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Integrating HIPAA Compliant Email with EHR Systems

HIPAA Compliant Hosting Requirements

With digital healthcare here to stay, today’s providers, payers and suppliers are making increasing use of Electronic Health Record (EHR) systems for more connected care – and better health outcomes.

However, while EHR systems help increase the speed and efficiency at which care can be delivered to patients, healthcare companies must still consider the security of electronic protected health information (ePHI) throughout the process, especially when it comes to communicating sensitive data with patients, customers, and other organizations. 

Fortunately, integrating an EHR system with a HIPAA compliant email service provider (ESP), like LuxSci, offers a secure way to engage with your patients, while leveraging – and protecting – the wealth of information within EHR systems to personalize communications.

In this post, we discuss the benefits of integrating EHR systems with a HIPAA compliant email platform, as well as several use cases made possible by bringing these two powerful solutions together.

What is an EHR System?

An EHR system is a platform used by healthcare companies to store and manage their patient’s digital data, including PHI. In providing a digital repository for a patient’s medical history, including diagnoses, prescribed medication, lab results, and other data related to their healthcare journey, EHR systems enable organizations to access, update, and share patient data more quickly and efficiently.

As EHR systems have steadily replaced paper-based records, namely, after the HITECH Act was enacted in 2009, which incentivized EHR adoption, healthcare companies are better able to access and share PHI across different environments, greatly enhancing the coordination and cooperation of providers, payers, and suppliers.

Why Should You Integrate EHR Systems with a HIPAA Compliant Email Platform?

Let’s discuss the key benefits of integrating your EHR Systems with a HIPAA compliant email platform:

Secure ePHI Transmission

When the sensitive data in EHR systems is sent out to patients and other healthcare providers and organizations, it must be encrypted, as per HIPAA regulations to safeguard it from exposure. That way, even in the event of a security breach, it will be unreadable to malicious actors, preserving the privacy of patients and customers. In light of this, HIPAA compliant email delivery platforms emphasize strong encryption capabilities to ensure sensitive patient data is always encrypted during transmission.

LuxSci’s SecureLine encryption technology employs automatic, flexible encryption, which applies the appropriate encryption standard depending on the recipient’s email security posture and infrastructure, making sure emails are always encrypted in transit. 

HIPAA Compliant Patient Engagement Campaigns

Healthcare organizations are often reluctant to include the patient data stored in their EHR systems for fear of accidental exposure – and violating HIPAA regulations as a result. In addition to encryption, LuxSci provides other HIPAA-mandated security features, such as access control capabilities, to maintain precise control over who can access patient data, and audit logging, to track access to ePHI. Perhaps most importantly, LuxSci provides you with a Business Associate Agreement (BAA): a legal document, and key pre-requisite for HIPAA compliance, that clearly establishes its responsibilities in safeguarding the ePHI that originates in your EHR systems. 

With these security capabilities in place, healthcare providers can confidently incorporate patient and customer data from their EHR systems into their outreach efforts, using ePHI to personalize emails accordingly to maximize engagement and improve communications.

Automated Secure EHR-Driven Communication

EHR systems facilitate automated healthcare workflows, including for clinical or administrative events that require effective communications, such as appointment scheduling, a patient diagnosis, or test results becoming available, automatically triggering follow-up actions, including updating patient care plans, generating invoices, sending outbound emails. In addition to facilitating consistency and coordination between the various companies involved in a patient’s healthcare journey, it reduces the amount of required manual work, lowering each organization’s administrative overhead. 

LuxSci’s suite of HIPAA compliant, secure communications tools aid in the enhanced efficiency and productivity of EHR systems by streamlining digital communication across multiple channels. LuxSci Secure High Volume Email can automatically send personalized, HIPAA-compliant messages triggered by EHR events. Similarly, LuxSci Secure Text allows companies to notify patients via SMS, as per the situation or patient preferences. LuxSci’s Secure Forms, meanwhile, simplifies onboarding and consent processes by pre-filling web forms with EHR data, eliminating the need for manual input paperwork and manual entry.

Common Email and EHR Integration Use Cases

Integrating your EHR system with a HIPAA compliant email solution, like LuxSci, opens the door for a wide variety of enhanced patient engagement opportunities. Let’s explore some of the most valuable use cases for EHR integration below.

  • Appointment Confirmations and Reminders: companies can create EHR-driven workflows that send out an email confirmation as soon as an appointment is scheduled. Similarly, automated email reminders and text messages can be scheduled to go out a set number of days before the patient’s appointment, lowering the chance of a no-show.
  • Pre-Visit Instructions: when appropriate, tailored preparation instructions can be scheduled to be sent out by email before the appointment, according to the nature of the appointment and other relevant patient data.
  • Follow-Up Care Guidance: by the same token, an EHR event can be set up to send out personalized after-care advice, sourced from care plans or notes stored in the EHR system.
  • Test Results: an email or text can be triggered as soon as a patient’s lab results become available; this could be in the form of an alert to contact their provider to collect the results or a summary alongside a secure link to a portal for full access.
  • Preventive Screening Reminders: EHR data can be used to identify patients due for screenings, immunizations, or chronic care follow-ups.
  • Preventative Care: sending patients advice and recommendations relevant to their condition, based on ePHI stored in their healthcare provider’s EHR.
  • Early Detection Self-Assessments: EHR-driven emails can be used to send patients personalized risk assessments designed to detect early warning signs of conditions such as diabetes or cancer, based on ePHI like age, lifestyle factors, or family history.
  • Feedback Collection: healthcare organizations can schedule feedback to be collected from patients, e.g., surveys, questionnaires, etc, to measure patient satisfaction and identify key areas of improvement.  

Discover the Power of EHR Integration with LuxSci

Integrating HIPAA compliant communications solutions like LuxSci with EHR systems empowers healthcare companies to craft more timely, efficient and consistent digital healthcare communications and workflows. This personalized approach to patient and customer engagement enables efficient, effective and above all, compliant communications strategies that improve individual engagement, providing better health outcomes and a higher quality of life.

Want to learn more? Contact us today!

Picture of Pete Wermter

Pete Wermter

As a marketing leader with more than 20 years of experience in enterprise software marketing, Pete's career includes a mix of corporate and field marketing roles, stretching from Silicon Valley to the EMEA and APAC regions, with a focus on data protection and optimizing engagement for regulated industries, such as healthcare and financial services. Pete Wermter — LinkedIn

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Patient Engagement ROI

Patient Engagement ROI: The Business Case for Secure Email in Healthcare

Every IT investment in healthcare today is being evaluated through a sharper lens.

Budgets are tighter. Expectations are higher. AI is the shiny object. Across healthcare organizations, leadership is asking the same question: how does this investment drive measurable results?

That’s where Patient Engagement ROI comes in, and where many traditional approaches fall short.

The Hidden Cost of Ineffective Communication

Patient engagement isn’t just a healthcare priority. It’s a financial one.

Missed appointments, gaps in care, and low response rates all translate directly into increased costs, operational inefficiencies, and a poor patient experience. Yet many organizations still rely on fragmented, manual, or non-personalized communication strategies.

Why?

For many, it’s because of uncertainty around HIPAA compliance, and what’s allowed and not allowed. Too often, healthcare IT and marketing teams avoid using valuable patient data to avoid security and compliance risks, especially over the email channel. The result is often generic outreach that fails to connect, and fails to deliver meaningful results, such as better health outcomes, fewer missed appointments, and increased sales.

How Secure Email Delivers ROI in Healthcare

Among all healthcare IT investments, secure email stands out for one reason: it directly impacts both patient engagement and staff and process efficiency.

With the right HIPAA-compliant marketing automation platform, secure email enables organizations to:

  • Deliver personalized, relevant messages using PHI data in their emails
  • Automate outreach at scale with triggered, engagement-driven campaigns
  • Improve patient response rates and adherence for better outcomes
  • Reduce manual workload across teams for greater productivity

This is where patient engagement ROI becomes tangible.

Instead of one-size-fits-all messaging, organizations can connect with patients based on unique needs and health conditions, such as appointments, care plans, preventative care reminders, new product needs, and more. And because it’s automated, these improvements scale without adding to workloads.

Turning Compliance into Better Outcomes and Growth

HIPAA is often viewed as a constraint. In reality, it’s an opportunity. If you have the right tools.

At LuxSci, we focus exclusively on secure healthcare communications, helping organizations safely unlock the value of their data and communications. Our solutions are designed to remove the friction between compliance and communication, so you don’t have to choose between security and growth.

With capabilities like flexible encryption, advanced segmentation, and high-volume delivery, secure email marketing becomes more than a safeguard, it becomes a growth driver.

And with industry-leading security performance and recognition, organizations can trust that their communications are protected at every level with LuxSci.

Scaling Patient Engagement ROI with Automation

The real power of secure email comes when it’s combined with automated healthcare workflows.

HIPAA compliant marketing automation allows you to build multi-step, data-driven patient journeys that run continuously in the background, taking adaptive steps based on each individual’s email engagement activity. This can include:

  • Appointment reminders that reduce no-shows
  • Follow-up communications that improve outcomes
  • Preventative care outreach for check-ups, annual test and care reminders
  • New product offers, upgrades and promotions
  • Educational email campaigns that drive long-term engagement and better health

Each interaction is an opportunity to improve both patient experience and your financial performance. Over time, these incremental gains compound, resulting in significantly higher patient engagement that delivers real value to your business.

Why Act Now?

Healthcare organizations can no longer afford IT investments that don’t deliver clear, measurable value. Secure email, powered by HIPAA compliant marketing automation, offers one of the most direct paths to improving engagement, efficiency, and outcomes, all while maintaining the highest standards of security.

Ready to see how LuxSci secure email can transform your patient engagement into real ROI?

Connect with us today or book a demo to explore how HITRUST-certified, HIPAA-compliant marketing automation can work for your organization.

What Is B2B Marketing in Healthcare?

B2B marketing in healthcare describes the promotion of products and services to healthcare businesses rather than to patients or the public. The audience can include provider groups, payers, laboratories, medical suppliers, health technology firms, and service companies working across the sector. The work calls for a more measured approach than many other business categories because buying decisions tend to involve several stakeholders, internal review, and close attention to data handling, workflow impact, and commercial fit. Good execution depends on clear communication, useful content, and a strong sense of how healthcare organizations evaluate change.

Why healthcare buying requires a different approach

Healthcare companies rarely move through a buying process in a straight line. One person may open the conversation, though several others can influence whether it goes any further. Finance may want a clearer commercial case. Operations may focus on staffing, efficiency, and implementation pressure. IT may look at access, system fit, and data management. Compliance teams may review privacy implications or contractual language. B2B marketing in healthcare works better when the writing reflects those realities early. Buyers are looking for material that helps them assess risk, discuss options internally, and move forward with fewer unanswered questions.

A Difference in stakeholder priorities

A single account can contain several audiences at once. That is part of what makes this area demanding. A hospital operations leader may care about throughput and day to day workflow. A payer executive may be more interested in administrative efficiency or review times. A supplier may focus on coordination, ordering processes, or communication across partner relationships. Content becomes stronger when it takes those different perspectives seriously. The message does not need to become overly technical. It needs enough accuracy and relevance for each reader to feel that the company understands the conditions attached to their role.

Why credibility matters in every channel

Healthcare buyers tend to read promotional material carefully. They notice vague claims, inflated language, and unsupported promises very quickly. That is why credibility has to be built into the writing itself. A clean explanation of a business problem can carry real weight. A grounded case example can help a reader picture how a solution would work in practice. Clear language around implementation, support, privacy, or service structure can also help keep the conversation moving. When protected health information enters the picture, HIPAA may become part of the review as well, especially for companies handling regulated data or supporting covered entities and business associates.

Content to support real decisions

The most useful assets in this space are the ones that help buyers think more clearly. An article can frame a problem in a way that supports internal discussion. An email sequence can keep a company visible while review is taking place. A service page can answer practical questions before a meeting is booked. B2B marketing in healthcare gains traction when content has a clear job and a clear reader. That focus usually produces stronger engagement than broad copy built around generic thought leadership language. Buyers respond well to material that respects their time and gives them something worth passing along.

What strong performance looks like

Success in healthcare is rarely captured by surface numbers alone. Traffic and opens may show that content has reached people, though those signals do not say much on their own about buying intent. Better indicators include repeat visits from the same organization, replies from relevant contacts, deeper engagement with security or implementation pages, and growing activity across several stakeholders in one account. Those patterns can tell commercial teams where interest is becoming more serious. B2B marketing in healthcare proves its value when it helps those teams follow up with better timing, better context, and material that fits the next stage of evaluation.

What Is B2B Medical Marketing?

B2B medical marketing is the promotion of products and services to medical organizations, rather than to patients or general consumers. The audience can include provider groups, laboratories, payers, health technology companies, medical manufacturers, and service firms that sell into the healthcare space. The work involves more scrutiny than many other business sectors because buying decisions are reviewed through operational, financial, legal, and data related lenses. That environment shapes the way messages are written, the way proof is presented, and the pace at which commercial relationships develop.

Where B2B medical marketing fits in healthcare

Medical companies rarely buy on impulse. A new platform, service, or product may affect staff workflows, procurement planning, record handling, contract review, or coordination between teams. For that reason, B2B medical marketing sits close to the practical side of business decision making. Good content helps a buyer assess whether something will work inside an existing organization. It gives shape to the problem, explains the offer in plain terms, and provides enough context for internal discussion. In a medical setting, that matters because a single contact may show interest while several others influence whether the conversation continues.

Why the buying process feels slower

The pace of healthcare purchasing can frustrate vendors that are used to quicker decisions. Interest does not always translate into movement because the next step may depend on approval from finance, operations, IT, procurement, or compliance. Each group reads with a different priority in mind. An operations lead may look for staffing impact. An IT team may focus on access controls, system fit, and data use. Finance may ask whether the commercial case is persuasive enough to justify more review. B2B medical marketing works best when content reflects those realities from the start. Messages that feel rushed or overwritten tend to lose ground early.

Trust and proof carry weight

Medical buyers are used to reading claims with care. They want to know what the service does, how it fits into day to day work, and what kind of burden it may place on the people using it. That is why trust has to be earned through the material itself. Clear examples help. Credible case studies help. Sound explanations of process, security, implementation, or support also help because they answer the questions serious buyers are already asking. When privacy or protected health information enters the picture, references to HIPAA and related data handling expectations may also become part of the evaluation. B2B medical marketing gains traction when the language sounds careful, informed, and accountable on every page.

Content needs a job to do

A medical buyer reading an article, email, or landing page is usually looking for something useful rather than something flashy. The content may need to explain a workflow issue, support an internal conversation, prepare a reader for a product discussion, or clarify how a service would be introduced. That practical role should shape the writing. B2B medical marketing is stronger when each asset has a clear purpose and a clear reader. One article may help an operations contact define a bottleneck. Another may help a compliance stakeholder understand how data is handled. Another may give procurement a cleaner view of scope and process. Content works harder when it can travel inside the account and still make sense to the next person who reads it.

What good measurement looks like

Performance in this area is not captured by one metric. Page views and open rates may show that something has attracted attention, though they do not say much on their own about buying intent. Better signs come from repeat visits from the same account, deeper engagement with implementation or security pages, replies from people with decision making authority, and movement from light interest to active review. B2B medical marketing earns its value when it helps commercial teams see where attention is turning into evaluation. That is where better timing, stronger follow up, and sharper account insight begin to matter.

Zero Trust Email Security in Healthcare

Zero Trust Email Security in Healthcare: A Requirement for Sending PHI?

As healthcare organizations embrace digital patient engagement and AI-assisted care delivery, one reality is becoming impossible to ignore: traditional perimeter-based security is no longer enough. Email, still the backbone of patient and operational communications, has become one of the most exploited attack surfaces.

As a result, Zero Trust email security in healthcare is moving from buzzword to necessity.

At LuxSci, we see this shift firsthand. Healthcare providers, payers, and suppliers are no longer asking if they should modernize their security posture, but how to do it without disrupting care delivery or patient engagement.

Our advice: Start with a Zero Trust-aligned dedicated infrastructure that puts you in total control of email security.

Let’s go deeper!

What Is Zero Trust Email Security in Healthcare?

At its core, Zero Trust email security in healthcare applies the principle of “never trust, always verify” to every email interaction involving protected health information (PHI).

This means:

  • Continuous authentication of users and systems
  • Device and environment validation before granting access
  • Dynamic, policy-based encryption for every message
  • No implicit trust, even within internal networks

Unlike legacy approaches that assume safety inside the network perimeter, Zero Trust treats every email, user, and endpoint as a potential risk.

Why Email Is a Critical Gap in Zero Trust Strategies

While many healthcare organizations have begun adopting Zero Trust frameworks for network access and identity, email often remains overlooked.

This is a major problem.

Email is where:

  • PHI is most frequently shared
  • Human error is most likely to occur
  • Phishing and impersonation attacks are most effective

Without a Zero Trust email security approach, organizations leave a critical gap in their defense strategy, one that attackers can actively exploit.

Healthcare Challenge: Personalized Communication and PHI Risk

Modern healthcare ecosystems are highly distributed:

  • Care teams span multiple locations
  • Third-party vendors access sensitive systems
  • Patients expect digital, personalized communication

This creates a complex web of PHI exchange—much of it through email.

At the same time, compliance requirements like HIPAA demand that PHI email security is addressed at all times.

The result is a growing tension between:

  • Security and compliance
  • Usability, engagement, and better outcomes

From Static Encryption to Intelligent, Adaptive Protection

Traditional email encryption methods often rely on:

  • Manual triggers
  • Static rules
  • User judgment

This introduces risk. A modern zero trust email security in healthcare model replaces this with:

  • Automated encryption policies based on content and context
  • Flexible encryption methods tailored to recipient capabilities – TLS, Portal Fallback, PGP, S/MIME
  • Seamless user experiences that human error – automated email encryption, including content

At LuxSci, our approach to secure healthcare communications is built around this philosophy. By automating encryption and providing each customer with a zero trust-aligned dedicated infrastructure, organizations can protect PHI without relying on end-user decisions or the actions of other vendors on the same cloud, significantly reducing risk while improving performance, including email deliverability.

Aligning Zero Trust with HIPAA and Emerging Frameworks

Zero Trust is not a replacement for compliance, it’s an enabler. A well-implemented Zero Trust approach helps organizations:

  • Meet HIPAA requirements for PHI protection
  • Reduce the likelihood of breaches
  • Strengthen audit readiness and risk management

More importantly, it positions healthcare organizations to align with emerging cybersecurity frameworks that increasingly emphasize identity, data-centric security, and continuous verification.

PHI Protection Starts with Email

Zero Trust is no longer a conceptual framework, it’s becoming the operational standard for healthcare IT, infrastructure, and data security teams.

But success depends on execution. Email remains the most widely used, and vulnerable, communication channels in healthcare. Without addressing it directly, Zero Trust strategies will fall short.

Here are 3 tips to stay on track:

  • Treat every email as a potential risk
  • Automate encryption at scale – secure every email
  • Enable personalized patient engagement with secure PHI in email

At LuxSci, we believe that HIPAA compliant email is the foundation for the future of secure healthcare communications, protecting PHI while enabling better patient engagement and better outcomes.

Reach out today if you want to learn more from our LuxSci experts.

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HIPAA Compliant Email

Here’s What HIPAA Compliant Email Salespeople Don’t Tell You

With email security threats continuously increasing in number and sophistication, as well as healthcare companies requiring secure solutions to communicate with patients and customers, the need for HIPAA compliant email solutions has never been greater. 

However, when looking for the right secure email services provider (ESP), healthcare organizations run the risk of making inaccurate assumptions about HIPAA compliance via what they learn from prospective vendors. This is due to the tendency for sales materials for HIPAA compliant email services, such as web pages or promotional videos, to highlight the strengths of the platform, while downplaying a healthcare company’s own role and responsibilities in securing protected health information (PHI). 

With this firmly in mind, here are six key things that HIPAA compliant email salespeople don’t tell you about securing communications and achieving compliance. 

1. The Shared Responsibility Model

Firstly, HIPAA compliant email salespeople are unlikely to emphasize the idea of shared responsibility when it comes to data security. This is the idea that two entities that share access to data, e.g., a healthcare company and their ESP, have a shared responsibility to preserve the privacy of that data.

In reality, most sales pitches explain the benefits and features of the solution, as opposed to stressing that compliance truly depends on how it’s configured and used. Now, that’s not to say that a salesperson is trying to hide this fact, as they’ll probably allude to training and configuration requirements. But, they’ll be less likely to make light of this and, more broadly, how shared responsibility factors into compliance.

2. A BAA Doesn’t Automatically Make You HIPAA Compliant

A business associate agreement (BAA) is essential for HIPAA compliance, but signing one doesn’t automatically make you compliant. Your organization still has to use the email delivery solution in a way that aligns with HIPAA regulations, which involves proper configuration, training, oversight, and reporting.

The misconception among some healthcare companies that a BAA equals compliance may be perpetuated by the term “HIPAA compliant email services provider”.  This could give some the impression that the vendor is fully HIPAA compliant and, subsequently, in signing a BAA with them, the use of their services is fully compliant.

But, it’s not that simple.

Simply signing a BAA obscures the real effort involved in achieving compliance. There’s no official HIPAA seal of approval, and HIPAA compliant means that the solution is capable of being configured for compliant use, which is a shared responsibility. HIPAA compliant email salespeople are unlikely to volunteer this nuance, especially if their email solution requires considerable configuration or has a steep learning curve to use it securely.

3. Not All Solutions or Features Are HIPAA Compliant

Another key detail often underplayed by vendor sales materials of HIPAA compliant email solutions is that some of their features, or even entire services, aren’t covered by their BAAs, so they can’t be used to handle PHI. 

These tools are referred to as “out of scope” and may include tools capable of integration with the email service, such as analytics or AI capabilities, but they don’t possess the cyber risk mitigation measures that align with HIPAA regulations. Perhaps the main reason for this is that many mass-market email delivery solutions, such as Microsoft 365 or Google Workspace, are designed for companies across all sectors. Consequently, while they can be HIPAA compliant, they weren’t developed from the ground up with the stringent regulatory demands of the healthcare industry in mind.

4. Solutions Are Not HIPAA Compliant “Out of The Box”

HIPAA compliant email salespeople may suggest that compliance is built into their platform, and healthcare organizations can use it to transmit PHI straight away, but this isn’t the case. Healthcare companies must still configure the email platform accordingly, as per the security requirements determined by their risk assessment, e.g., applying the right level of encryption. 

Also, if the email service is difficult to configure for HIPAA compliance or if the vendor’s configuration documentation lacks detail, that presents another obstacle to its compliant use. 

In addition to configuration, healthcare companies also have to implement access management controls and policies, establishing the extent to which each employee can access PHI in respect to their roles and responsibilities. From there, they will have to train their workforce on how to use the HIPAA compliant email solution securely, which may include those tools that fall outside the scope of your BAA with the vendor, and must not be used for the disclosure of patient data.

5. Essential Security Features Cost Extra 

Another more egregious version of an ESP not being HIPAA compliant out of the box is having features required for compliance, such as encryption or audit logging, as premium add-ons and not included in the solution’s base pricing. 

A vendor’s sales materials for its email service might list the necessary safeguards, but underemphasize the fact that only some versions of their platform are truly HIPAA compliant. Consequently, healthcare companies must confirm that the features required for HIPAA compliant email communications are included in the plan they’re purchasing. 

6. The Importance of Staff Training on HIPAA

HIPAA compliant email salespeople are often remiss in stressing the need for additional workforce training alongside the deployment of their platform. A healthcare company’s employees must be trained on how to securely use the email client, how to ID potential threats, and best practices for including PHI in email communications, as well as the regulations tied to HIPAA and data security.

This includes educating users on the differences between regular and secure email, and what they must do to safeguard patient and customer data. Fortunately, secure email solutions from providers like LuxSci enable automated email encryption, and users do not need to take any additional actions to ensure encryption when sending emails.

Additionally, in some cases, employees will need to be trained on which tools or features do not align with HIPAA guidelines and must not be used to process PHI.

LuxSci: Fully HIPAA Compliant – No Hidden Surprises

LuxSci specializes in solutions that enable companies to carry out secure, personalized, and HIPAA compliant email communications and campaigns. With more than 20 years of experience and billions of emails sent for companies including Athenahealth, 1 800 Contacts, Lucerna Health and Rotech Healthcare, we’ve acquired invaluable experience in helping healthcare organizations enhance their engagement efforts, all while adhering to HIPAA regulations. In addition, LuxSci’s secure high-volume and marketing email solutions feature HIPAA-required security controls, including encryption, audit logging, and multi-factor authentication (MFA) by default, not as optional, hidden extras.

Contact us today to learn more about how LuxSci’s secure email solutions can help increase the ROI on your patient and customer outreach efforts, while safeguarding PHI in line with HIPAA requirements.

encrypted email transmission

Is the Email Encrypted? How to Tell if an Email is Transmitted Using TLS

SMTP TLS encryption is popular because it provides adequate data protection without creating a complicated user experience for email recipients. Sometimes, though, the experience is too seamless, and recipients may wonder if the message was protected at all.

Luckily, there is a way to tell if an email was encrypted using TLS. To see if a message was sent securely, we can look at the raw headers of the email. However, it requires some knowledge and experience to understand the text. It is actually easier to tell if a recipient’s server supports TLS than to tell if a particular message was securely transmitted.

To analyze a message for transmission security, we will look at an example email message sent from Hotmail to LuxSci. We will explain what to look for when decoding the message headers and how to tell if the email was transmitted using TLS encryption.

An Example Email Message

First, we must understand how an email message typically travels through several machines on its way from the sender to the recipient. Roughly speaking:

  1. The sender’s computer talks to the sender’s email or WebMail server to upload the message.
  2. The sender’s email or WebMail server then talks to the recipient’s inbound email server and transmits the message to them.
  3. Finally, the recipient downloads the message from their email server.

It is step 2 that people are most concerned about when trying to understand if their email message is transmitted securely. They usually assume or check that everything is secure and OK at the two ends. Indeed, most users who need to can take steps to ensure that they are using SSL-enabled WebMail or POP/IMAP/SMTP/Exchange services so that steps 1 and 3 are secure. The intermediate step, where the email is transmitted between two different providers, is where messages may be sent insecurely.

To determine if the message was transmitted securely between the sender’s and recipient’s servers (over TLS), we need to extract the “Received” header lines from the received email message. If you look at the source of the email message, the lines at the top start with “Received.” Let’s look at an example message from a Hotmail user below. The email addresses, IPs, and other information are obviously fake.

LuxSci:

The Outlook email was sent to a LuxSci user. The Received headers appear in reverse chronological order, starting with the server that touched the message last. Therefore, in this example, we see the LuxSci servers first.

Received: from abc.luxsci.com ([1.1.1.1])
	by def.luxsci.com (8.14.4/8.13.8) with ESMTP id r7JEfLgH003867
	(version=TLSv1/SSLv3 cipher=DHE-RSA-AES256-SHA bits=256 verify=NOT)
	for <user-xyz@def.luxsci.com>; Mon, 19 Aug 2019 10:41:21 -0400
Received: from abc.luxsci.com (localhost.localdomain [127.0.0.1])
	by abc.luxsci.com (8.14.4/8.13.8) with ESMTP id r7JEfK0Z030182
	for <user-xyz@def.luxsci.com>; Mon, 19 Aug 2019 09:41:20 -0500
Received: (from mail@localhost)
	by abc.luxsci.com (8.14.4/8.13.8/Submit) id r7JEfKXD030178
	for user-xyz@def.luxsci.com; Mon, 19 Aug 2019 09:41:20 -0500
Received: from dispatch1-us1.ppe-hosted.com (dispatch1-us1.ppe-hosted.com [2.2.2.2])
	by abc.luxsci.com (8.14.4/8.13.8) with ESMTP id r7JEfIkK030002
	(version=TLSv1/SSLv3 cipher=DHE-RSA-AES256-SHA bits=256 verify=NOT)
	for <someone@luxsci.net>; Mon, 19 Aug 2019 09:41:19 -0500

Proofpoint:

LuxSci uses an email filtering service, Proofpoint. Messages reach Proofpoint’s servers before being delivered to LuxSci. Here’s what their servers report about the email transmission:

Received: from unknown [65.54.190.216] (EHLO bay0-omc4-s14.bay0.hotmail.com)
	by dispatch1-us1.ppe-hosted.com.ppe-hosted.com
        (envelope-from <someone@hotmail.com>);
	Mon, 19 Aug 2019 08:41:18 -0600 (MDT)

Outlook:

And finally, here’s what we see from Oultook’s server.

Received: from BAY403-EAS373 ([65.54.190.199]) by bay0-omc4-s14.bay0.outlook.com
       with Microsoft SMTPSVC(6.0.3790.4675); 
       Mon, 19 Aug 2019 07:41:19 -0700

How to Use Received Message Headers to Tell if the Email is Encrypted

The message headers contain information that can help us determine if an email is encrypted. Here are a few helpful notes to help you decode the text:

  1. We said this above, but the message headers appear in reverse chronological order. The first one listed shows the last server that touched the message; the last one is the first server that touched it (typically the sending server).
  2. Each Received line documents what a server did and when.
  3. There are three sets of servers involved in this example: one machine at Hotmail, one machine at Proofpoint, where our Premium Email Filtering takes place, and some machines at LuxSci, where final acceptance of the message and subsequent delivery happened.

Presumably, the processing of email within each provider is secure. The place to be concerned about is the hand-offs between Hotmail and Proofpoint and between Proofpoint and LuxSci, as these are the big hops across the internet between providers.

In the line where LuxSci accepts the message from Proofpoint, we see:

(version=TLSv1/SSLv3 cipher=DHE-RSA-AES256-SHA bits=256 verify=NOT)

This section, typical of most email servers running “sendmail” with TLS support, indicates that the message was encrypted during transport with TLS using 256-bit AES encryption. (“Verify=not” means that LuxSci did not ask Proofpoint for a second SSL client certificate to verify itself, as that is not usually needed or required for SMTP TLS to work correctly). Also, “TLSv1/SSLv3” is a tag that means that “Some version of SSL or TLS was used;” it does not mean that it was SSL v3 or TLS v1.0. It could have been TLS v1.2 or TLS v1.3.

So, the hop between Proofpoint and LuxSci was locked down and secure. What about the hop between Hotmail and Proofpoint? The Proofpoint server’s Received line makes no note of security at all! This means that the email message was probably not encrypted during this step.

Hotmail either did not support opportunistic TLS encryption for outbound emails, or Proofpoint did not support receipt of messages over TLS, and thus, TLS could not be used. With additional context, you can know which server supports TLS and which does not.

In this case, we know that Proofpoint supports inbound TLS encryption. In fact, from another example message where LuxSci sent a message to Proofpoint, we see the Received line:

Received: from unknown [44.44.44.44] (EHLO wgh.luxsci.com)
	by dispatch1-us1.ppe-hosted.com.ppe-hosted.com
        (using TLSv1.2 with cipher ECDHE-RSA-AES256-GCM-SHA384 (256/256 bits))
	with ESMTP id b-022.p01c11m003.ppe-hosted.com
        (envelope-from <from@domain.com>);
	Mon, 02 Feb 2009 19:28:27 -0700 (MST)

The red text makes it clear that the message was indeed encrypted. Based on the additional context, we can deduce that the Hotmail sending server did not securely transmit the email using TLS.

How To Tell if an Email is Encrypted With TLS

  1. When analyzing your message headers, consider the following items to determine if the email is encrypted:
    1. The receiving server will log what kind of encryption, if any, was used in receiving the message in the headers.
    2. Different email servers use different formats and syntax to display the encryption used. Look for keywords like “SSL,” “TLS,” and “Encryption,” which will signify this information.
    3. Not all servers will record the use of encryption. While LuxSci has always logged encryption use, not every email service provider does. It is possible to use TLS encryption and not log it. Sometimes, there is no way to tell from the headers if a message is encrypted if it is not logged.
    4. Messages passed between servers at the same provider do not necessarily need TLS encryption to be secure. For example, LuxSci has back-channel private network connections between many servers so that information can be securely passed between them without SMTP TLS. So, the lack of TLS usage between two servers does not mean the transmission between them was “insecure.” You may also see multiple received lines listing the same server: the server passes the message between different processes within itself. This communication also does not need to be TLS encrypted.
    5. If you are a LuxSci customer, you can view online email delivery reports to see if TLS was used for any particular message. We record the kind of encryption in the delivery reports, so it’s easy to see which emails were encrypted.

How can you Ensure Emails Are Securely Transmitted?

With some servers not recording TLS in message headers, how can you determine if a message was transmitted securely from sender to recipient?

To answer this question accurately, you must understand the properties, servers, and networks involved. It may be easy to determine that the message was transmitted securely if included in the header information. However, the absence of information does not necessarily mean the message was insecurely transmitted. You can only know this if you know what each system’s servers record.

In our example of a message from Hotmail to LuxSci, you need to know that:

  1. Proofpoint and LuxSci will always log the use of TLS in the headers. We can infer that the Hotmail to Proofpoint transmission was not secure as nothing was recorded there.
  2. The transmission of messages within LuxSci’s infrastructure is secure due to private back channel transmissions. So, even though there is no mention of TLS in every Received line after LuxSci accepts the message from Proofpoint (in this example), transferring the messages between servers in LuxSci is as secure as using TLS. Also, the same server can add multiple received lines as it talks to itself. Generally, these hand-offs on the same server will not use TLS, as there is no need. In the LuxSci example, we see this as “abc.luxsci.com” adds several headers.
  3. We don’t know anything about Hotmail’s email servers, so we don’t know how secure the initial transmissions within their network are. However, since we know they did not securely transmit the message to Proofpoint, we are not confident that the transmissions and processing within Hotmail (which may have gone unrecorded) were secure.

Was the email message sent and received using encryption?

We skipped steps 1 and 3 and focused on step 2 – the transmission between servers. Steps 1 and 3 are equally, if not more, necessary. Why? Because eavesdropping on the internet between ISPs is less of a problem than eavesdropping near the sender and recipient (i.e., in their workplace or local wireless hotspot). So, it’s essential to ensure messages are sent securely and received securely. This means:

  • Sending: Use SMTP over SSL or TLS when sending messages from an email client or use WebMail over a secure connection (HTTPS).
  • Receiving: Ensure your POP or IMAP connection is secured via SSL or TLS. If using WebMail to read your email, be sure it is over a secure connection (HTTPS).
  • WebMail: There is generally no record in the email headers to indicate if a message sent using WebMail was transmitted from the end-user to WebMail over a secure connection (SSL/HTTPS).

You can typically control one side and ensure it is secure; you can’t control the other without taking extra steps. So, what can you do to ensure your message is secure even if it might not be transmitted with encryption or if the recipient tries to access it insecurely?

You could use end-to-end email encryption (like PGP or S/MIME, which are included in SecureLine) or a secure web portal that doesn’t require the recipient to install or set up anything to get your secure email message. These methods meet HIPAA and other regulatory compliance requirements for secure data transmission and provide complete confidence that the message will be sent and received securely.

LuxSci’s SecureLine offers flexible encryption options, including TLS, secure web portal, PGP, and S/MIME. Its dynamic capabilities can determine what types of encryption the recipient’s server supports to ensure your emails are always sent securely. Contact our team today to learn more about how to secure your emails.

hands on a keyboard sending secure email

How to Secure SMTP Email Delivery with TLS

Secure email sending is a priority for organizations that communicate sensitive data externally. One of the most common ways to send secure emails is with SMTP TLS. TLS stands for Transport Layer Security and is the successor of SSL (Secure Socket Layer). TLS is one of the standard ways that computers on the internet transmit information over an encrypted channel. In general, when one computer connects to another computer and uses TLS, the following happens:

  1. Computer A connects to Computer B (no security)
  2. Computer B says “Hello” (no security)
  3. Computer A says, “Let’s talk securely over TLS” (no security)
  4. Computers A and B agree on how to do this (secure)
  5. The rest of the conversation is encrypted (secure)

In particular:

  • The conversation is encrypted
  • Computer A can verify the identity of Computer B (by examining its SSL certificate, which is required for this dialog)
  • The conversation cannot be eavesdropped upon (without Computer A knowing)
  • A third party cannot modify the conversation
  • Third parties cannot inject other information into the conversation.

TLS and SSL help make the internet a more secure place. One popular way to use TLS is to secure SMTP to protect the transmission of email messages between servers.

Secure SMTP Email Delivery with TLS 

The mechanism and language by which one email server transmits email messages to another email server is called Simple Mail Transport Protocol, or SMTP. For a long time, email servers have had the option of using TLS to transparently encrypt the message transmission from one server to another.

When available, using TLS with SMTP ensures the message contents are secured during transmission between the servers. Unfortunately, not all servers support TLS! Many email providers, especially free or public ones, have historically not supported TLS. Thankfully, the trend is shifting. LuxSci found that most providers now support TLS- approximately 85% of domains tested as of July 2022.

Using TLS requires that the server administrators:

  1. purchase SSL certificates
  2. configure the email servers to use them (and keep these configurations updated)
  3. allocate additional computational resources on the email servers involved.

For TLS transmission to be used, the destination email server must offer support for TLS, and the sending computer or server must be configured to use TLS connections when possible.

The sending computer or server could be configured for:

  1. No TLS: never use it.
  2. Opportunistic TLS: use it if available; if not, send it insecurely.
  3. Forced TLS: use TLS or do not deliver the email at all.

How Secure is Email Delivery over SMTP TLS?

TLS protects the transmission of the email message contents. It does nothing to protect the security of the message before it is sent or after it arrives at its destination. For that, other encryption mechanisms may be used, such as PGP, S/MIME, or storage in a secure portal.

For sending sensitive information to customers, transmission security is the minimum standard for compliance with healthcare and financial regulations. TLS is appropriate to meet most compliance requirements and offers an excellent alternative to more robust and less user-friendly encryption methods (like PGP and S/MIME).

There are different versions of TLS- 1.0 and 1.1 use older ciphers and are not as secure, while TLS 1.2 and 1.3 use newer ciphers and are more secure. When an email is sent, the level of TLS used is as secure as can be negotiated between the sending and receiving servers. If they both support strong encryption (like AES 256), then that will be used. If not, a weaker grade of encryption may be used. The sending and receiving servers can choose the types of encryption they will support. If there is no overlap in what they support, then TLS will fail (this is rare).

What About Replies to Secure Messages?

Let’s say you send a message to someone that is securely delivered to their inbox over TLS. Then, that person replies to you. Will that reply be secure? This may be important if you are communicating sensitive information. The reply will use TLS only if:

  1. The recipient’s servers support TLS for outbound email (there is no way to test this externally).
  2. The mail servers (where the “From” or “Reply” email address is hosted) support TLS for inbound email.
  3. Both servers support overlapping TLS ciphers and protocols and can agree on a mutually acceptable means of encryption.

Unless familiar with the providers in question, it cannot be assumed that replies will use TLS. So, what should you do? Ultimately, it depends on what compliance standards you must meet, the level of risk you are willing to accept, and the types of communications you send. There are two general approaches to this question:

  1. Conservative. If replies must be secure in all cases, assuming TLS will be used is unreasonable. In this case, a more secure method should be used to encrypt the messages in transit and store them upon arrival. The recipient must log in to a secure portal to view the message and reply securely. Alternatively, PGP or S/MIME could be used for additional security.
  2. Aggressive. In some compliance situations like HIPAA, healthcare providers must ensure that ePHI is sent securely to patients. However, patients are not beholden to HIPAA and can send their information insecurely to anyone they want. If the patient’s reply is insecure, that could be okay. For these reasons, and because using TLS for email security is so easy, many do not worry about the security of email replies. However, this should be a risk factor you consider in an internal security audit. Consider nuanced policies that allow you to send less sensitive messages with TLS while sending more sensitive messages with higher security.

What are the Weaknesses of SMTP TLS?

As discussed, SMTP TLS has been around for a long time and has recently seen a great deal of adoption. However, it has some deficiencies compared to other types of email security:

  • There is no mandatory support for TLS in the email system.
  • A receiver’s support of the SMTP TLS option can be trivially removed by an active man-in-the-middle because TLS certificates are not actively verified.
  • Encryption is not used if any aspect of the TLS negotiation is undecipherable/garbled. It is very easy for a man-in-the-middle to inject garbage into the TLS handshake (which is done in clear text) and have the connection downgraded to plain text (opportunistic TLS) or have the connection fail (forced TLS).
  • Even when SMTP TLS is offered and accepted, the certificate presented during the TLS handshake is usually not checked to see if it is for the expected domain and unexpired. Most MTAs offer self-signed certificates as a pro forma. Thus, in many cases, one has an encrypted channel to an unauthenticated MTA, which can only prevent passive eavesdropping.

The Latest Updates to Secure SMTP TLS

Some solutions help remedy these issues—for example, SMTP Strict Transport Security. SMTP STS enables recipient servers to publish information about their SMTP TLS support in their DNS. This prevents man-in-the-middle downgrades to plain text delivery, ensures more robust TLS protocols are used, and can enable certificate validation.

In addition, users can adopt TLS 1.3. NIST recommends that government agencies develop migration plans to support TLS 1.3 by January 1, 2024. LuxSci supports both SMTP MTA-STS and TLS 1.3.

How Secure SMTP TLS Email Works with LuxSci

Inbound TLS

LuxSci’s inbound email servers support TLS for encrypted inbound email delivery from any sending email provider that also supports that. For selected organizations, LuxSci also locks down its servers to only accept email from them if delivered over TLS.

Outbound Opportunistic TLS

LuxSci’s outbound email servers will always use TLS with any server that claims to support it and with whom we can talk TLS v1.0+ using a strong cipher. The message will not be sent securely if the TLS connection to such a server fails (due to misconfiguration or no security protocols in common). Outbound opportunistic TLS encryption is automatic for all LuxSci customers, even those without SecureLine.

Forced TLS

When Forced TLS is enabled, the message is either dropped or sent with an alternate form of encryption if the recipient’s server does not support TLS. This ensures that messages will never be sent insecurely. Forced TLS is also in place for all LuxSci customers sending to banks and organizations that have requested that we globally enforce TLS to their servers.

Support for strong encryption

LuxSci’s servers will use the strongest encryption supported by the recipient’s email server. LuxSci servers will never employ an encryption cipher that uses less than 128 bits (they will fail to deliver rather than deliver via an excessively weak encryption cipher), and they will never use SSL v2 or SSL v3.

Does LuxSci Have Any Other Special TLS Features?

When using LuxSci SecureLine for outbound email encryption:

  1. SMTP MTA STS: LuxSci’s domains support SMTP MTA STS, and LuxSci’s SecureLine encryption system leverages STS information about recipient domains to improve connection security.
  2. Try TLS: Account administrators can have secure messages “try TLS first” and deliver that way. If TLS is unavailable, the messages would fall back and use more secure options like PGP, S/MIME, or Escrow. Email security is easy, seamless, and automatic when communicating internally or with others who support TLS.
  3. TLS Exclusive: This is a special LuxSci-exclusive TLS sending feature. TLS Exclusive is just like Forced TLS, except that messages that can’t connect over TLS are just dropped. This is ideal for low-importance emails that must still be compliant, like email marketing messages in healthcare. In such cases, the ease of use of TLS is more important than receiving the message.
  4. TLS Only Forwarding: Account administrators can restrict any server-side email forwarding settings in their accounts from allowing forwarding to any email addresses that do not support TLS for email delivery.
  5. Encryption Escalation: Often, TLS is suitable for most messages, but some messages need to be encrypted using something stronger. LuxSci allows users to escalate the encryption from TLS to Escrow with a click (in WebMail) or by entering particular text in the subject line (for messages sent from email programs like Outlook).
  6. Domain Monitoring: When TLS delivery is enabled for SecureLine accounts, messages will never be insecurely sent to domains that purport to be TLS-enabled, i.e., TLS delivery is enforced and no longer “opportunistic.” The system monitors these domains and updates their TLS-compliance status daily.
  7. Double Encryption: Messages sent using SecureLine and PGP or S/MIME will still use Opportunistic TLS whenever possible for message delivery. In these cases, messages are often “double encrypted.” First, they are encrypted with PGP or S/MIME and may be encrypted again during transport using TLS.
  8. No Weak TLS: Unlike many organizations, LuxSci’s TLS support for SMTP and other servers only supports those protocol levels (e.g., TLS v1.0+) and ciphers recommended by NIST for government communications and which are required for HIPAA. So, all communications with LuxSci servers will be over a compliant implementation of TLS.

For customers who can use TLS to meet security or compliance requirements, it enables seamless security and “use of email as usual.” SecureLine with Forced TLS enables clients to take advantage of this level of security whenever possible while automatically falling back to other methods when TLS is unavailable.

Of course, using Forced TLS as the sole method of encryption is optional; if your compliance needs are more substantial, you can turn off TLS-Only delivery or restrict it so that it is used only with specific recipients.

If your email use cases are complicated, LuxSci’s flexibility enables the secure sending of emails to any recipient, regardless of their email service provider’s support for TLS. Contact the LuxSci sales team to learn more about our secure SMTP TLS email sending.

healthcare marketing

How are B2B and B2C Strategies Used in Healthcare Marketing?

Healthcare marketing employs distinct B2B and B2C strategies to reach different audiences within the medical and healthcare product and services sectors. B2B marketing targets healthcare providers, medical suppliers, and insurance companies, while B2C marketing focuses on patient outreach and service promotion. Both approaches require specialized marketing tactics that comply with healthcare regulations, such as HIPAA, while meeting business objectives.

Marketing to Healthcare Businesses

Medical device manufacturers, pharmaceutical companies, and healthcare technology providers develop B2B marketing plans to reach hospitals, medical practices, and other healthcare organizations. These campaigns focus on technical specifications, return on investment, and operational benefits. Marketing teams create detailed product documentation, research papers, and case studies to support their sales efforts. Teams usually participate in healthcare trade shows, industry conferences, and professional networking events to build relationships with potential buyers, as well as deploying email campaigns and social media engagement programs. B2B healthcare marketing requires extensive knowledge of medical procurement processes, insurance reimbursements, compliance requirements, and industry standards.

Patient-Focused Marketing Strategies

B2C healthcare marketing connects medical providers, payers and suppliers with potential patients through direct outreach and service promotion. Marketing campaigns display treatment options, medical expertise, and patient benefits. Organizations develop educational content about health conditions, preventive care, and treatment outcomes, and typically carry out email campaigns and engagements programs to connect with targets. They use patient testimonials and success stories to build trust with prospective patients and customers. Marketing content and materials should be education and informative, addressing common health concerns and explaining medical procedures and advice in accessible language. Patient engagement and response rates are tracked by teams to measure campaign effectiveness.

Channel Selection and Message Development

Healthcare organizations select different marketing channels based on their B2B or B2C audience. B2B campaigns utilize secure email campaigns, industry websites and media outlets, and LinkedIn for content distribution. B2C marketing can also include advertising, social media awareness and engagement, and consumer health websites. Marketers should develop separate content strategies for each audience type. B2B content emphasizes technical details and business value, while B2C messages focus on patient experience and better health outcomes. Channel selection, such as email and/or patient portals, considers audience preferences, regulatory requirements, and cost-effectiveness.

Building Professional Networks

B2B healthcare marketing can contribute to building relationships through professional networking and industry partnerships. Organizations develop referral networks with other healthcare providers and supplest, and maintain connections with payers, such insurance companies and government health plans. Marketing teams may organize educational events for healthcare professionals, including digital marketing and CX teams, and participate as members in industry associations, where they create partnership programs that benefit both organizations and their patients. These relationships help healthcare providers expand their service reach and improve awareness. Marketing efforts focus on maintaining long-term business relationships that generate consistent referrals and business opportunities.

Managing Patient Relationships

B2C marketing in healthcare focuses on patient acquisition and retention through personalized communication over channels like email and text. Organizations develop patient engagement programs that include regular health updates, marketing promotions, plan renewals, new product offers, appointment reminders, and wellness information. Marketers can create patient education materials and health resource libraries, where they manage online review platforms and patient feedback systems to maintain strong relationships. Patient relationship management includes tracking satisfaction scores and addressing service concerns promptly. Marketing campaigns can encourage patient loyalty through quality care experiences and relevant, responsive communication.

Measuring Healthcare Marketing Performance

Healthcare organizations typically track different metrics for B2B and B2C marketing success. B2B measurements include conversions, contract values, partnership agreements, and referral volumes. B2C metrics focus on patient acquisition costs, service utilization, and satisfaction ratings. Data is analyzed from all channels to optimize their strategies and resource allocation. Team should compare campaign performance across different audience segments and marketing approaches. Regular performance reviews help organizations adjust their marketing mix to achieve better results. Teams will then use analytics tools to track marketing return on investment and guide future campaign planning.