It happens — you’re sending email messages without issue, and then suddenly emails are not being delivered, or they’re being flagged as spam. A little digging reveals that the problem is that your “IP reputation” is poor, and you need to fix it somehow.
What is IP Reputation?
Email service providers (e.g. AOL, Gmail, LuxSci) and email filtering systems (e.g. Barracuda, McAfee, Proofpoint, SenderScore) collaborate on and track the sending of unwanted emails to reduce the blight of email spam that continues to plague the Internet. Some of the significant factors that they track include:
Quantity of email sent from your IP address
The spam-like characteristics of these messages (based on spam filter analysis)
The number of spam complaints by recipients of these messages
The number of messages sent to invalid recipients or honey pots. Honey pots are email addresses that do not belong to real people and are traps for senders who have acquired these email addresses via web site scraping or some other illegitimate manner.
Put together, these factors end up determining the reputation of that IP address with respect to the sending of email messages. If the reputation becomes poor, then spam filters will start to quarantine or reject your email messages, resulting in poor deliverability.
What is the “bad neighborhood” effect?
If your sending server is in the same neighborhood as other sending servers, then its reputation can be affected by the others’ actions. The following are some well-known “bad neighborhoods”:
Public cloud servers (e.g. at Amazon). As these servers can be owned by anyone, they are often used for sending unwanted emails. As a result, if you use one of these servers, your IP address probably has a diminished reputation.
Big Internet Service Providers (ISPs). ISPs like Comcast always have problems with suppressing spam coming from their users’ systems (due largely to malware infecting end users and sending unsolicited emails from unsuspecting people’s machines). If you are sending messages directly from your ISP, your reputation can fluctuate wildly as a function of your neighborhood.
If you are suffering from the bad neighborhood effect, your choices are limited and simple:
You can talk to your ISP about the problem, but they may not take any action.
Instead of sending emails directly from servers in this location, you need to relay the messages through a third-party email sending service with a good reputation. This service should also scrub your messages, removing all trace of the tarnished IP of origin.
What can I do to fix IP reputation?
Assuming that you are not a victim of a bad neighborhood, you can take steps to repair the reputation of your server’s IP address. The first thing you need to do is stop sending outbound emails until you take further steps. This can be frustrating, but it is better to send no email than to continue sending problematic email.
Resolving your server reputation problem will take some work. You need to make sure that you’re only sending legitimate emails to real people, as doing this for a while will establish a track record of good sending for your server.
Review Email Lists and Message Content
To fix your IP reputation, take a look at the types of emails you are sending and who is receiving them.
Content. Review the actual content of the messages that you are sending. Make sure that it doesn’t sound like spam. Some software systems can help you analyze your message content for “spamminess.”
CAN-SPAM. Make sure that any bulk email is compliant with CAN-SPAM. Your purpose for emailing, identity, and method for unsubscribing should all be clear.
Sending Rate. Make sure that your server is not sending messages too fast to places like AOL, Yahoo, Google, etc. Pushing too many too fast is a red flag and can hurt your reputation.
Real Addresses. Sending to old or invalid email addresses does significant harm to your IP reputation. You need to review bounced emails and remove dead-end addresses from your lists.
Good Addresses. The single most important thing that you can do for your IP reputation is to send to only people who actually want and expect your email messages. This means, in particular:
Do not use or send to purchased lists.
Discard addresses obtained through scraping web pages or copied from directories or books.
You must get rid of all spam-trap and honey pot email addresses that you may have accumulated.
Eliminate all addresses that have not subscribed to your messages or with whom you do not have an existing business relationship.
Remove the addresses of all people that have requested to be unsubscribed or otherwise eliminated from future mailings.
Remove the addresses of all people that have complained that your messages are spam.
Items 1-3 relate to your message content and sending pattern and are fairly easy to address. The rest of the issues involve actively cleaning and managing your recipient lists. You need to clean all of your existing lists and then manage them going forward.
How do I clean my lists?
Cleaning mailing lists can be difficult and expensive without getting into more trouble with your IP reputation. We recommend the following steps, in the order presented. Depending on your current situation, you might not have enough information to perform them all — that will just increase the cost of the last step.
First, contact your email service provider or IT staff and:
Find a list of all of your bouncebacks and remove them
Find a list of all spam complaints and remove these recipients
Then, take your lists to FreshAddress, and use their SafeToSend email address validation service. It will take your lists, sanitize them, and then provide you with new, improved, and cleaned lists. SafeToSend will:
Validate. Ensure that email addresses are well-formatted, correspond to valid domain names that accept email, and match a working email address.
Correct. The addresses are checked for common spelling errors and typos and corrected as needed (e.g. @gmail.com instead of @gamil.com).
Protect. SafeToSend will identify and remove: spam trap email addresses, role accounts, disposable domains, fictitious and malicious email addresses, and addresses on “do not email lists” and FCC wireless domains.
After sanitizing your lists with SafeToSend and after removing people who have not opted-in to email messages, your delivery rate will skyrocket and complaints will plummet.
How long does it take to improve my IP reputation?
Sending a solid stream of messages with appropriate content to your new, safe list will reestablish your server’s IP reputation. However, it could take a number of days or even weeks to rebuild your reputation. It will depend on how much good email you are sending after repairing your content and lists. Poor IP reputation will continue to affect your email delivery rates as you rebuild that reputation.
To improve email deliverability quickly, the only other option is to relay your email out through a third-party email sending provider and having them scrub your server’s IP address. It won’t rebuild your IP reputation, though the lack of email being sent from your server can slowly improve its reputation to normal levels. However, if your reputation is due to poor lists, third-party email providers will not want your business and may terminate your account if they detect your use of bad email lists.
How do I maintain my lists?
Going forward, you need to be actively collecting bounceback and failure messages and removing these recipient addresses from your lists. Additionally, you need to be collecting spam complaints via feedback loops from the major email service providers (i.e. AOL, Yahoo, etc.) and remove these complainer addresses as well.
If you do not have the facility to capture bounces and feedback, you should use an email sending service that can take care of this for you.
List maintenance is critical. Failing to maintain your list will cause your IP reputation to gradually decline until your sending issues return.
Secure email is not the same as “email with encryption turned on.” True secure email requires enforced automated encryption, a signed BAA, access controls, audit logs, and documented processes — not just a feature toggle.
Standard email platforms like Gmail and Microsoft 365 rely on opportunistic TLS by default, which can silently fall back to unencrypted delivery if the recipient’s server doesn’t support encryption.
HIPAA’s encryption safe harbor means a misdirected but properly encrypted email is a non-event. The same email sent unencrypted is a presumed breach unless a risk assessment shows otherwise.
A signed Business Associate Agreement (BAA) with your email provider is non-negotiable — without one, you cannot legally send or store PHI through that provider.
The proposed 2025 HIPAA Security Rule update, planned for finalization in 2027, would make encryption of ePHI in transit and at rest a mandatory requirement rather than “addressable,” raising the stakes for organizations still relying on opportunistic TLS.
Best for: Healthcare IT Directors, Compliance Officers, Privacy Officers, and Marketing Managers at provider, payer, and supplier organizations that handle protected health information (PHI).
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)
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
Feature
Standard Email
Secure Email (HIPAA-Compliant)
Encryption in Transit
Opportunistic TLS — attempted but not enforced
Enforced TLS — connection fails if encryption unavailable, can include delivery via secure portal option
Encryption at Rest
Not guaranteed; provider-dependent
Required — server-side encryption of stored messages
End-to-End Encryption
Not available
Supported via S/MIME and/or PGP
Digital Signatures
Not available
Included — verifies sender identity and message integrity
Authentication (SPF / DKIM / DMARC)
Optional, rarely enforced
Required — spoofing and impersonation protection
Business Associate Agreement (BAA)
Not provided on standard plans
Required — must be signed before sending PHI
Audit Logs
Basic or none
Full audit trail — required under HIPAA Security Rule
Access Controls
Basic password only
Role-based access, MFA, admin controls
Misdirected Email
Reportable HIPAA breach
Non-reportable if properly encrypted (safe harbor)
HIPAA Compliant by Default
No
Yes
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.
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:
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.
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.
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.
Most healthcare organizations view email as a utility, a necessary tool for sending messages between staff, communicating with patients, sending out newsletters, connecting workflows, and so on. Historically, IT teams focused on keeping it running, security teams worried about phishing, and compliance teams made sure sensitive emails were encrypted.
Today, however, that view is rapidly becoming outdated.
Email has evolved into one of healthcare’s most critical digital infrastructure components, and also one of it’s biggest security threats. It’s a core channel for patient engagement, care coordination, revenue cycle operations, digital marketing, remote monitoring, and increasingly, AI-powered communications. The organizations that recognize this shift are building communications platforms designed for security, performance, automation, and growth. With the new HIPAA Security Rule requiring email encryption on the horizon, those companies that don’t may find themselves constrained by systems that were never intended to support modern healthcare.
Email Is No Longer Just a Messaging Tool
Healthcare organizations now depend on email to support dozens of mission-critical workflows every day.
Patients receive appointment reminders, registration instructions, imaging results, billing notifications, Explanation of Benefits (EOBs), prescription updates, preventive care reminders, patient education, and post-discharge follow-up. Marketing teams deliver personalized wellness campaigns and service line promotions. Clinical systems generate transactional notifications. Revenue cycle teams rely on secure digital communications to accelerate payments and reduce paper costs.
For many organizations, mission-critical patient communications flow through email every month.
When viewed collectively, email is more than a simple communications channel. It has become operational infrastructure with high levels of security needed and increasing compliance requirements.
The Stakes Continue to Rise
As healthcare becomes more digital, every communication carries greater business and clinical importance.
A delayed billing email may postpone payment. A failed appointment reminder can increase no-show rates. An undelivered care management message may impact patient outcomes. A misconfigured security policy can expose protected health information (PHI). Poor deliverability can undermine expensive patient engagement initiatives before they ever reach the inbox.
These are no longer isolated IT issues. Email can affect revenue, patient satisfaction, operational efficiency, compliance, and organizational reputation.
Today’s healthcare leaders require email infrastructure to provide the same reliability and visibility they demand from electronic health records, identity management systems, and other core infrastructure.
AI Is Raising the Bar Even Higher
There’s little doubt that artificial intelligence (AI) promises to transform patient communications.
Healthcare organizations everywhere are exploring AI-generated patient education, personalized outreach, intelligent scheduling, multilingual communications, and automated follow-up programs.
But AI also increases the importance of the underlying communications infrastructure.
Generating more personalized emails means little if organizations cannot:
Automatically protect PHI.
Apply consistent security policies.
Maintain complete audit trails.
Deliver messages reliably.
Integrate with EHRs, RCM and CRM platforms, and customer data platforms.
Demonstrate compliance during an audits.
In many ways, AI amplifies both the opportunities and the risks. Your email platform can help determine whether AI initiatives succeed or create new compliance and operational challenges.
Infrastructure Matters More Than Features
Healthcare buyers have traditionally evaluated email platforms based on individual features such as encryption, spam filtering, or secure portals.
Those capabilities remain important, but they no longer tell the whole story.
Today’s healthcare organizations should be evaluating communications platforms the same way they evaluate any mission-critical infrastructure.
Questions increasingly include:
Can it support both transactional and marketing communications?
Does it automatically enforce security policies without relying on user decisions?
Can it integrate with EHRs, CRM systems, CDPs, and business applications?
Will it scale during peak communication periods?
Does it provide detailed audit logging and reporting?
Can it adapt as regulatory expectations evolve?
Does it maintain high deliverability at enterprise scale?
Does it support single-tenant dedicated infrastructure for high performance and increased security?
These infrastructure characteristics often determine long-term success far more than any single feature comparison.
Email and the Future Of Secure Healthcare Communications
Healthcare is steadily moving toward a world where nearly every patient interaction is digital, personalized, and data-driven.
Healthcare leaders often ask whether they need a more secure email solution. That may be the wrong question.
The better question is whether their communications infrastructure is ready for where healthcare is headed over the next decade.
If you want talk about the future of your healthcare email infrastructure, reach out today and schedule a 30-minute assessment call with our experts.
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:
Computer A connects to Computer B (no security)
Computer B says “Hello” (no security)
Computer A says, “Let’s talk securely over TLS” (no security)
Computers A and B agree on how to do this (secure)
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:
purchase SSL certificates
configure the email servers to use them (and keep these configurations updated)
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:
No TLS: never use it.
Opportunistic TLS: use it if available; if not, send it insecurely.
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:
The recipient’s servers support TLS for outbound email (there is no way to test this externally).
The mail servers (where the “From” or “Reply” email address is hosted) support TLS for inbound email.
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:
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.
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:
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.
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 likePGP, S/MIME, or Escrow. Email security iseasy, seamless, and automatic when communicating internally or with others who support TLS.
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.
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.
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).
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.
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.
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.
As in any industry, the healthcare sector is eager to embrace any new technology solution that increases productivity, enhances operational efficiency, and cuts costs. However, the rate at which healthcare companies – and their patients and customers – have had to adopt new software and digital tools has skyrocketed since the pandemic. And while a lot of this software is beneficial, a key question arises: is it HIPAA compliant? While an application may serve an organization’s needs – and may be eagerly embraced by patients – it also needs to have the right measures in place to safeguard protected health information (PHI) to determine if it is indeed HIPAA compliant.
Whether you’re a healthcare provider, software vendor, product team, or IT professional, understanding what makes software HIPAA compliant is essential for safeguarding patient data and insulating your organization from the consequences of falling afoul of HIPAA regulations.
With this in mind, this post breaks down the key indicators of HIPAA compliant software, the technical requirements you should look for, and best practices for ensuring your software is HIPAA compliant.
What Does It Mean for Software to Be HIPAA-Compliant?
The Health Insurance Portability and Accountability Act (HIPAA) sets national standards for safeguarding PHI, which includes any data related to a patient’s health, treatment, or payment details. In light of this, any applications and systems used to process, transmit, or store PHI must comply with the stringent privacy, security, and breach notification requirements set forth by HIPAA.
Subsequently, while healthcare organizations use a wide variety of software, most of it is likely to be HIPAA-compliant. Alarmingly, many companies aren’t aware of which applications are HIPAA-compliant and, more importantly, if there’s a need for compliance in the first place.
However, it’s important to note that HIPAA itself does not certify software. Instead, it’s up to software vendors to implement the necessary security and privacy measures to ensure HIPAA compliance. Subsequently, it’s up to healthcare providers, payers, and suppliers to do their due diligence and source HIPAA compliant software.
How to Determine If Software Is HIPAA Compliant
So, now that we’ve covered why it’s vital that the applications and systems through which sensitive patient data flows must be HIPAA compliant, how do you determine if your software meets HIPAA requirements? To assess whether software is HIPAA compliant, look for these key indicators:
1. Business Associate Agreement (BAA)
A HIPAA compliant software provider must sign a Business Associate Agreement (BAA) with covered entities, i.e., the healthcare company. A BAA is a legal contract that outlines the vendor’s responsibility for safeguarding PHI. If a software provider doesn’t offer a BAA, their software is NOT HIPAA compliant.
Now, if a vendor offers a BAA, it should be presented front and center in their benefits, terms or conditions, if not on their website homepage as part of their key features. If a vendor has taken the time and effort to make their infrastructure robust enough to meet HIPAA regulations, they’ll want to make it known to reassure healthcare organizations of their suitability to their particular needs.
2. End-to-End Encryption
A key requirement of the HIPAA Security Rule is that sensitive patient data is encrypted end to end during its transmission. This means being encrypted during transit, i.e., when sent in an email or entered into a form, and at rest, i.e., within the data store in which it resides.
In light of this, any software that handles PHI should use strong encryption standards, such as:
Transport Layer Security (TLS – 1.2 or above): for secure transmission of PHI in email and text communications.
AES (Advanced Encryption Standard) 256: the preferred encryption method for data storage as per HIPAA security standards, due to its strength.
3. Access Controls and User Authentication
One of the key threats to the privacy of patient data is access by unauthorized parties. This could be from employees within the organization who aren’t supposed to have access to PHI. In some, or even many, cases, this may come down to lax and overly generous access policies. However, this can result in the accidental compromise of PHI, affecting both a patient’s right to privacy and, in the event patient data is unavailable, operational capability.
Alternatively, the exposure of PHI can be intentional. One on hand, it may be from employees working on behalf of other organizations, i.e., disgruntled employees about to jump ship to a competitor. More commonly, unauthorized access to patient data is perpetrated by malicious actors impersonating healthcare personnel. To prevent the unintended exposure of PHI, HIPAA compliant infrastructure, software and applications must support access control policies, such as:
Role-based access control (RBAC): the restriction of access to PHI based on their job responsibility in handling PHI, i.e.., an employee in billing or patient outreach. A healthcare organization’s security teams can configure access rights based on an employee’s need to handle patient data in line with their role in the company.
Multi-factor authentication (MFA): this adds an extra layer of security beyond user names and passwords. This could include a one-time password (OTP) sent via email, text, or a physical security token. MFA is very diverse and can be scaled up to reflect a healthcare organization’s security posture. This could include also biometrics, such as retina and fingerprint scans, as well as voice verification.
Zero-trust security: a rapidly emerging security paradigm in which users are consistently verified, as per the resources they attempt to access. This prevents session hijacking, in which a user’s identity is trusted upon an initial login and verification. Instead, zero trust continually verifies a user’s identity.
Robust password policies: another simple, but no less fundamental, component of user authentication is a company’s password policy. While conventional password policies emphasize complexity, i.e., different cases, numbers, and special characters, newer password policies, in contrast, emphasize password length.
4. Audit Logs & Monitoring
A key HIPAA requirement is that healthcare organizations consistently track and monitor employee access to patient data. It’s not enough that access to PHI is restricted. Healthcare organizations must maintain visibility over how patient data is being accessed, transferred, and acted upon (copied, altered, deleted). This is especially important in the event of a security event when it’s imperative to pinpoint the source of a breach and contain its spread.
In light of this, HIPAA compliant software must:
Maintain detailed audit logs of all employee interactions with PHI.
Provide real-time monitoring and alerts for suspicious activity.
Support log retention for at least six years, as per HIPAA’s compliance requirements.
5. Automatic Data Backup & Disaster Recovery
Data loss protection (DLP) is an essential HIPAA requirement that requires organizations to protect PHI from loss, corruption, or disasters. With this in mind, a HIPAA-compliant software solution should provide:
Automated encrypted backups: real-time data backups, to ensure the most up-to-date PHI is retained in the event of a security breach.
Comprehensive disaster recovery plans: torapidly restore data in case of cyber attack, power outage, or similar event that compromises data access.
Geographically redundant storage: a physical safeguard that sees PHI. stored on separate servers in different locations, far apart from each other. So, if one server goes down or is physically compromised (fire, flood, power outage, etc.,) patient data can still be accessed.
6. Secure Messaging and Communication Controls
For software that involves email, messaging, or telehealth, i.e., phone or video-based interactions, in particular, HIPAA regulations require:
End-to-end encryption: for all communications, as detailed above.
Access restrictions: policies that only enable those with the appropriate privileges to view communications containing patient data.
Controls for message expiration: automatically deleting messages after a prescribed time to mitigate the risk of unauthorized access.
Audit logs: to monitor the inclusion or use of patient data.
7. HIPAA Training & Policies
Even the most secure software can be compromised if its users aren’t sufficiently trained on how to use it. More specifically, the risk of a security breach is amplified if employees don’t know how to identify suspicious behavior and who to report it to if an event occurs. With this in mind, it’s prudent to look for software vendors that:
Offer HIPAA compliance and cyber safety awareness training for users.
Implement administrative safeguards, such as usage policy enforcement and monitoring.
Support customizable security policies to align with your organization’s compliance needs.
Shadow IT and HIPAA Compliance
Shadow IT is an instance of an application or system being installed and used within a healthcare organization’s network without an IT team’s approval. Despite its name, shadow IT is not as insidious as it sounds: it’s simply a case of employees unwittingly installing applications they feel will help them with their work. The implications, however, are that:
IT teams are unaware of said application, and how data flows through it, so they can’t secure any PHI entered into it.
The application may have known vulnerabilities that are exploitable by malicious actors. This is all the more prevalent with free and/or open-source software.
While discussing the issue of shadow IT in general, it’s wise to discuss the concept of “shadow AI” – the unauthorized use of artificial intelligence (AI) solutions within an organization without its IT department’s knowledge or approval.
It’s easily done: AI applications are all the rage and employees are keen to reap the productivity and efficiency gains offered by the rapidly growing numbers of AI tools. Unfortunately, they fail to stop and consider the data security risks present in AI applications. Worse, with AI technology still in its relative infancy, researchers, vendors, and other industry stakeholders have yet to develop a unified framework for securing AI systems, especially in healthcare.
Consequently, the risks of entering patient data into an AI system – particularly one that’s not been approved by IT – are considerable. The privacy policies of many widely-used AI applications, such as ChatGPT, state the data entered into the application, during the course of engaging with the platform, can be used in the training of future AI models. In other words, there’s no telling where patient data could end up – and how and where it could be exposed.
The key takeaway here is that entering PHI into shadow IT and AI applications can pose significant risks to the security of patient data, and employees should only use solutions vetted, deployed, and monitored by their IT department.
Best Practices for Choosing HIPAA Compliant Software
Now that you have a better understanding of how to evaluate software regarding HIPAA compliance, here are some best practices to keep in mind when selecting applications to facilitate your patient engagement efforts:
✔ Look for a BAA: quite simply, having a BAA in place is an essential requirement of HIPAA-compliant software. So, if the vendor doesn’t offer one, move on.
✔ Verify encryption standards: ensure the software encrypts PHI both at rest and in transit.
✔ Test access controls: choose HIPAA-compliant software that allows you to restrict access to PHI based on an employee’s role within the organization.
✔ Review audit logging capabilities: HIPAA compliant software should track every PHI interaction. This also greatly assists in incident detection and reporting (IDR), as it enables security teams to pinpoint and contain cyber threats should they arise.
✔ Ensure compliance support: knowing the complexities of navigating HIPAA regulations, a reputable software vendor should provide comprehensive documentation on configuring their solution to match the client’s security needs. Better yet, they should provide the option of cyber threat awareness and HIPAA compliance training services.
✔ Create a List of Software Vendors: combining the above factors, it’s prudent for healthcare organizations to compile a list of HIPAA compliant software vendors that possess the features and capabilities to adequately safeguard PHI.
Choosing HIPAA Compliant Software
Matching the right software to a company’s distinctive workflows and evolving needs is challenging enough. However, for healthcare companies, ensuring the infrastructure and applications within their IT ecosystem also meet HIPAA compliance standards requires another layer of, often complicated, due diligence.
Failure to deploy a digital solution that satisfies the technical, administrative, and physical security measures required in a HIPAA compliant solution exposes your organization to the risk of suffering the repercussions of non-compliance.
If select and deploy the appropriate HIPAA compliant software, in contrast, your options for patient and customer engagement are increased, and you’ll be able to include PHI in your communications to improve patient engagement and drive better health outcomes. Schedule a consultation with one of our experts at LuxSci to discuss whether the software in your IT ecosystem meets HIPAA regulations. and how we can assist you in ensuring your organization is communicating with patient and customers in a HIPAA compliant way.
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 notHIPAA-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.
Email deliverability is important as it directly determines whether healthcare organizations can successfully communicate with patients, providers, and business partners when it matters most. Poor email deliverability can result in missed appointments, delayed care coordination, lost revenue, and compliance violations that put both patient safety and organizational reputation at risk. For healthcare providers, payers, and suppliers, maintaining high email deliverability rates means ensuring that appointment reminders reach patients, lab results arrive on time, and billing communications are received without delay. When deliverability fails, the entire healthcare communication chain breaks down, creating gaps in the patient journey and administrative efficiency.
Email Deliverability Affects Patient Care Coordination
Patient care coordination depends heavily on timely, reliable email communication between healthcare providers, specialists, and patients themselves. When email deliverability rates drop, appointment reminders fail to reach patients, leading to increased no-show rates and delayed care. Lab results that end up in spam folders can delay treatment decisions, while referral communications that never arrive can disrupt the continuity of care between primary physicians and specialists. Healthcare organizations with poor email deliverability face cascading effects throughout their patient care processes. A single missed communication can lead to delayed diagnoses, postponed treatments, and frustrated patients who feel disconnected from their care team. Emergency departments may not receive timely notifications about incoming patients, while discharge instructions delivered via email may never reach patients who need them most. The ripple effects of poor email deliverability extend far beyond simple communication failures, directly impacting patient outcomes and satisfaction scores.
Poor Email Deliverability Creates Revenue Loss
Revenue loss from poor email deliverability affects missed appointments, delayed payments, failed billing communications, and reduced patient engagement with healthcare services. When billing statements and payment reminders fail to reach patients due to deliverability issues, healthcare organizations experience increased accounts receivable aging and higher collection costs. Insurance claim notifications and EOBs that end up in spam folders can delay reimbursement processes, affecting cash flow and financial stability. Healthcare organizations also lose revenue through reduced patient engagement with preventive care services and elective procedures. Email campaigns promoting wellness programs, health screenings, and specialized services generate lower response rates when deliverability problems prevent messages from reaching patient inboxes. The financial impact compounds over time, as organizations invest in email marketing and patient communication tools that fail to deliver expected returns due to underlying email deliverability challenges.
Compliance Risks When Deliverability Fails
Healthcare organizations face large compliance risks when email deliverability problems prevent timely delivery of required communications. HIPAA regulations require covered entities to implement reasonable safeguards for protecting patient information, and failed email delivery can create documentation gaps that expose organizations to regulatory scrutiny. When patient communications fail to reach their intended recipients, or worse, reach an unintended recipient, healthcare organizations compliance lapses and data breaches can occurr. Failed email deliverability can also create audit trail problems, as organizations may not realize that required communications never reached patients or business partners. This lack of visibility into delivery failures can lead to compliance violations that result in fines, penalties, and increased regulatory oversight. Healthcare organizations operating under value-based care contracts face additional risks when poor email deliverability prevents timely communication of quality metrics and performance data to payers and regulatory bodies.
Operational efficiency in healthcare depends on smooth communication flows between departments, providers, external partners, and patients and customers. When email deliverability issues disrupt these communication channels, healthcare organizations experience increased administrative burden, duplicated efforts, and workflow interruptions. Staff members spend additional time following up on communications that may have been filtered into spam folders or blocked entirely, reducing productivity and increasing operational costs. Poor email deliverability also affects supply chain management, as communications with vendors, suppliers, and business partners may fail to reach their intended recipients. Order confirmations, shipping notifications, and inventory updates that end up in spam folders can lead to supply shortages, delivery delays, and increased procurement costs. Healthcare organizations may need to implement alternative communication methods, such as phone calls or postal mail, which are more expensive and time-consuming than email.
Technology Integration Challenges
Healthcare organizations rely on integrated technology systems that depend on reliable email deliverability for automated notifications, alerts, and data exchanges. Electronic health record systems, customer data platforms, and patient portal platforms all generate email communications that can be affected by deliverability issues. When these automated systems cannot reliably deliver messages, healthcare organizations may experience system-wide communication breakdowns that affect multiple departments and workflows. Poor email deliverability can also disrupt integration with third-party healthcare applications, telemedicine platforms, and health information exchanges. These systems rely on email notifications to alert providers about new patient data, test results, or system updates. When deliverability problems prevent these notifications from reaching their intended recipients, healthcare organizations may miss important information that affects patient care decisions and operational planning.
Building Sustainable Practices
Healthcare organizations can build sustainable email deliverability practices by implementing authentication protocols, monitoring sender reputation, and maintaining clean recipient lists. Regular audits of email deliverability performance help identify problems before they affect patient care, customer communications, or operational efficiency. Organizations benefit from establishing dedicated resources for managing email deliverability, including staff training on best practices and ongoing monitoring of delivery metrics across different communication channels.
Sustainable email deliverability practices also include developing contingency plans for communication failures, such as alternative contact methods and backup notification systems. Healthcare organizations can reduce their vulnerability to email deliverability issues by diversifying their communication channels while maintaining primary reliance on email for routine communications. This balanced approach helps ensure that patient care and operational efficiency remain intact even when challenges arise.
Want to learn more? Reach out and contact us today.
