secure Web Forms

Proper use of SSL for encryption and trust is only part of creating secure website forms. You must be concerned with many other aspects to protect your users, your application, and your company’s reputation. These include (but are not limited to):

1. Cross-Site Scripting (XSS). Suppose you include dynamic content on your web pages (i.e., information submitted by other users or content submitted via form fields), and that content is not cleaned of JavaScript and HTML. In that case, bad actors could make arbitrary content appear on your website, capture user data, or worse. All data displayed should be clear of undesirable content (script tags, special characters, HTML, and other things). This is one of the most significant security issues with dynamic web pages across the internet.

2. Secure Server-Side Programming: The scripts and programs that accept and process the data from online forms must be created with security in mind. They must validate all submitted data as needed without making assumptions about its format and content. The scripts must not provide avenues for attacks like SQL Injection. Scripts must not use submitted content as actual filenames or URLs for remote loading content. They should log any strange errors or problems for later analysis. They should provide a mechanism for blocking undesirable actions or users from using the scripts.

3. Validation: Validation of all input data is part of the above two points. However, it is so essential that we will repeat it and go over some of the fundamental points:

  • If you validate submitted content, always perform your validation on the server side. Even if you use JavaScript to validate the data on the client side, you should always re-validate it on the server side. Why? Because people can get around JavaScript and submit arbitrary content directly to your scripts. The scripts should be prepared to handle that.
  • Always de-taint submitted data. What does that mean? It means never trust submitted data and take pains to ensure that the submitted data matches what you expect. For example, if you have a select list that sends your script a number as the value, do not assume you are getting a number. Instead, check that it is a numeric value or convert whatever is submitted into a number.
  • Remove disallowed content from the text submitted by users. Remove or block special characters, embedded codes, and other things that should not be there.
  • Ensure the submitted data is manageable enough to be used.
  • Do not assume anything — program defensively.

4. Preserving State with Hidden Form Fields or Cookies: If your program remembers information from one page to another by saving the data in hidden form fields, then your program must also ensure that the content of those fields was not tampered with. One good way to do this is to make a hash of all the data, together with a secret value, and include that hash in the form data. Then, when the form is submitted, you can recompute the hash and compare it with what passed from the form. If they match, you are okay; if they do not, the data has been tampered with. No one can break this scheme without knowing your secret value or breaking your hashing algorithm. This method can also be used to validate data saved in cookies. You can go further and use time stamps to prevent replay attacks.

5. Third-Party Applications: If you install programs from third parties on your website, you must ensure there are no known security issues with these programs, and you must be sure to update these programs as soon as new versions are released. If you let your website languish with an older, vulnerable version of a program, it will become a target for hackers as they constantly search the internet for such websites. Your site will likely be hacked in these cases, possibly causing loss of business, deactivation of your website, and tarnishing your website’s reputation. Using a third-party application is easy, but you need to select a good one that places the burden of keeping it updated on you. An exception is using a third-party application hosted by the third party itself. In these cases, the third party ensures that the program is continuously updated with anything needed to address any security issues. The burden is on them and not you. If you choose a good, respectable vendor, you should have no problems.

All these things, and more, are critical to developing a secure web application.

Securing the Form Data After Submission

Ensuring that users’ data is transmitted securely to your web server is critical, as is ensuring that your application is secure and will not be hacked. To secure sensitive data, you must understand what happens to that data after your program receives it. Many people forget that transmitting the data from the web server may require just as much preparation as receiving it from their users in the first place.

In the following subsections, we will look at three different ways of saving and retrieving your users’ data. In each case, we will explain what is needed to secure the data in your systems.

Send Form Data via Email 

The most common action data processing scripts do is email the submitted data to the website owner’s email address. The website owner knows when there are new submissions by checking their email and can access the data immediately. Most people running websites check their email reasonably often, which integrates well with their business operations.

However, the standard ways of sending emails are entirely insecure. So, how can you use email while ensuring the data is secure and viewable only by the intended recipient?

  1. Have your website script encrypt the data.
  2. Send this encrypted data (or a link to download the encrypted data) to the intended viewers via regular email.

As the form data is encrypted within the email message, most insecurities inherent in email are obviated. You can also use secure third-party services to have your form data emailed to you securely without programming anything yourself.

Save the Submission in a Database

Many website owners like to save the submitted form data in a database (even if it is also emailed to someone). Why?

  1. The data is saved online and potentially accessible from anywhere.
  2. If the emailed copies of the data are lost, the copies in the database are still there.
  3. The database can be accessed through a web browser with a suitable user interface.
  4. The data is typically backed up and can be restored.

If storage in an online database is for you, then you need to:

  1. Use encryption, like SSL or PGP, to ensure the data is securely stored in the database. Why? The contents of database tables are not encrypted or secure in general. Storing unencrypted data makes it available to anyone with access to the database or its backups.
  2. Provide a user interface that allows you to access the database data. It must be secure, have robust access controls, and provide a means for decrypting the data.

The database option requires much work to make a secure and usable solution. For this reason, most small organizations do not end up using secure database storage for important form data.

Save the Data in Files

The file storage option is the “quick and dirty” alternative to secure database storage. Essentially, your program will:

  1. Make a file containing the form data.
  2. Encrypt that file using PGP or SSL.
  3. Save that encrypted file in a directory on the web server that is not accessible from the website. Another option is to save it in an online file-sharing service.

Then, the website owners can log in to the web server using Secure FTP and download these files as needed. They can be decrypted locally when the data must be accessed. Other simpler data access mechanisms are available if the files are saved in an online file share.

This solution is secure and provides an excellent backup to securely emailed data.

Other Technical Tips for Creating Secure Website Forms

There are many other considerations in developing and maintaining a secure website and forms. It would be impossible to cover or even list them all. However, here are some more interesting and valuable tips.

Use Secure Cookies

If your secure site uses cookies for anything, set the “secure” cookie and the “httpOnly” flags. This will ensure that these cookies are never sent insecurely over the internet when the visitor arrives at any insecure pages of your website (they are not sent at all to insecure pages) and thus helps preserve the security of the contents of these secure cookies.

Prevent Form Spam

Form spam occurs when automated programs find your web forms and try to send spam through them. Form spam can result in hundreds or thousands of useless form posts daily. Once you start getting form spam, stopping it is a priority. There are two primary ways to help prevent spam:

  1. CAPTCHA – This method requires end-users to read text embedded in an image and type that text successfully into a form field. The back-end program then validates this. Since most spam programs cannot read text embedded in images, it will successfully block almost all automated forms spam. However, CAPTCHA requires the users to perform one more step, which can be annoying.
  2. JavaScript and Cookies – Most automated form spam programs do not process JavaScript or use cookies. If your web form requires JavaScript to submit the form successfully, bots cannot do this, and most form spam will be blocked. This method is less reliable than CAPTCHA but does not require any extra work from the end-user. Note that if you wish to use the JavaScript method, you must be sure that arbitrary submissions to the default action URL of your forms will never succeed—only submissions made after the execution of your custom JavaScript should succeed.

Minimize the Need for Trust

A good rule of thumb is to minimize the need to trust third parties and trust only the trustworthy.

  1. If you do not trust your internal IT staff, do not host your web application on your servers or give them access to the server used.
  2. If you do not trust the third-party hosting your website, encrypt the form data as soon as possible. This helps ensure that the data is not saved anywhere in plain text and is not backed up in plain text, thus minimizing your exposure to unauthorized people. Further, ensure that the private keys and passwords needed to decrypt the data are not stored on the web host’s servers.
  3. Ensure that only authorized staff can access the submitted form data. Ideally, it should always be encrypted, and only authorized people should be able to decrypt it.

These are just a few obvious points. As you evaluate your web application and data flow, ask yourself, “Who can access the raw data and how?” at each stage. Are there stages where you are trusting people who should not be trusted?

Forced use of strong encryption in SSL

The strength of encryption used by SSL is a function of both the user’s web browser and the server. Even if your web server supports excellent encryption, like AES256, the user’s browser may choose a weaker level of encryption. Older versions of Internet Explorer are notable for choosing weaker encryption in the interest of speed.

You can modify your web server configuration so that only levels of encryption you approve can be used to access your site.

Use Two-Factor Authentication

Two-factor authentication is standard on very secure sites now. You require a password and something else (a code or token) to validate their identity. With both, the user can log in. Avoid using only SMS texting as the second factor, which is no longer considered secure.

Get Started Creating Secure Web Forms

Outsourcing your form hosting and processing can be the fastest and most cost-effective way to get started. LuxSci’s Secure Form was designed for security and compliance. Contact us today to learn more about protecting sensitive information online.

Picture of Erik Kangas

Erik Kangas

With 30 years engaged in to both academic research and software architecture, Erik Kangas is the founder and Chief Technology Officer of LuxSci, playing a core role in building the company into the market leader for HIPAA compliant, secure healthcare communications solutions that it is today. An international lecturer on messaging security, Erik also advises and consults on email technology strategies and best practices, secure architectures, and HIPAA compliance. Erik holds undergraduate degrees in physics and mathematics from Case Western Reserve University, and a doctoral degree in computational biophysics from MIT. Erik Kangas — LinkedIn

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Related Posts

HIPAA violation

What Is a HIPAA Violation? Types, Examples & How to Avoid Fines

Few terms in healthcare get thrown around as loosely as “HIPAA violation.” It gets invoked when a nurse mentions a patient’s diagnosis to a friend outside of work, when a technician talks about a well-known patient who came through the clinic, or when a physician casually brings up a person’s rare diagnosos at a backyard barbecue — situations that sound like violations but often have nothing to do with the actual law. That confusion isn’t just an oversight, but rather, it points to a gap in understanding what HIPAA covers, who it applies to, and what genuinely puts an organization at risk.

For health care providers, compliance officers and IT professionals, the stakes behind that confusion are anything but casual. The Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has issued settlements ranging from a few thousand dollars to over $16 million for the same underlying failures, such as a missed risk assessment, an unencrypted laptop, a chart accessed by the wrong person. This guide breaks down what actually constitutes a HIPAA violation, the most common ways organizations end up on OCR’s radar, what genuinely falls outside HIPAA’s scope, and what to do if you’re managing risk or responding to an incident right now.

If your organization handles PHI over email — one of the highest-risk channels for exactly this kind of violation — our HIPAA Compliant Email guide is a useful next read once you’ve worked through this one.

What Is a HIPAA Violation?

A HIPAA violation occurs when a covered entity, business associate, or a member of either’s workforce fails to comply with a standard set out in the HIPAA Privacy Rule, Security Rule, or Breach Notification Rule — or fails to follow an internal policy implemented to support HIPAA compliance.

That definition matters because it draws a hard boundary around who can actually commit one. HIPAA applies to:

  • Covered entities — healthcare providers, health plans, healthcare suppliers, payers, and healthcare clearinghouses
  • Business associates — vendors and contractors that create, receive, maintain, or transmit protected health information (PHI) on a covered entity’s behalf
  • Workforce members — employees, volunteers, and contractors of either of the above
image What Is a HIPAA Violation? Types, Examples & How to Avoid Fines

HIPAA does not apply to private individuals acting outside of a covered role — a distinction that trips up far more people than you’d expect, and one we’ll come back to later in this guide.

The Health Insurance Portability and Accountability Act (HIPAA) was designed to protect the confidentiality of medical records and patient data while still allowing healthcare organizations to function and share information when appropriate. A violation happens when that balance breaks down — when PHI is accessed, used, or disclosed in a way the law doesn’t permit, or when required safeguards simply aren’t in place.

The Three HIPAA Rules a Violation Can Break

Every HIPAA violation traces back to one (or more) of three core rules. Understanding which rule is in play helps clarify what actually went wrong — and what needs to be fixed.

RuleWhat It GovernsExample Violation
Privacy RuleWho can access, use, and disclose PHI, and under what circumstancesSharing a patient’s diagnosis with someone outside their care team without authorization
Security RuleAdministrative, physical, and technical safeguards for electronic PHI (ePHI)Failing to encrypt emails in transit or a laptop that stores patient information
Breach Notification RuleRequirements for notifying affected individuals and HHS after a breach of unsecured PHIMissing the 60-day deadline to notify patients after a data breach

Most real-world violations involve more than one rule at once, such as a stolen, unencrypted laptop is a Security Rule failure that can also trigger Breach Notification Rule obligations. Keeping the three rules distinct in your own documentation, though, makes it much easier to identify exactly where a gap exists.

Most Common Types of HIPAA Violations

These are the violation categories that show up most often in OCR settlements, and the ones every provider, payer, and supplier organization should actively guard against.

Unauthorized Access / Snooping

This is the violation most people have actually heard about, usually because of a celebrity or high-profile patient case that made headlines. A staff member accesses a patient’s medical record without a legitimate, job-related reason — often out of curiosity, not malice — and it still counts as a serious violation.

What’s easy to miss here: the violation is about the access itself, not just what happens to the information afterward. Looking at a chart you have no clinical reason to view is a violation the moment it happens, even if you never repeat, share, or act on what you saw. Hospitals take this seriously enough to flag high-profile patient charts automatically and audit access in real time — which is exactly why staff who snoop tend to get caught quickly, and why termination is the near-universal outcome when they do.

A useful way to think about it: the sensitivity of the underlying information isn’t what determines whether accessing it was a violation — the authorization to access it through that specific system is and if a job role requires it. Pulling PHI through a restricted system without a legitimate reason is a violation even in cases where the same information might, in theory, be available through some other, non-restricted channel. Improper access through the wrong door is still improper access.

Example: Dr. Huping Zhou was sentenced to four months in federal prison after accessing celebrity medical records 323 times with no legitimate reason. UCLA Health System was separately fined $865,000 related to similar unauthorized access incidents.

Failure to Conduct a Risk Analysis

The Security Rule requires covered entities and business associates to conduct an organization-wide risk analysis identifying vulnerabilities to the confidentiality, integrity, and availability of ePHI. Skipping this step — or doing a superficial version of it — is one of the single most commonly cited failures in OCR settlements, because it’s foundational: nearly every other safeguard depends on knowing where your actual risks are.

Example: Premera Blue Cross paid $6,850,000, and Excellus Health Plan paid $5,100,000, both tied in part to failures to conduct adequate risk analyses before major breaches occurred.

Insufficient Access Controls

Access controls determine who can view or modify ePHI, and they need to be granular enough that staff can only access the minimum information necessary for their role. When access controls are too loose, such as shared logins, no role-based restrictions, no automatic logoff, organizations lose the ability to actually enforce the “minimum necessary” standard HIPAA requires.

Example: Anthem Inc. paid $16,000,000, the largest HIPAA settlement to date, following a breach connected in part to access control failures affecting nearly 79 million individuals.

Failure to Encrypt ePHI on Portable Devices

Laptops, phones, and USB drives leave the building. When they’re lost or stolen without encryption, an isolated incident becomes a reportable breach — because unencrypted PHI on a missing device is, by definition, unsecured PHI.

Example: Children’s Medical Center of Dallas paid $3.2 million after multiple incidents involving lost, unencrypted mobile devices containing ePHI.

Missing or Incomplete Business Associate Agreements

Any vendor that creates, receives, maintains, or transmits PHI on a covered entity’s behalf — from a billing company to an email provider — is a business associate under HIPAA, and business associates are legally required to sign a Business Associate Agreement (BAA) before handling that data. Skipping this step, or using a vendor without one, is a violation regardless of whether anything actually goes wrong with the data itself.

Example: North Memorial Health Care of Minnesota paid $1.55 million after failing to enter into a BAA with a business associate that later experienced a breach.

Impermissible Disclosures of PHI

This category covers PHI shared with someone who wasn’t authorized to receive it — a press release naming a patient, a social media post, filming patients without consent, or telling family or coworkers more than they’re entitled to know.

Example: New York Presbyterian Hospital paid $2,200,000 after filming patients for a documentary without proper consent.

Improper Disposal of PHI

Paper records tossed in regular trash instead of being shredded, or old hard drives discarded without being wiped, both count as impermissible disclosures — PHI doesn’t stop being protected just because someone’s done using it.

Example: Parkview Health paid $800,000 after leaving patient medical records unattended in a driveway during a records transfer.

Exceeding Breach Notification Deadlines

Once a breach of unsecured PHI is discovered, the Breach Notification Rule sets a hard 60-day deadline to notify affected individuals (and HHS, for breaches involving 500+ records). Missing that window turns a bad situation into a compounding one.

Example: Presence Health paid $475,000 for failing to notify affected individuals within the required timeframe following a breach.

Denying Patient Access to Records

Patients have a right to access their own medical records, generally within 30 days of a request, without excessive fees or unreasonable barriers. Denying or delaying that access is one of the more consistently enforced violation categories in recent years.

Example: Cignet Health of Prince George’s County paid $4,300,000 for denying 41 patients access to their own medical records.

Every one of these categories comes back to the same underlying question: does your organization actually have documented, enforced processes for who can touch PHI, how it’s protected, and what happens when something goes wrong? If email is part of that picture — and for nearly every healthcare organization, it is — our HIPAA Compliance Checklist walks through exactly what needs to be in place.

What Is Not a HIPAA Violation (Common Misconceptions)

HIPAA gets invoked constantly in situations it has nothing to do with — and clearing up that confusion matters, because it helps healthcare professionals, IT and compliance teams focus their actual attention where it belongs.

A family member discussing your health isn’t a HIPAA violation. HIPAA governs covered entities, business associates, and their workforces — not private individuals speaking in a personal capacity. Your mother telling a relative about your diagnosis might be a breach of your trust, but it’s not a HIPAA violation, because she isn’t bound by HIPAA in the first place.

Confusing HIPAA with FERPA or the ADA is common, and usually incorrect. Educational records fall under FERPA (the Family Educational Rights and Privacy Act), not HIPAA — a teacher discussing a student’s grades or attendance isn’t a HIPAA issue. Similarly, questions about a disability accommodation, like a mask exemption or a service animal, generally fall under the Americans with Disabilities Act (ADA), not HIPAA.

Asking about someone’s health isn’t the same as disclosing it. HIPAA restricts what covered entities and their workforces can disclose, it doesn’t restrict what any individual, including a coworker, cashier, or stranger, can ask. Someone asking why you’re wearing a mask or requesting proof of a medical condition might be inappropriate or even illegal under a different law, but it isn’t itself a HIPAA violation.

Vague references aren’t the same as identifiable disclosures. HIPAA violations require that protected health information (PHI) be tied to an identifiable individual. Referring to “a patient” or “a young adult male” in casual conversation is too vague to trigger a violation. Naming a specific person — “my patient, Mike, who lives on Oak Street” — alongside health information crosses that line.

A simple way to keep the distinction clear:

  • A nurse telling friends a specific patient’s name, date of birth, and diagnosis → HIPAA violation.
  • A pharmacist telling a customer their prescription refill is delayed → not a HIPAA violation.

The line isn’t about whether something feels private. It’s about whether protected health information tied to an identifiable person was disclosed by someone bound by HIPAA in the first place.

HIPAA Violation Penalties: The 4-Tier Structure

OCR calculates civil penalties based on the violator’s level of culpability, not just the severity of the incident. Understanding which tier applies matters, because the same underlying mistake can result in wildly different consequences depending on whether it was a one-off oversight or a known, ignored risk.

TierCulpability LevelFine Range (Per Violation)Annual CapExample Scenario
Tier 1No Knowledge$100 – $50,000$25,000The organization could not have reasonably known about the violation
Tier 2Reasonable Cause$1,000 – $50,000$100,000The organization should have known, but the violation wasn’t due to willful neglect
Tier 3Willful Neglect (Corrected)$10,000 – $50,000$250,000Willful neglect occurred, but the issue was corrected within 30 days
Tier 4Willful Neglect (Not Corrected)$50,000 (fixed)$1.5 million+Willful neglect occurred and was not corrected in time

Penalty amounts are periodically adjusted for inflation, and current maximum penalties can exceed $2 million annually per violation category — figures worth confirming against HHS’s current published rates before citing specific numbers internally.

Criminal penalties sit outside this civil tier structure entirely. Knowing or willful violations can result in criminal fines ranging from $50,000 to $250,000, plus up to 10 years in prison for the most serious offenses — typically reserved for cases involving intent to sell, transfer, or use PHI for personal gain or malicious harm.

How Are HIPAA Violations Discovered?

Violations don’t usually surface because someone confesses. They’re found through a handful of consistent channels:

  • Audit logs and automated access-flagging. Most modern EHR systems automatically flag unusual access patterns — a chart accessed by someone outside the care team, or a spike in access to a high-profile patient’s record. This is precisely how most unauthorized-access violations come to light; systems are built to catch exactly this pattern.
  • Patient complaints. Patients can, and do, file complaints directly with HHS when they believe their information was mishandled.
  • Breach self-reporting. Covered entities and business associates are required to self-report breaches meeting certain thresholds.
  • OCR compliance audits. HHS periodically conducts proactive audits of covered entities and business associates, independent of any specific complaint or breach.

One nuance worth understanding: not every violation escalates the same way. A single, isolated mistake, such as an email sent to the wrong recipient or a chart accidentally opened, is often handled through internal correction and documentation. A repeated pattern of the same behavior is a different story entirely, and is far more likely to become something an organization is required to report to HHS. This is one of the most important distinctions for healthcare organizations and compliance teams to build into internal escalation policies: document every incident, but treat repetition as a signal that internal correction alone is no longer sufficient.

How to Report a HIPAA Violation

If you’re a patient, employee, or compliance officer who has identified a potential violation, there are two established paths ti report a violation, and they aren’t mutually exclusive.

Step 1: Report it to the employer or covered entity directly. Most healthcare organizations have an internal compliance officer or reporting process specifically for this purpose. Internal reporting is often the fastest way to get a genuine mistake corrected before it escalates.

Step 2: File a complaint with HHS’s Office for Civil Rights. If internal reporting isn’t appropriate, isn’t effective, or the violation is serious enough to warrant it, complaints can be filed directly through HHS’s official complaint portal. Complaints generally must be filed within 180 days of when the violation was discovered, though extensions are sometimes granted for good cause.

A few practical notes:

  • Anonymous reporting is possible, but limited. OCR accepts anonymous complaints, but the lack of contact information can restrict how thoroughly they’re able to investigate.
  • Retaliation against someone who reports in good faith is itself prohibited under HIPAA.
  • Not every complaint results in a formal investigation — OCR reviews each complaint to determine whether it falls within HIPAA’s scope before proceeding.

How to Avoid HIPAA Violations & Fines

For Organizations

  • Conduct — and document — a genuine risk assessment. This isn’t a one-time checkbox; risk assessments should be revisited whenever systems, vendors, or workflows change.
  • Sign a BAA with every vendor that touches PHI, including email, billing, and IT service providers — no exceptions.
  • Implement role-based access controls so staff can only access the minimum PHI necessary for their specific role.
  • Encrypt ePHI in transit and at rest, especially on portable devices and email, where enforced encryption remains one of the most consistently under-implemented safeguards.
  • Train staff regularly, not just at onboarding. A single training session at hire rarely holds up against years of evolving risk.

For Individual Staff Members

  • Only access patient records tied to a legitimate, job-related reason — never out of curiosity, even for patients you know personally.
  • Never discuss identifiable patient information outside of your care team, including with family, friends, or on social media.
  • Report suspected violations, including your own mistakes, immediately rather than waiting to see if anyone notices.
  • Treat every device and email containing PHI as if it could be lost, stolen, or misdirected tomorrow, because eventually, statistically, one will be.

Since email remains one of the highest-volume channels for exactly this kind of accidental exposure, secure, HIPPA compliant solutions, such as LuxSci’s SecureLine encryption technology, are built specifically to remove the guesswork — enforcing encryption automatically rather than relying on staff to remember to apply it correctly every time.

HIPAA vs. State Privacy Laws

HIPAA sets a federal floor, not a ceiling. States are free to enact privacy laws that are stricter than HIPAA, and when they do, the stricter standard generally governs. This matters for multi-state healthcare organizations especially, such as a provider, payer, or supplier operating across state lines may need to comply with HIPAA everywhere, plus additional, more stringent requirements in specific states.

This guide focuses on federal HIPAA requirements, but compliance officers should treat HIPAA as the baseline, not the finish line, when evaluating their organization’s full regulatory exposure.

What Should I Do Now?

Understanding what counts as a HIPAA violation is the first step. Actually closing the gaps that lead to one is the harder, ongoing work — and email is one of the most common places that work quietly falls through the cracks.

Here are three ways to keep moving forward:

  1. Read our HIPAA Compliant Email guide to understand exactly what makes an email platform compliant — and where standard email tools like Gmail and Microsoft 365 fall short.
  2. Work through our HIPAA Compliance Checklist to audit your organization’s current safeguards against what HIPAA actually requires.
  3. Explore LuxSci’s SecureLine encryption technology to see how enforced encryption and a signed BAA work together to close the exact gaps that show up most often in OCR settlements.
  4. Read our Definitive Guide on the New HIPAA Security Rule, making email encryption mandatory in 2027

Frequently Asked Questions

1. What are the most common HIPAA violations?

The most common violations include unauthorized access to patient records, failure to conduct a risk analysis, insufficient access controls, failure to encrypt ePHI on portable devices, missing Business Associate Agreements, impermissible disclosures of PHI, improper disposal of records, and exceeding breach notification deadlines.

2. What’s the difference between a HIPAA violation and a FERPA or ADA issue?

HIPAA governs protected health information handled by covered entities and business associates in healthcare settings. FERPA governs education records, and the ADA governs disability discrimination and accommodation. A teacher discussing grades falls under FERPA, not HIPAA. A question about a disability accommodation typically falls under the ADA, not HIPAA.

3. How do I report a HIPAA violation?

Report it directly to the employer or covered entity first, if appropriate. If that isn’t effective or the violation is serious, file a complaint with HHS’s Office for Civil Rights within 180 days of discovering the violation, using the official HHS complaint portal.

4. Can I sue someone for violating HIPAA?

No. HIPAA does not provide a private right of action, meaning individuals cannot sue directly under HIPAA. Patients can file a complaint with HHS/OCR, and in some cases may have separate legal remedies under state privacy or negligence laws.

5. Is looking up a patient’s chart without a work reason a HIPAA violation, even if I don’t share the information?

Yes. Accessing a patient’s record without a legitimate, job-related reason is a violation the moment it happens — it doesn’t require sharing, saving, or acting on the information afterward. This is one of the most consistently enforced categories, particularly for high-profile or celebrity patients whose charts are routinely audited.

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LuxSci Email Security

What Is Secure Email? The Complete Guide for Healthcare Organizations

In healthcare IT, the term “secure email” gets thrown around loosely. Vendors slap the label on anything with a padlock icon, and internal teams often assume that because their provider offers TLS, they’re covered. They’re not, and the gap between what’s assumed and what’s actually required is where data breaches occur and HIPAA violations happen.

This guide breaks down exactly what secure email means from a technical and regulatory standpoint, why the email platform your staff uses every day probably isn’t compliant out of the box, and what to look for when evaluating a provider that needs to protect PHI at scale. If you want the full picture of what compliance requires beyond email specifically, our HIPAA Compliance Checklist is a useful companion read.

What Is Secure Email?

Secure email refers to an email system that protects the confidentiality, integrity, and availability of message content — specifically PHI — through a combination of technical safeguards and contractual protections. It’s not a single feature. It’s a stack of controls working together.

At minimum, secure email in a healthcare context includes:

  • Enforced encryption in transit, so messages can’t fall back to plaintext delivery
  • Encryption at rest, so stored messages remain protected on the server
  • Authentication protocols (SPF, DKIM, DMARC) that prevent spoofing and impersonation
  • Access controls and audit logs that track who accessed what, and when
  • A signed Business Associate Agreement (BAA) with the email provider

The distinction that trips up most organizations is this: encryption is a component of secure email, not the whole picture. A provider can offer encryption and still fail to meet HIPAA requirements if that encryption isn’t enforced, if there’s no BAA in place, or if audit logging doesn’t exist. Secure email is the combination of all these pieces functioning as a system, which is why it needs to be evaluated holistically rather than checked off feature by feature.

For healthcare provider, payer, and supplier organizations, this matters because email remains one of the highest-volume channels for PHI exposure, from clinical referrals to patient billing statements to routine staff communication. Getting the definition right is the first step toward closing the compliance gap.

Why Standard Email Is Not HIPAA-Compliant

Many healthcare organizations run on Gmail (Google Workspace) or Microsoft 365, and most assume they’re protected because encryption exists somewhere in the stack. That assumption is the single most common — and most dangerous — misconception in healthcare email security.

Here’s the problem: standard email services use opportunistic TLS by default. TLS is attempted between mail servers, but if the receiving server doesn’t support it, the message is delivered anyway — unencrypted, in plaintext. Neither the sender nor the recipient typically sees a warning. The email just goes through.

This isn’t a hypothetical edge case. IT professionals managing healthcare email infrastructure have flagged this exact issue directly: opportunistic TLS is often enabled by default and creates a false sense of security, since it offers no guarantee that a given message, including one containing PHI, won’t be transmitted in plaintext if the recipient’s mail server doesn’t support encryption. Organizations assume they’re protected simply because TLS is technically “on,” without realizing it isn’t enforced.

That gap has real consequences under HIPAA. The Security Rule currently treats transmission encryption as an “addressable” safeguard, meaning covered entities can, in theory, implement an equivalent alternative measure instead. In practice, regulators and auditors from the Office for Civil Rights (OCR) expect enforced encryption as the standard of care. “Addressable” has never meant optional — it means an organization needs a documented, defensible reason if it isn’t doing enforced encryption, and few reasons hold up under scrutiny. Finally, under OCR’s proposed changes to the HIPAA Security Rule for ePHI, scheduled for final publication in July 2027, email encryption moves from addressable to mandatory.

Beyond the encryption gap, standard consumer and even most business email plans typically lack:

  • A BAA that’s actually offered and signed (available on some enterprise tiers, but not automatic)
  • Enforced access controls beyond basic password authentication
  • Audit logging sufficient to meet HIPAA Security Rule requirements
  • Built-in encryption at rest guarantees for stored messages

None of this means Gmail or Microsoft 365 are inherently insecure products. It means their default configuration is built for general business use, not for an environment where every misrouted or intercepted message carries breach notification liability. Making either platform HIPAA-appropriate requires layering on additional tools, policies, and critically, a provider relationship that includes a signed BAA covering the exact services in use. 

The Technical Components of Secure Email

Secure email is built upon five technical layers. Understanding each one, and where it fails in standard email, clarifies exactly what a compliant solution needs to deliver.

Encryption in Transit (TLS)

Transport Layer Security (TLS) encrypts the connection between mail servers as a message travels from sender to recipient. There are two flavors, and the difference between them is the crux of most healthcare email compliance failures:

  • Opportunistic TLS attempts an encrypted connection but falls back to unencrypted delivery if the receiving server doesn’t support it. This is the default across most consumer and business email platforms.
  • Enforced TLS requires an encrypted connection for delivery to succeed. If encryption can’t be established, the message fails to send rather than going out in plaintext, or a link to secure portal can be sent to securely access the information.

HIPAA’s Security Rule lists encryption as addressable, but enforced TLS has become the de facto standard that auditors and OCR expect from covered entities and business associates handling PHI over email. As one healthcare IT professional put it while debating this exact tradeoff internally: the goal is to require TLS for all outbound email and then document the remaining controls around it, treating enforced TLS as the technical baseline, with policy and process built on top.

Encryption at Rest

Transit encryption only protects a message while it’s moving. Once it lands on a mail server — sender’s outbox, recipient’s inbox, backups, archives — it needs to remain encrypted in storage. This is encryption at rest, and it’s where many organizations underestimate their exposure.

Encryption in transit alone offers zero control over a message after it’s been delivered. If the destination server isn’t itself encrypting stored data, or if a backup snapshot is taken without encryption, PHI sitting in an inbox is exposed regardless of how securely it arrived. HIPAA’s Security Rule requires safeguards for ePHI both in transit and at rest, a compliant secure email provider needs to guarantee both, not just one.

End-to-End Encryption (S/MIME, PGP)

End-to-end encryption (E2EE) encrypts message content itself, not just the connection it travels over — meaning even the email provider can’t read the content. Two standards dominate here:

  • S/MIME uses certificate-based encryption and is common in enterprise environments, such as healthcare, particularly where organizations already manage a public key infrastructure.
  • PGP (Pretty Good Privacy) uses a public/private key model and is more common in technical or security-conscious communities, though it’s less frequently deployed at scale in healthcare due to key management complexity.

E2EE isn’t a baseline requirement for every PHI-containing email, enforced TLS plus encryption at rest satisfies most use cases. But it becomes necessary for especially sensitive communications, cross-organization data sharing where you don’t control the recipient’s infrastructure, or when a business associate agreement specifically requires it.

Authentication (SPF, DKIM, DMARC)

These three protocols work together to prevent domain spoofing and email impersonation, a growing attack vector against healthcare organizations specifically, given how often phishing campaigns impersonate providers, payers, or patients.

  • SPF (Sender Policy Framework) specifies which mail servers are authorized to send email on behalf of a domain.
  • DKIM (DomainKeys Identified Mail) adds a cryptographic signature verifying a message wasn’t altered in transit.
  • DMARC (Domain-based Message Authentication, Reporting & Conformance) tells receiving servers what to do when SPF or DKIM checks fail, and provides reporting visibility.

Without these configured correctly, an organization’s domain can be spoofed to send convincing phishing emails to patients or staff, creating a security failure that compounds the compliance risk of email interception.

Digital Signatures

Digital signatures verify sender identity and confirm a message hasn’t been tampered with between sending and receipt. Paired with encryption, they close the loop on message integrity, confirming not just that content was protected, but that it came from who it claims to have come from and arrived unaltered.

Standard Email vs. Secure Email: Feature Comparison

FeatureStandard Email Secure Email (HIPAA-Compliant)
Encryption in TransitOpportunistic TLS — attempted but not enforcedEnforced TLS — connection fails if encryption unavailable, can include delivery via secure portal option
Encryption at RestNot guaranteed; provider-dependentRequired — server-side encryption of stored messages
End-to-End EncryptionNot availableSupported via S/MIME and/or PGP
Digital SignaturesNot availableIncluded — verifies sender identity and message integrity
Authentication (SPF / DKIM / DMARC)Optional, rarely enforcedRequired — spoofing and impersonation protection
Business Associate Agreement (BAA)Not provided on standard plansRequired — must be signed before sending PHI
Audit LogsBasic or noneFull audit trail — required under HIPAA Security Rule
Access ControlsBasic password onlyRole-based access, MFA, admin controls
Misdirected EmailReportable HIPAA breachNon-reportable if properly encrypted (safe harbor)
HIPAA Compliant by DefaultNoYes

What Makes Email HIPAA-Compliant Specifically

Technical safeguards alone don’t make email HIPAA-compliant. Compliance is a combination of technology, contracts, and documented processes — all four need to be in place simultaneously. This includes:

A signed BAA with your email provider – Any vendor that transmits, processes, or stores PHI on your behalf is a business associate under HIPAA, and business associates are legally required to sign a BAA before handling that data. Email providers have persistent access to ePHI — even end-to-end encrypted messages pass through their infrastructure at some point — which makes this requirement absolute, not situational. If a provider won’t sign a BAA, using them to send or store PHI isn’t a compliance risk you can mitigate; it’s a violation from the start.

Encryption as an addressable safeguard – Under 45 CFR §164.312(e)(2)(ii), the HIPAA Security Rule lists encryption of ePHI in transit as “addressable” rather than strictly “required.” In practice, this doesn’t mean optional, it means an organization must implement it, or document and justify an equivalent alternative safeguard. Enforced encryption has become the expected standard, and with the newly proposed HIPAA Security Rule planned for July 2027 publication, NPRM would formalize that expectation by making encryption of ePHI in transit and at rest mandatory rather than addressable. Organizations still relying on opportunistic TLS as their “equivalent alternative” should treat this as a closing window.

Access controls and audit logs – HIPAA requires the ability to track who accessed PHI, when, and what they did with it. This means role-based access permissions, multi-factor authentication, and a complete, retained audit trail — not just for compliance reporting, but for identifying and responding to incidents quickly.

The encryption safe harbor – This is one of the most consequential, and most underused, provisions in HIPAA. If PHI is sent via properly encrypted email and ends up misdirected to the wrong recipient, it is not a reportable breach under the Breach Notification Rule, because the encrypted content is considered unreadable and therefore not “unsecured PHI.” The exact same misdirection with unencrypted email is a reportable breach, triggering notification obligations to the individual and to HHS/OCR. Encryption isn’t just a security best practice here, it’s the line between a non-event and a formal breach investigation.

HITRUST certification as a trust signal – When evaluating vendors, HITRUST CSF certification is a strong external indicator that a provider’s security controls have been independently assessed against a recognized healthcare-specific framework. It’s not a HIPAA requirement in itself, but it meaningfully reduces the diligence burden on your side when vetting a provider.

Types of Healthcare Email That Must Be Secure

Not all internal debate here is about “should we secure email” — it’s about scope. Which specific email flows actually carry PHI, and therefore need to run through a compliant channel? In practice, the answer is broader than most teams initially assume.

Screenshot 2026 07 29 at 9.47.13 AM What Is Secure Email? The Complete Guide for Healthcare Organizations

The common thread: if a message references anything that could identify a patient in connection with health information — a name next to a diagnosis, an account number tied to a service date, an annual test reminder — it needs to move through a secure channel, regardless of whether it’s clinical, financial, or administrative in nature.

How to Evaluate a Secure Email Provider for Healthcare

Vendor evaluation in this category tends to go one of two ways: teams either take a provider’s “HIPAA-compliant” label at face value, or they get buried in RFP questions without knowing which answers actually matter. Ask these key questiosn to focus the evaluation on what’s operationally and legally significant.

“Does the provider sign a BAA? This is the first filter, not the last. If a vendor won’t sign a BAA — or offers a heavily limited one — everything else is irrelevant. Some organizations go a step further and negotiate indemnity or make-whole clauses into the BAA itself, seeking financial protection beyond the baseline liability allocation.

What encryption methods are supported? Confirm specifically whether the provider offers TLS only, or also supports S/MIME and/or PGP for end-to-end encryption where needed. TLS-only coverage is sufficient for most standard PHI communication; organizations with cross-border data sharing or especially sensitive use cases may need E2EE options available.

Is encryption enforced or opportunistic? This is the single most important technical question to ask directly, in those terms. A vendor that describes its encryption vaguely, without distinguishing enforced from opportunistic delivery, hasn’t answered the question. Push for specifics.

How are large attachments handled? Lab results, imaging files, and clinical documents often exceed standard attachment size limits. Confirm the provider has a secure, compliant method for large file transfer that doesn’t force users onto an unencrypted workaround.

What audit logging and reporting capabilities exist? You need visibility into delivery, access, and any failed encryption attempts, not just a generic sent/received log. Ask whether logs are retained for a period consistent with your organization’s HIPAA documentation requirements.

Do they support high-volume transactional email? Appointment reminders, billing notices, and patient communications at scale require infrastructure built for volume without sacrificing per-message compliance. Confirm the provider’s platform is built for this your specific pattern, not just person-to-person messaging.

Is the platform US-based with US data residency? For many healthcare organizations, where data physically resides — and under which jurisdiction — is a material factor in vendor risk assessment, particularly for payers and larger provider organizations with strict data governance policies.”

One operational factor worth weighing alongside these questions: secure email portals — the kind that require recipients to click through to a separate web page to read a message — solve the encryption problem but often create a real adoption problem. IT teams have reported a direct conflict between phishing-awareness training and portal-based workflows: staff and patients trained not to click suspicious links in emails are, understandably, reluctant to click the “secure link” a portal email contains. This is a legitimate reason many organizations increasingly prefer platforms that enforce encryption transparently in the background — like LuxSci’s SecureLine encryption technology — rather than routing every message through a separate portal experience.

Secure Email Checklist for Healthcare Organizations

Every safeguard covered in this guide comes down to a handful of concrete, verifiable actions. Use the checklist below as a working reference for what needs to be in place across your legal agreements, technical controls, and internal processes. This is not a one-time setup task, but something worth revisiting as your email volume, vendors, and regulations evolve. Share it across  your compliance and IT teams as a starting point for an internal audit.

  • Legal and Contractual – BAA signed with email provider and all third-party vendors handling PHI.
  • Encryption – Forced TLS, not opportunistic only for emails in transit and all stored data encrypted with AES-256 bit encryption.
  • Access and Audit – Unique user IDs, role-based access, and login monitoring with advanced MFA enabled for all email accounts; audit logs active and maintained.
  • People and Processes – Staff trained in PHI handling, established breach response plan, annual email security policy review.

What Should I Do Now?

Secure email isn’t a single setting you switch on — it’s a combination of enforced encryption, a signed BAA, access controls, and documented process working together. Get any one piece wrong, and the rest doesn’t hold up under an OCR audit or a breach investigation.

If your organization is still relying on opportunistic TLS, an unsigned or incomplete BAA, or a patchwork of workarounds to move PHI through email, now is the time to close that gap, especially with the proposed 2025 HIPAA Security Rule update poised to make encryption a mandatory requirement rather than an addressable one in 2027.

Below are three ways you can continue your journey to securing your healthcare email:

  1. Explore LuxSci’s SecureLine encryption technology to see how automated encryption, enforced TLS, and a signed BAA work together — no complex configuration required.
  2. Read our HIPAA Compliance Checklist to understand the full scope of what your organization needs to have in place beyond email.
  3. Stay ahead of the new regulation with Email Encryption Under the New HIPAA Security Rule for a closer look at what the mandatory encryption shift means for your organization.

FAQs

1. Is email HIPAA compliant?

Email can be HIPAA compliant, but only when the right safeguards are in place — enforced encryption, a signed BAA with your email provider, access controls, audit logs, and staff training on PHI handling. Standard email without these safeguards is not compliant.

2. Do I need to sign a BAA with my email provider?

Yes. Email providers have persistent access to ePHI — even encrypted messages pass through their servers — making them Business Associates under HIPAA. A signed BAA is required. If your provider won’t sign one, you cannot legally use them to send or store PHI.

3. What is the difference between opportunistic TLS and enforced TLS — and which does HIPAA require?

Opportunistic TLS attempts encryption but falls back to plaintext if the recipient’s server doesn’t support it. Enforced TLS stops delivery rather than sending unencrypted. HIPAA’s Security Rule treats transmission encryption as an addressable specification, in practice, enforced TLS is the standard auditors and OCR expect. The proposed 2025 HIPAA Security Rule NPRM would make encryption of ePHI in transit a mandatory requirement in 2027.

4. What happens if I send PHI in an unencrypted email?

It is an impermissible disclosure under HIPAA’s Privacy Rule and triggers the Breach Notification Rule, requiring you to notify the individual and HHS/OCR within 60 days. Penalties range from $100 to $50,000 per violation. Had the email been properly encrypted, the same incident would qualify for HIPAA’s encryption safe harbor, meaning no notification required.

5. Is Gmail or Microsoft 365 HIPAA compliant for sending patient emails?

Neither is compliant in their default configuration. Both use opportunistic TLS, meaning PHI can be sent in plaintext if the recipient’s server doesn’t support encryption. A signed BAA is available on enterprise plans but doesn’t close the technical gap alone. A purpose-built HIPAA-compliant email platform is the reliable solution.

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new HIPAA Security Rule

New HIPAA Security Rule Update: Mandatory Email Encryption Delayed to 2027

If you’ve been waiting for the final word on the new HIPAA Security Rule before you touch your email encryption strategy, you now have an official reason to keep waiting.

Our advice: Don’t do it.

What is the new HIPAA Security Rule for ePHI?

The Department of Health and Human Services’ Office for Civil Rights had targeted May 2026 for a final rule implementing the most significant update to the HIPAA Security Rule in over two decades. The proposal eliminates the “addressable” standard and makes encryption of ePHI in transit and at rest mandatory for every covered entity and business associate. That deadline came and went quietly. Now we know why: an updated federal regulatory agenda shows OCR’s timeline has moved to July 2027, with the rule-making downgraded from “final rule stage” to “long-term action.” OCR is still working through more than 4,700 public comments on the January 2025 proposal.

For an industry that had been expecting a tighter deadline, a year-plus delay is the kind of news that invites a collective exhale — and a shelved project plan. At LuxSci, we think that would be a mistake, for three reasons:

  • The current rule already requires you to address encryption. “Addressable” was never “optional.” It has always meant you must implement the safeguard, implement an equivalent alternative, or document in writing why neither is reasonable for your organization. Most healthcare organizations have never done that documentation rigorously, and OCR’s existing enforcement authority applies today, not in 2027.
  • Breach costs haven’t waited for the rule. IBM’s 2025 Cost of a Data Breach Report puts the average healthcare breach at $7.42 million, still the highest of any industry. At the same time, email remains the number one attack vector into healthcare organizations. None of that risk is paused by a regulatory delay.
  • Delay is not withdrawal. OCR has not signaled it’s abandoning the encryption mandate, only that it’s taking longer to finalize it. Organizations that build now toward the standard already proposed will be ahead (and more secure) regardless of exactly when, or in what final form, the rule lands. Organizations that wait risk a compressed scramble once it does.

What should healthcare IT and compliance leaders actually do with this news?

Reevaluate your ePHI security posture, recalibrate its urgency, and use the extra runway to do the job right, instead of racing against a deadline. This includes:

  • Getting a real inventory of where ePHI moves by email today, inbound and outbound, and where encryption is inconsistent or absent.
  • Closing the documentation gap on “addressable” now, while you have time to do it well rather than defensively.
  • Pushing your email vendor for concrete answers on encryption standards, MFA enforcement, audit logging, and breach notification — the same technical controls the proposed rule would make mandatory.
  • Building (or updating) a written, enforcement-ready posture: policies, vendor agreements, certifications and verifications, test results, and training records that would hold up under an OCR investigation today, not just in a future compliance deadline.

Get LuxSci’s new Definitive Guide on the new HIPAA Security Rule

From Addressable to Mandatory: Email Encryption Under the New HIPAA Security Rule provides the latest update on the rule, what it means for healthcare email encryption, and what you can do now to properly prepare for what’s coming in 2027. The guide also includes an interactive scorecard that lets you evaluate your current email set up and vendor across seven security and compliance dimensions in under two minutes, no email address required.

You can read the guide here: From Addressable to Mandatory: Email Encryption Under the New HIPAA Security Rule

If you want a second set of eyes on where your organization stands, our team offers a free 30-minute compliance assessment of your current email environment against the proposed rule’s requirements.

Reach out today and schedule a call.

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HIPAA Security Rule Email Encryption Requirements

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Benefits of Patient Engagement

What Are the Benefits of Patient Engagement in Healthcare?

The benefits of patient engagement include improved health outcomes, reduced healthcare costs, greater patient satisfaction, and better adherence to treatment plans. Engaged patients take active roles in their healthcare decisions, leading to measurable improvements across clinical, financial, and experiential dimensions of care. Healthcare systems worldwide document returns on investment from patient engagement initiatives through reduced emergency utilization, fewer hospital readmissions, and better chronic disease management. Evidence consistently demonstrates that patients who participate actively in their care achieve superior health results while requiring fewer costly interventions.

Health Outcome Improvements

Diabetic management exemplifies the clinical benefits of patient engagement most clearly. Patients tracking their daily glucose levels and sharing readings with providers maintain hemoglobin A1c values within target ranges at improved rates compared to those receiving routine care alone. The difference stems from real-time feedback loops that enable immediate adjustments to medication, diet, and activity levels based on glucose patterns rather than waiting for quarterly clinic visits to identify problems. Cardiovascular patients show remarkable recovery rates through engagement programs. Post-surgical cardiac patients participating in rehabilitation achieve fewer complications and return to normal activities earlier than those declining program enrollment. Weight management, exercise compliance, and medication adherence all improve when patients understand their recovery goals and receive tools to monitor their progress independently.

Cancer screening participation illustrates how engagement transforms preventive care utilization. Mammography rates climb in practices using patient engagement platforms that send personalized reminders, provide educational content, and enable convenient appointment scheduling. Colonoscopy completion rises when patients receive pre-procedure education addressing their specific concerns and questions about the screening process.

Financial Impact That Creates Value

Emergency department utilization drops among patient populations with access to nurse triage lines and secure messaging platforms. This reduction creates healthcare savings annually across large health systems. Patients gain confidence in managing minor health concerns independently while knowing they have reliable pathways to seek guidance when needed. The cost savings extend beyond direct emergency care to include reduced diagnostic testing, shorter wait times, and decreased staff overtime expenses. Hospital readmissions are another area where the benefits of patient engagement deliver measurable economic value. Facilities implementing structured discharge education and post-discharge communication protocols see readmission rates fall within the first year of program implementation. Medicare penalties for excessive readmissions can reach hundreds of thousands of dollars annually for individual hospitals, making patient engagement programs essential for financial sustainability in value-based care contracts.

Prescription medication expenses decrease through multiple engagement pathways. Generic substitution rates increase among patients receiving medication counseling and cost-effectiveness education. Medication adherence improves dramatically, reducing the need for emergency interventions due to untreated conditions. Prescription drug waste declines when patients understand proper dosing schedules, storage requirements, and disposal methods for unused medications.

Patient Satisfaction Reaches Higher Standards

Appointment preparation changes fundamentally when patients have access to their health records and understand what to expect during visits. Rather than spending consultation time gathering basic information, providers can focus on clinical decision-making and answering patient questions. Patients arrive with written lists of concerns, current symptom logs, and specific questions about their treatment options, making appointments more productive and satisfying for both parties.

Provider-patient relationships deepen through transparent communication about diagnosis uncertainty, treatment alternatives, and realistic outcome expectations. Patients receiving honest information about their prognosis report higher trust levels and satisfaction scores compared to those given vague or overly optimistic explanations. Second opinion seeking decreases among patients who feel their providers answered questions thoroughly and included them in treatment decisions.

Waiting times and scheduling frustrations diminish through patient engagement technologies. Online appointment scheduling allows patients to select convenient times without playing phone tag with busy reception staff. Automated appointment reminders reduce no-show rates, creating more available appointment slots for other patients. Real-time updates about provider delays or schedule changes help patients adjust their plans rather than waiting unnecessarily in reception areas.

Quality Metrics Demonstrate System-Wide Benefits

Clinical quality indicators rise across multiple measurement domains in healthcare systems prioritizing patient engagement initiatives. Blood pressure control rates improve among hypertensive patients using home monitoring devices and sharing readings electronically with their care teams, compared to control rates among patients relying solely on office visits for blood pressure management. Diabetic eye exam completion rates increase in practices with patient engagement platforms versus traditional care settings.

Patient safety events decline as engaged patients feel empowered to report concerns about their care and understand how to prevent medication errors. Hospital-acquired infection rates drop when patients receive education about hand hygiene, understand their role in infection prevention, and feel comfortable advocating for proper safety protocols from their care teams. The benefits of patient engagement include reduced medication error rates among patients who participate in medication reconciliation processes and maintain updated medication lists accessible to all their providers.

Healthcare disparities narrow through targeted engagement strategies addressing cultural differences, language preferences, and socioeconomic barriers to care access. Minority populations show improved chronic disease management when the benefits of patient engagement programs include community health workers and culturally appropriate educational materials. Rural patients achieve better health outcomes through telehealth platforms that eliminate transportation barriers and provide flexible scheduling options accommodating work and family obligations.

Technology Amplifies Engagement Effectiveness

Remote monitoring capabilities enable proactive intervention before health conditions require emergency treatment. Heart failure patients using home monitoring devices experience fewer hospitalizations because their care teams receive automated alerts about weight changes, decreased activity levels, or other concerning indicators. Early intervention prevents costly emergency department visits and lengthy hospital stays while helping patients maintain independence in their home environments.

Patient portal adoption correlates directly with improved medication adherence, appointment attendance, and chronic disease management. Patients accessing their electronic health records demonstrate better understanding of their treatment plans and ask more informed questions during provider visits. Lab result access through patient portals reduces anxiety about test outcomes while enabling patients to track their progress over time and understand how lifestyle changes affect their health indicators.

Wearable device integration with electronic health records creates seamless data sharing without placing documentation burden on patients or providers. Sleep apnea patients demonstrate improved compliance with CPAP therapy when their usage data automatically uploads to their provider’s system and they receive personalized feedback about their treatment progress. The benefits of patient engagement are evident in activity tracking that helps patients with mobility limitations gradually increase their exercise tolerance while providing objective data to guide physical therapy recommendations.

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Send Secure Emails: Alternatives to Web Portals

Digital technologies have entirely shifted how individuals want to interact with their healthcare providers. As consumers have become used to emailing or texting with their hairstylists, mechanics, and other providers to schedule appointments, they want to have the same level of interaction with their healthcare providers.

However, many healthcare organizations find it challenging to deliver the same experience because of their compliance requirements under HIPAA. They must balance usability and access with security and patient privacy. To send secure emails, they often resort to secure web portals. 

mail sending from phone Send Secure Emails: Alternatives to Web Portals

Problems with Secure Web Portals

One of the most common ways that healthcare organizations communicate securely with patients is by using the secure web portal method of email encryption. In this scenario, messages are sent to a secure web server, and a notification is sent to the recipient, who then logs into the portal to retrieve the message.

While highly secure, this method is not popular with recipients because of the friction it creates.

To maintain a high level of security, users must log in to a separate account to retrieve the message. This extra step creates a barrier, especially for individuals who are not tech-savvy. In addition to creating a new account, they must remember a different username and password to access their secure messages. If the recipient doesn’t have this information readily available, they will likely delete the message and move on with their day. Many users will never bother logging in because of the inconvenience. This creates issues for organizations that want to use email for standard business communications and patient engagement efforts. 

While this method may be appropriate for sending highly sensitive information like medical records, financial documents, and other valuable information, many emails that must meet compliance requirements only infer sensitive information and do not require such a high level of security. Flu shot reminder emails are not as sensitive or potentially devastating as sending the wrong medical file to someone. Healthcare organizations need to use secure email solutions that are flexible enough to send only the most sensitive emails to the portal and less sensitive emails using other methods.

How to Meet Compliance Requirements for Sending Secure Email

So, what other options do you have for sending secure emails? The answer will depend on what specific requirements you need to meet. Healthcare organizations that must abide by HIPAA regulations will find a lot of flexibility regarding the technologies they can use to protect ePHI in transit.

In addition to a secure web portal, three other types of encryption are suitable for email sending: TLS, PGP, and S/MIME. PGP and S/MIME are more secure than a web portal. They also require advanced technological skills and coordination with the end-user to implement, which makes them impractical for most business email sending.

That leaves us with TLS, which is suitable to meet most compliance standards (including HIPAA) and delivers an email experience much like that of a “regular” email.

Send Secure Emails with TLS Encryption

TLS encryption is an excellent option for secure email sending that provides a seamless experience for the recipient. Emails sent securely with TLS appear like regular, unencrypted emails in the recipient’s inbox.

TLS encrypts the message contents as they travel between mail servers to prevent interception and eavesdropping. Once the message reaches the inbox, it is unencrypted and can be read by anyone with access to the email account. For this reason, it is less secure than a portal but secure enough to meet compliance requirements like HIPAA.

If you’re wondering why this is, HIPAA only requires covered entities and business associates to protect PHI when it is stored on their systems or as it is transmitted elsewhere. After the message reaches the recipient, it is up to the recipient to decide what they want to do to secure the information. HIPAA does not apply to individuals. Each person is entitled to share and store their health information however they see fit.

Conclusion

Balancing security and usability is a significant challenge for healthcare organizations. If the message is too secure, it may be difficult for the recipient to open and engage with it. If it’s not secure enough, it is too easy for cybercriminals and other bad actors to intercept private information as it is sent across the internet. 

Choosing an email provider like LuxSci, which offers flexible email encryption options, allows users to choose the right level of encryption for each message to maximize engagement and improve health outcomes. Contact our team today to learn more about how we can support your efforts.

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healthcare email marketing campaigns

How Do Healthcare Email Marketing Campaigns Work?

Healthcare email marketing campaigns are targeted communication strategies that healthcare organizations use to engage patients, promote wellness programs, share educational content, and encourage preventive care while maintaining HIPAA compliance and patient privacy protections. These campaigns differ from standard marketing approaches because they must balance promotional objectives with regulatory requirements and patient trust considerations. Healthcare providers, payers, and suppliers use healthcare email marketing campaigns to improve patient engagement, increase appointment bookings, promote health screenings, and provide valuable medical information to their communities. Understanding how healthcare email marketing campaigns function helps organizations develop compliant communication strategies that support patient care objectives while respecting privacy regulations and building stronger patient relationships.

Compliance Requirements For Healthcare Email Marketing Campaigns

Healthcare email marketing campaigns must comply with HIPAA privacy regulations when using patient information or communicating with current patients about their health conditions or treatment options. Organizations cannot use protected health information for marketing purposes without obtaining specific patient authorization, except for face-to-face communications or promotional gifts of nominal value. This means that targeted campaigns based on diagnosis codes, treatment history, or medication usage require explicit patient consent.

The CAN-SPAM Act applies to all commercial email communications, including healthcare email marketing campaigns, requiring clear sender identification, truthful subject lines, and easy unsubscribe mechanisms. Healthcare organizations must include physical addresses in their emails and honor unsubscribe requests promptly. These requirements apply regardless of whether campaigns target existing patients or potential patients in the community.

State privacy laws may impose additional restrictions on healthcare email marketing campaigns, particularly regarding the use of patient information and consent requirements. Organizations must evaluate applicable state regulations and implement the most restrictive requirements when multiple jurisdictions apply. Some states have specific rules about marketing to minors or individuals with certain medical conditions.

Patient consent mechanisms should clearly explain how email addresses will be used, what types of communications patients can expect, and how they can modify their preferences or opt out completely. Healthcare email marketing campaigns benefit from granular consent options that allow patients to choose specific types of communications while declining others. Documentation of consent helps demonstrate compliance during regulatory reviews.

Content Strategy And Patient Education Focus

Healthcare email marketing campaigns should prioritize educational content and patient value over promotional messaging to build trust and encourage engagement. Educational newsletters featuring seasonal health tips, preventive care reminders, and wellness information provide value to recipients while maintaining professional credibility. Disease-specific education campaigns can help patients manage chronic conditions and understand treatment options when properly targeted and authorized.

Preventive care campaigns promote routine screenings, vaccinations, and wellness visits that benefit patient health while supporting organizational revenue objectives. These campaigns can highlight the importance of annual check-ups, cancer screenings, and immunizations without requiring patient authorization since they promote general health services. Timing campaigns around health awareness months or seasonal health concerns improves relevance and engagement rates.

Content personalization in healthcare email marketing campaigns must balance engagement benefits with privacy requirements and technical capabilities. Generic personalization such as first names and preferred appointment times can improve response rates without requiring extensive patient information use. More detailed personalization based on health conditions or treatment history requires specific patient authorization and careful data management.

Health promotion campaigns can address community health issues, public health emergencies, or population health initiatives that benefit entire patient populations. These campaigns support organizational missions while providing valuable community services. Content should be accurate, evidence-based, and culturally appropriate for the target audience demographics and health literacy levels.

Segmentation And Targeting Strategies

Patient segmentation for healthcare email marketing campaigns should focus on demographic factors, service interests, and communication preferences rather than protected health information whenever possible. Geographic segmentation allows organizations to promote location-specific services and events without requiring patient authorization. Age-based segmentation can support appropriate messaging for different life stages and health needs.

Service line segmentation enables healthcare email marketing campaigns to promote specific departments or specialties to patients who have expressed interest or attended related events. Orthopedic services, women’s health programs, and cardiac care can be promoted to relevant audience segments based on self-reported interests rather than medical history. This approach maintains engagement while respecting privacy requirements.

Communication preference segmentation allows patients to select email frequency, content types, and communication channels that match their individual preferences. Some patients may prefer monthly newsletters while others want immediate alerts about health topics of interest. Preference management systems help maintain engagement while reducing unsubscribe rates and complaints.

Behavioral segmentation based on website interactions, event attendance, or previous email engagement can inform campaign targeting without using protected health information. Patients who visit specific web pages or attend health education events may be interested in related services or information. This targeting approach uses publicly observable behaviors rather than confidential medical information.

Technology Platforms And Integration Considerations

Healthcare email marketing campaigns require platforms that support HIPAA compliance, patient privacy protections, and integration with existing healthcare systems. Email marketing platforms used by healthcare organizations should provide business associate agreements, data encryption, audit logging, and secure data handling procedures. These platforms must protect patient information during campaign creation, delivery, and performance tracking.

Integration with patient relationship management systems allows healthcare email marketing campaigns to leverage patient preferences and communication history while maintaining privacy protections. Automated workflows can trigger campaigns based on appointment scheduling, discharge events, or routine care intervals without exposing sensitive medical information. These integrations improve campaign relevance while reducing manual workload.

List management capabilities should support consent tracking, preference management, and compliance reporting for healthcare email marketing campaigns. Organizations need systems that can document when and how patients provided consent for marketing communications. Automated consent renewal and preference update processes help maintain compliance as regulations and patient preferences change over time.

Analytics and reporting features should provide campaign performance metrics while protecting patient privacy and complying with data retention requirements. Healthcare organizations need to track engagement rates, conversion metrics, and patient feedback without creating unnecessary privacy risks. Aggregate reporting and anonymized analytics help measure campaign effectiveness while maintaining patient confidentiality.

Performance Measurement And Optimization

Healthcare email marketing campaigns should be evaluated based on patient engagement, health outcomes, and organizational objectives rather than purely commercial metrics. Open rates and click-through rates provide basic engagement measurements, but healthcare organizations should also track appointment bookings, screening completions, and patient satisfaction scores. These metrics better reflect the campaign’s impact on patient care and organizational mission.

Patient feedback mechanisms allow healthcare organizations to understand how recipients perceive email communications and identify opportunities for improvement. Surveys, focus groups, and direct patient comments provide insights into content preferences, communication frequency, and messaging effectiveness. This feedback helps optimize future healthcare email marketing campaigns while maintaining patient-centered approaches.

A/B testing can improve campaign performance by comparing different subject lines, content formats, or call-to-action approaches while maintaining compliance requirements. Testing should focus on elements that affect engagement and patient value rather than manipulative tactics. Results should guide evidence-based improvements to campaign strategy and content development.

Long-term performance tracking helps healthcare organizations understand the cumulative impact of email marketing efforts on patient relationships, care utilization, and health outcomes. Regular analysis of campaign performance supports continuous improvement and demonstrates the value of patient communication investments to organizational leadership and stakeholders.

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Email HIPAA Compliance

Is ActiveCampaign HIPAA Compliant?

ActiveCampaign is a cloud-based marketing automation platform that helps organizations manage their email marketing, customer relationships, and sales automation, and it can be HIPAA compliant for enterprise deployments. The platform’s automation capabilities enable organizations to streamline their workflows and carry out marketing campaigns with less administrative overhead, saving both time and money. Additionally, ActiveCampaign’s advanced segmentation tools allow companies to personalize campaigns according to demographics, behavior, and past interactions.

While these capabilities are highly sought after by healthcare organizations who want to enhance their engagement with patients and customers, they require one characteristic above all in their marketing platform of choice: HIPAA compliance.

More specifically, for a company to send electronic protected health information (ePHI) through an email marketing platform, it must comply with the Health Insurance Portability and Accountability Act (HIPAA).

Let’s take a closer look…

Is ActiveCampaign HIPAA Compliant?

Firstly, to address the question directly – is ActiveCampaign HIPAA compliant? – it is not HIPAA-compliant by default. Healthcare organizations can only conduct HIPAA compliant marketing campaigns if they are signed up for the Enterprise version of the solution.

Our findings revealed that companies are required to configure ActiveCampaign accordingly to ensure HIPAA compliance. Again, that healthcare organizations need to ensure compliance themselves – and how they do so – isn’t made 100% clear in any of the company’s literature.

ActiveCampaign’s Security Features

ActiveCampaign does not provide message-level encryption for outbound campaign emails (e.g., portal-based pickup or enforced encryption to recipients), so you generally should not put PHI in the body of campaign emails. This limits your ability to engage patients with personalized and relevant messages that result in more opens, clicks and conversions.ActiveCampaign’s sole mention of HIPAA compliance is on their security features page, on which they state:

“ActiveCampaign is heavily focused on GDPR, SOC 2, and HIPAA compliance. We constantly improve our security to go above and beyond compliance standards.”

Now, while they don’t go into further detail, ActiveCampaign does indeed feature some security controls that lend themselves towards HIPAA compliance. These include:

  • Single Sign-On (SSO): users can sign into ActiveCampaign through an existing identity provider, such as Google, without requiring a separate set of credentials. This helps protect data through stronger access control and allows for simpler user authentication.
  • Multi-Factor Authentication (MFA): ActiveCampaign supports MFA, requiring users to verify their identity through text or time-based one-time password (TOTP) authentication. This adds another layer of security, in line with HIPAA regulations, and is something that could be more emphasized if changes to the Security Rule come into effect later this year. 
  • Automatic Session Timeouts: idle sessions are automatically logged out after a short amount of time: protecting them from session hijacking and related cyber threats. 

Additionally, users are responsible for setting up the proper email authentication protocols themselves, including:

  • SPF (Sender Policy Framework): Specifies authorized mail servers for your domain.DKIM (DomainKeys Identified Mail): Adds a digital signature to your emails, verifying their authenticity.DMARC (Domain-based Message Authentication, Reporting & Conformance): Provides instructions to email providers on handling messages that fail SPF or DKIM checks.

Setting up these protocols helps fight against email spoofing and phishing attacks, ensuring that your emails are recognized as legitimate by recipients’ mail servers.

Will ActiveCampaign Sign a BAA?

Now, even with some security features and stating they are focused on compliance, a marketing platform can’t truly comply with HIPAA regulations unless they sign a Business Associate Agreement (BAA).

ActiveCampaign’s BAA availability appears limited and may depend on plan level; confirm directly with ActiveCampaign.

Discover HIPAA Compliant Alternatives to ActiveCampaign

As this post illustrates, while it is possible to make ActiveCampaign HIPAA compliant, it’s not straightforward. Fortunately, there are alternative email and marketing solutions that are fully HIPAA-compliant – out-of-the-box – removing the guesswork and ambiguity from securing your digital communications and allowing you to focus on engaging with your patients and customers. This includes LuxSci Secure Marketing, which enables healthcare organizations to proactively reach patients and customers with HIPAA compliant email marketing campaigns that can securely include PHI for increased engagement, lead generation and sales.

Discover how LuxSci can elevate your secure healthcare engagement efforts with PHI data, resulting in better health outcomes for your patients, in addition to enhancing your brand identity and achieving your company’s growth objectives. Reach out today for a call or demo.

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