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What You Need to Know About PHI Identifiers

LuxSci PHI Identifiers

It’s hard to understate the benefits of using protected health information (PHI) in your patient engagement efforts. By effectively leveraging PHI, you can create highly-targeted and personalized email marketing campaigns, which have greater potential to connect with your patients and customers – and drive your desired outcomes.

However, before diving in, it’s essential to be aware of HIPAA’s complex compliance requirements and how they govern healthcare organizations’ marketing communications. Chief among these considerations is the concept of PHI identifiers and the role they play in classifying and protecting sensitive patient data. With this in mind, let’s explore HIPAA’s 18 PHI identifiers

What is a PHI Identifier?

Before we detail the 18 different PHI identifiers, it’s crucial to first distinguish between what counts as PHI and what, in reality, is personally identifiable information (PII).

PHI (as well as its digital equivalent or electronic protected health information (ePHI)), is defined as “individually identifiable protected health information” and specifically refers to three classes of data:

  • An individual’s past, present, or future physical or mental health or condition.
  • The past, present, or future provisioning of health care to an individual.
  • The past, present, or future payment-related information for the provisioning of health care to an individual.

In short, for an individual’s PII to be classed as protected health information it must be related to a health condition, their healthcare provision, or the payment of that provision. So, a patient’s email address in isolation, for example, isn’t necessarily PHI. However when combined with any information about their healthcare – such as in a patient engagement email campaign – it would constitute PHI.

Put another way, as HIPAA is designed to enforce standards and best practices in the healthcare industry, it’s concerned with protecting health-related information. While the protection of general PII is of the utmost importance, that’s a significantly larger remit – and, consequently, one that’s shared by a variety of data privacy regulations covering different industries and regions (PCI-DSS, GDPR, etc.).

What are the 18 PHI Identifiers?

With the above background in mind, we now have a clearer understanding of what is classed as PHI and, as a result, what data needs to be de-identified. The HIPAA Privacy Rule provides two methods for the de-identification of PHI: the Expert Determination and Safe Harbour methods.

Expert Determination requires a statistical or scientific expert to assess the PHI and conclude that the risk of it being able to identify a particular patient is very low. Safe Harbour, meanwhile, involves systematically removing or securing specific data types to mitigate the risk of patient identification. It’s from the Safe Harbour method that we get the following 18 PHI identifiers:    

  • Patient Names
  • Geographical Elements: street address, city, and all other subdivisions lower than the state.
  • Dates Related to Patient’s ID or Health History: eD.O.B, D.O.D, admission and discharge dates, etc.
  • Telephone Numbers
  • Fax Numbers
  • Email Addresses
  • Social Security Numbers
  • Medical Record Numbers
  • Health Insurance Beneficiary Numbers
  • Account Numbers
  • Certificate or License Numbers: as these can confirm an individual’s professional qualifications or credentials, and when combined with PHI, are exploitable by malicious actors.
  • Vehicle Identifiers: i.e., license plate and serial numbers
  • Device Identifiers and Serial Numbers: those belonging to smartphones, tablets, or medical devices, because they communicate with healthcare companies during provision and can be linked back to the patient
  • Digital Identifiers: namely website addresses used by healthcare companies that patients may visit (for healthcare education, event registration, etc.)
  • Internet Protocol (IP) Addresses: the digital location from where a patient’s device accesses the internet; this can be used to acquire subsequent PHI
  • Biometric Identifiers: e.g., fingerprints, voice samples, etc.
  • Full Face Photographs: in additional to other comparable images
  • Other Unique Numbers, Codes, or Characteristics: not covered by the prior 17 categories

As illustrated by the above list, HIPAA’s list of PHI identifiers is comprehensive, covering all aspects of an individual’s identity and digital footprint. In light of this, when handling patient data it’s crucial to use platforms and digital solutions that have been designed with the secure transmission and storage of PHI in mind.

Harness the Benefits of Using PHI for Better Patient Engagement

As the most experienced provider of HIPAA-compliant communications, LuxSci specializes in secure email, text, marketing and forms for healthcare providers, payers and suppliers. LuxSci’s Secure Healthcare Communications suite offers flexible encryption, customizable security policies, and automated features to ensure HIPAA compliance and the protection of PHI data.

Interested in discovering how LuxSci’s solutions can help you securely engage with your patients and customers?

Contact us today!

 

Picture of Erik Kangas

Erik Kangas

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

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Most Popular LuxSci Blog Posts of 2025

As we close out 2025, healthcare communicators, IT and compliance leaders, and digital marketers face an ever-changing landscape of security threats, regulatory updates, and technology innovations. At LuxSci, we’re committed to helping you with continuous updates and guidance on the future of secure healthcare communications.

In case you missed it, or need a refresh, below are some of our most popular blog posts from 2025. Enjoy!

1. Improve Email Engagement and Marketing Results with Automated Workflows

Automated workflows are transforming how healthcare organizations engage patients and customers — enabling dynamic, event-driven campaigns that easily scale your outreach and keep you HIPAA compliant. In this post, we introduce LuxSci’s Automated Workflows capability for our Secure Marketing healthcare solution. Learn how sequence-based journeys can personalize outreach and optimize engagement with behavior-based triggers that improve campaign performance — without sacrificing data security.

Read the full post: LuxSci Enhances Secure Marketing with Automated Workflows

2. Healthcare Email Threat Readiness Strategies

Email remains a frontline channel for healthcare communications, and a prime target for cyber threats and criminals. This deep-dive into email threat readiness strategies covers essential practices like continuous monitoring, business continuity planning, and workforce training to mitigate email-borne security risks. Whether you’re responsible for clinical systems, marketing, or enterprise IT, this post provides a strategic playbook to strengthen your defenses, while maximizing your results.

Read the full post: Healthcare Email Threat Readiness Strategies

3. HIPAA Compliant Email — 20 Tips in 20 Minutes

For practical guidance you can apply right now, this on-demand webinar distills 20 key tips for HIPAA-compliant email across technical, legal, and operational domains. Whether you’re refining your infrastructure, improving deliverability, or modernizing your data security posture in 2026, this resource is a time-efficient way to elevate your compliance and security.

Read the post and watch the webinar on demand: HIPAA Compliant Email: 20 Tips in 20 Minutes

4. Is SendGrid HIPAA-Compliant? What You Should Know

Choosing the right email provider matters, especially when Protected Health Information (PHI) is at stake. In this post, we examine SendGrid’s capabilities in the context of HIPAA compliance, outline what it takes to send PHI securely, and offer guidance on evaluating third-party services for secure healthcare email and communication needs.

Read the full post: Is SendGrid HIPAA-Compliant?

5. LuxSci Shines in G2 Winter 2026 Reports

Customer feedback matters to LuxSci. In this post, we share the most recent news about LuxSci’s performance in the G2 Winter 2026 Reports, where we earned 20 badges across categories like Email Security, Encryption, Gateway, and HIPAA-Compliant Messaging. These reviews reflect not just product excellence, but trust from real users, which we work hard to build every day!

Read the full post: LuxSci Shines in G2 Winter 2026 Reports

Looking Ahead to 2026

We look forward to providing more information and insights on secure healthcare communications in the coming year, including the latest on HIPAA compliant email, PHI security, healthcare marketing, threat readiness, and personalized engagement. In the meantime, if you’re not already, follow us on LinkedIn below, and we’ll see you here in 2026!

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HIPAA compliant email

LuxSci Welcomes Angel Mazariegos as Head of Finance

LuxSci, a leader in secure healthcare communications and HIPAA compliant email, is pleased to announce the appointment of Angel Marie Mazariegos as the company’s new Head of Finance. With over 25 years of experience in financial management, accounting, and human resources, Angel will play a central role in advancing LuxSci’s operational excellence and supporting the company’s rapid growth in 2026 and beyond.

Angel brings a wealth of expertise to LuxSci, having held senior leadership positions at organizations focused on financial services, language and access services for healthcare, and human resources. In these roles, Angel has led multi-department Finance and HR teams, spearheading critical initiatives, including ERP implementations, streamlined employee onboarding, and financial process optimization.

In her role at LuxSci, Angel will oversee all aspects of the company’s finance operations, including budgeting, forecasting and reporting. Additionally, Angel will manage the company’s HR function, ensuring that LuxSci continues to foster a strong, people-driven culture based on its Secure, Trust, Responsible and Smart company values.

“Angel’s blend of financial and HR leadership makes her an invaluable addition to the LuxSci executive team and a real asset for our people,” said Mark Leonard, CEO of LuxSci. “We look forward to working with Angel to build the high-performing teams that will be critical to our future growth and serving the evolving needs of our customers.”

Angel holds dual MBA degrees in Accounting and Human Resource Management from Cappella University, as well as dual BS degrees in Business Administration (Accounting and CIS Business Systems) from California State University, Los Angeles.

“I am honored to join the LuxSci team at such an exciting time for the company,” said Mazariegos. “I look forward to working with the team and helping build on LuxSci’s reputation for excellence and reliability in secure healthcare communications.”

HIPAA Compliant Email

LuxSci Shines in G2 Winter 2026 Reports, Underscoring Commitment to Product Leadership and Trusted Relationships

We’re pleased to announce that LuxSci has been recognized for excellence and leadership for HIPAA compliant email and messaging in the just-released G2 Winter 2026 Reports!

Based on verified customer reviews, LuxSci earned 20 G2 badges as part of the most recent G2 reports, including top honors such as Grid Leader, Highest User Adoption, Best Support, and Best Estimated ROI.

This recognition further validates what we’ve always believed: our customers don’t just choose a great product — they choose a great partner. At LuxSci, we build long-term, trusted relationships with our customers, anchored in product reliability, industry-leading email deliverability and performance, and the best customer support in the business.

Why G2 Matters

G2 is a globally trusted peer‑review platform that aggregates verified user feedback and real‑world usage data to rank software and service providers. G2’s seasonal reports like the Winter 2026 editions shine a spotlight on latest tools and vendors that deliver consistent value and satisfaction to real customers.

Earning 20 badges this quarter signals a strong vote of confidence from our customers and community, helping affirm that LuxSci is a leading, highly adopted secure email solutions provider.

What We Earned in Winter 2026

Among the 20 badges awarded to LuxSci across Email Security, Email Encryption, Email Gateway and HIPAA Compliant Messaging are:

  • Grid Leader
  • Highest User
  • Best Support
  • Best Estimated ROI

This broad range of accolades spanning leadership, adoption, support and return on investment underscores the reliability of our solutions and the trust our customers place in us.

Awards Reflect Our Commitment to Customer Success

Reliable. Winning Grid Leader and Highest User Adoption demonstrates that thousands of users are depending on LuxSci, securely delivering emails to today’s most popular platforms, including Gmail, Apple Mail, Yahoo Mail and AOL, to name a few.

Proven. With Best Estimated ROI, customers are saying that LuxSci delivers tangible results, whether in secure email delivery, regulatory compliance, or operational efficiency.

Long‑Term Trust. Best Support is perhaps the most telling because for us, success isn’t just about features, it’s about being there for our customers every step of the way.

Thank you to all of our customers. We remain committed to your success — today and in the future.

Want to learn more about LuxSci? Reach out and connect with us today!

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.

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Is SendGrid HIPAA compliant?

Is SendGrid HIPAA-Compliant?

Twilio’s SendGrid is a cloud-based email marketing platform that contains the tools and resources that organizations need to carry out bulk email marketing campaigns. By providing companies with a robust, scalable email infrastructure, SendGrid reduces the technical and management overhead from delivering emails at scale.

SendGrid’s capabilities and benefits are undeniable – and are the reason why the popular platform is the email delivery service of choice for prominent companies like Spotify and Airbnb. For healthcare organizations, however, while reliability and scalability are essential for large-scale patient engagement campaigns and communications, security is another crucial concern. More specifically, for a healthcare company to send electronic protected health information (ePHI) through an email services platform, the service must be HIPAA-compliant.

This then begs the question, is SendGrid a HIPAA compliant email service? Subsequently, can companies use SendGrid to transmit ePHI?

The short answer is no, they are not. Let’s take a closer look

Is SendGrid HIPAA-Compliant?

SendGrid is not a HIPAA-compliant email service.  There are two key reasons for this:

  1. It lacks sufficient encryption measures
  2. SendGrid does not sign business associate agreements (BAAs)

Let’s discuss each reason in greater detail.

Basic Encryption

SendGrid only offers the basic encryption provided by the Simple Mail Transmission Protocol (SMTP), i.e., the standard mechanism used to transmit emails.

Unfortunately, this level of encryption leaves ePHI vulnerable to cyber threats such as business email compromise (BEC) attacks, ransomware, and device loss or theft. In contrast, for an email services platform to be HIPPA-compliant, it must protect ePHI in transit and at rest, using security measures like Transport Layer Security (TLS) encryption and end-to-end encryption.

Refreshingly, SendGrid is clear and upfront about this (in contrast to, Mailchimp, for example, who make you dig a little deeper to determine their non-compliance) – as Twilio’s documentation explicitly says that they do not offer HIPAA-compliant data transmission. Stating, “SendGrid does not natively support HIPAA-compliant data transmission. We do not offer any encryption or security measures surrounding message transmission beyond those included in the SMTP RFC, which was not designed with HIPAA compliancy in mind.”

In short, SendGrid wasn’t designed to withstand the increased cyber risk that accompanies handling ePHI and isn’t HIPPA-compliant as a result.

No Business Associate Agreement

Additionally, in addition to lower levels of encryption, SendGrid does not sign the business associate agreements (BAA) required to be HIPPA-compliant.

A business associate agreement (BAA) is a written contract between a covered entity (your company) and a business associate (a service provider, such as an email services or email marketing platform) that’s an essential requirement of HIPAA compliance. A BAA details how two organizations can share data and the legal responsibilities of each party.

This is again stated on Twilio’s website that says, “Twilio SendGrid does not intend uses of the Service to create obligations under The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the Gramm-Leach-Bliley Act (“GLBA”) or similar laws and makes no representations that the Service satisfies the requirements of such laws. If You are (or become) a Covered Entity or Business Associate (as defined in HIPAA) or a Financial Institution (as defined in GLBA), You agree not to use the Service for any purpose or in any manner involving Protected Health Information (as defined in HIPAA) or Nonpublic Personal Information (as defined in GLBA).”

Here, Twilio is explicitly telling you that SendGrid does not fit the requirements of HIPPA-compliant and that you should not use their service to transmit ePHI.

HIPAA-Compliant Alternatives to SendGrid

While healthcare companies cannot rely on popular options like SendGrid if they want to utilize ePHI in their patient outreach campaigns, fortunately, there are HIPAA-compliant email platforms that are specifically designed for organizations that have to comply with the regulations.

As the most experienced HIPAA-compliant email provider, LuxSci specializes in providing secure and scalable HIPAA-compliant services for companies aiming to send hundreds of thousands – or millions – of emails. In light of this, we place security, regulatory and practical considerations front and center when building our solutions – from their early planning stages until final deployment.

Our approach results in tailor-made tools and services like HIPAA-compliant bulk email, secure text and secure marketing. This includes flexible encryption functionality, such as TLS, end-to-end, or role-based access encryption, that enable healthcare organizations to align their security with the sensitivity of the transmitted and their specific business requirements – all while remaining HIPAA compliant.

To discover how LuxSci and SendGrid stack up against each other, as well as with other HIPAA-compliant, general purpose and marketing email providers on the market, including Virtru and Mailchimp, take a look at our Vendor Comparison Guide.  The guide takes a deep dive on 12 email delivery platforms, offering insights on what to consider when selecting a provider – and how to choose the vender best suited to meet your secure healthcare communications needs.

Get your copy here, and reach out to us with any questions.

HIPAA compliant email services

How To Implement HIPAA Compliant Email Marketing?

HIPAA compliant email marketing requires healthcare organizations to obtain written patient authorization before using protected health information in promotional communications, implement end-to-end encryption for all marketing messages, execute business associate agreements with email service providers, and maintain detailed audit trails of all promotional activities. Medical practices must distinguish between permissible treatment communications and restricted marketing activities, ensuring that any promotional campaigns involving patient data receive explicit consent through properly executed authorization forms while utilizing secure email platforms that meet HIPAA requirements.

Healthcare organizations may feel pressure to attract new patients through digital marketing channels while navigating privacy regulations. Email marketing campaigns that appear straightforward in other industries are legally complicated when patient information enters the equation, demanding careful planning and compliance oversight.

Patient Authorization for HIPAA Compliant Email Marketing

Written patient consent precedes any use of protected health information in promotional email campaigns, including patient testimonials, demographic targeting, or treatment outcome sharing. Authorization forms require sixteen specific elements including detailed descriptions of information usage, recipient identification, expiration dates, and clear explanations of revocation rights. Healthcare organizations cannot condition treatment or payment on patients providing marketing authorization. HIPAA compliant email marketing authorization forms use plain language that patients understand without legal expertise. Organizations cannot combine marketing authorization with treatment consent documents or bundle multiple promotional purposes into single authorization requests. Each marketing campaign requiring PHI usage needs separate, specific authorization that clearly explains how patient information will be used.

Patients retain the right to revoke marketing authorization at any time, forcing organizations to immediately remove those individuals from all promotional campaigns. Revocation requests receive prompt attention, with most organizations processing these within 48 hours of receipt. Organizations maintain systems to quickly identify and remove revoked patients from active marketing lists across all platforms and campaigns.

Email Platform Selection Ensures HIPAA Compliant Email Marketing

Email service providers handling patient information for marketing purposes sign business associate agreements that outline HIPAA compliance responsibilities, data protection requirements, and breach notification procedures. These agreements cannot be generic vendor contracts but specifically cover healthcare privacy obligations and liability allocations for potential violations. Marketing platforms provide end-to-end encryption for all messages, secure data storage with access controls, and comprehensive audit logging capabilities. Email systems encrypt data both in transit and at rest, utilize strong authentication protocols, and maintain detailed records of message creation, transmission, delivery, and recipient interactions.= Cloud-based email marketing platforms present compliance challenges because patient data may be stored on servers in multiple geographic locations. Organizations ensure their chosen platforms maintain appropriate data residency controls and can demonstrate compliance with HIPAA safeguards through independent security assessments and certifications.

Platform configuration requires careful attention to default settings that may not meet HIPAA requirements. Marketing teams disable automatic data sharing features, configure appropriate access controls based on staff roles, and establish secure backup and disaster recovery procedures that protect patient information throughout the email marketing infrastructure.

Content Creation Within Privacy Protection Guidelines

Marketing email content avoids using patient information without proper authorization, even for seemingly innocuous purposes like demographic statistics or general treatment outcome claims. Any reference to patient experiences, treatment results, or practice statistics derived from patient data requires explicit authorization from affected individuals or proper de-identification according to HIPAA standards. HIPAA compliant email marketing content creation involves careful review processes to ensure no protected health information appears in marketing messages without appropriate consent. Stock photography replaces actual patient images, and testimonials include proper authorization documentation. Even appointment scheduling or service reminder emails can become marketing communications if they promote extra services or third-party products. De-identification offers an alternative to patient authorization but requires removing all identifying elements that could reveal patient identity when combined with other available information. Safe harbor de-identification requires removing eighteen specific identifier categories, while expert determination methods need statistical analysis to ensure re-identification risks stay appropriately low.

Content review workflows include legal oversight for any marketing emails that reference patient data, treatment outcomes, or practice statistics. Organizations benefit from establishing clear guidelines about what constitutes marketing versus treatment communications to prevent inadvertent violations when staff create promotional content.

Segmentation and Targeting

Patient list segmentation for marketing purposes requires careful evaluation of whether targeting criteria constitute protected health information usage. Segmenting patients based on age, gender, or geographic location may be permissible, while targeting based on medical conditions, treatment history, or appointment patterns requires specific authorization for marketing purposes. Email marketing platforms provide sophisticated targeting capabilities that can inadvertently use protected health information without proper authorization. Healthcare organizations configure these systems to prevent automatic segmentation based on medical data while still enabling effective marketing communication with appropriate patient segments. External marketing vendors and consultants need clear guidelines about permissible data usage when creating targeted email campaigns. Business associate agreements specifically prohibit vendors from using patient information for purposes beyond the agreed-upon marketing activities, and organizations monitor vendor compliance through audits and oversight procedures.

Marketing automation workflows present particular challenges because they may trigger different messages based on patient behavior or characteristics that constitute protected health information. Organizations carefully design these automated systems to ensure all triggered communications comply with authorization requirements and privacy protection standards.

Security Measures and System Protection

HIPAA compliant email marketing systems implement appropriate safeguards including access controls, audit logs, integrity protection, and transmission security measures. User authentication requires strong passwords, multi-factor authentication for administrative access, and access reviews to ensure only authorized personnel can access patient information used for marketing purposes. Email transmission security requires encryption protocols that protect messages during delivery to patient email accounts. Transport Layer Security protocols need proper configuration, and organizations verify that recipient email systems can receive encrypted messages appropriately. Some patients may need alternative secure communication methods if their email providers cannot handle encrypted messages. Backup and disaster recovery procedures for marketing email systems maintain the same privacy protections as primary systems. Marketing data backups containing patient information require encryption, access controls, and secure disposal procedures when retention periods expire. Organizations test recovery procedures to ensure patient data stays protected during system restoration activities.

Network security measures isolate marketing email systems from other practice management systems when possible, reducing potential exposure if security breaches occur. Firewalls, intrusion detection systems, and security monitoring help protect patient information used in marketing campaigns from unauthorized access or cyberattacks.

Performance Monitoring and Compliance Auditing

HIPAA compliant email marketing requires monitoring of campaign performance, patient engagement metrics, and compliance adherence across all promotional activities. Organizations track authorization status for all marketing recipients, monitor revocation requests, and maintain detailed records of patient consent for regulatory auditing purposes. Email marketing analytics avoid collecting protected health information without authorization. Standard metrics like open rates, click-through rates, and unsubscribe rates don’t require extra authorization, but behavioral tracking that reveals health-related interests or conditions may trigger privacy protection requirements. Compliance audits examine marketing authorization documentation, vendor compliance with business associate agreements, and safeguard implementation across all email marketing systems. These audits help identify potential violations before they result in regulatory enforcement actions or patient complaints.

Staff training on HIPAA compliant email marketing occurs annually and whenever marketing procedures change significantly. Training covers authorization requirements, content creation guidelines, and system usage to ensure all team members understand their compliance responsibilities when handling patient information for marketing purposes.

Enforcement Trends and Violation Prevention

Recent Office for Civil Rights enforcement actions have targeted healthcare organizations for using patient information in email marketing without proper authorization, sharing marketing data with vendors without business associate agreements, and failing to honor patient requests to opt out of marketing communications. These cases show increasing regulatory scrutiny of healthcare marketing practices. Common violations include using patient email accounts obtained for treatment purposes in marketing campaigns without separate authorization, incorporating patient testimonials or photos in promotional emails without consent, and failing to properly segment marketing lists to exclude patients who have revoked authorization. Organizations establish clear procedures to prevent these compliance failures.

Settlement agreements require organizations to implement HIPAA compliant email marketing programs, conduct staff training, and submit to monitoring for extended periods. Compliance programs that consider these enforcement priorities can minimize violation risks and avoid costly regulatory investigations that disrupt practice operations and damage professional reputations.

LuxSci Third Party Integrations

The Risks of Third-Party Email Integrations for Healthcare Companies

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

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

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

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

What Are The Risks of Third-Party Email Integrations?

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

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

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

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

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

How To Mitigate Email Integration Risk

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

Verify A Third-Party Vendor’s Security Practices

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

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

Business Associate Agreements (BAAs)

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

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

Encrypting PHI

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

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

Threat Intelligence

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

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

Developing An Incident Response Plan For Vendor-Related Breaches

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

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

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

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

Choose a HIPAA-Compliant Email Provider

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

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

Train Staff on Secure Email Communication Practices

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

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

How LuxSci Mitigates the Risks of Third-Party Integrations

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

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

Email Marketing Best Practices for Healthcare

Email marketing can be a powerful tool for healthcare organizations, but it requires careful planning and execution because of HIPAA compliance requirements. In this blog post, we will discuss email marketing best practices to help healthcare marketers achieve their goals. 

woman viewing email program

1. Define Your Campaign Goals

The success of any email marketing campaign depends on the goals you want to achieve. However, because healthcare organizations are often not selling products to their patients, marketers can be confused about how to set measurable goals for their campaigns that aren’t tied to revenue generation.

Healthcare marketers want to use email marketing campaigns for various purposes, including patient engagement, education, and retention. Some possible objectives of your campaigns could be:

  • New patient acquisition
  • Re-engaging lapsed patients
  • Spreading awareness about vaccines, treatments, or medical conditions
  • Increasing treatment or medication adherence
  • Collecting survey responses or patient-reported outcomes

All of these campaign objectives will correlate with different metrics. Identifying the campaign goal and the corresponding metrics you need to track is critical before selecting the audience and crafting the content.

2. Select Your Audience

Gone are the days of sending giant email blasts to your entire contact list. The best email marketers are creating highly targeted campaigns for specific audiences. Healthcare marketers using patient data in their audience targeting efforts are at an advantage. They can use patient information to create distinct audience segments. Targeting a patient population with common attributes makes it easier to craft a relevant message to drive clear results. For example, marketers can create more relevant campaigns when they can divide their patient population into subgroups based on shared characteristics like diagnoses, risk factors, and demographic data.

3. Personalize Your Content

Once you have clearly defined your goal and your audience, it’s essential to use personalization techniques to craft relevant messaging. Healthcare consumers expect more personalization from their providers and want to receive messages that tie into their past experiences. Generic, irrelevant messaging is more likely to annoy patients than get them to act. Healthcare marketers are lucky to have a wealth of data points to use in their messaging, but they must be aware of patient privacy and take steps to secure their messaging. When you have taken the appropriate steps to secure patient data, including protected health information in email messages is possible. This improves the patient experience and makes it easier for healthcare marketers to achieve their objectives.

4. Use A Clear Call-to-Action

Your emails should include a clear call-to-action (CTA) that encourages your audience to take the desired action. These actions may include scheduling an appointment, downloading a resource, logging into a patient portal, filling out a survey, or contacting your organization. Ensure that your CTA is prominent, stands out from the rest of your content, and ties back to the goal of your campaign. Most importantly, implement appropriate tracking technologies so you can see how many email recipients followed through on the CTA.

Don’t include too many calls to action in one message! Including multiple prompts may confuse the recipient and make it more difficult for your team to understand how the campaign performed.

5. Review Your Data

Finally, it’s essential to monitor your email metrics to evaluate the success of your campaigns. Some key metrics may include open rates, click-through rates, surveys completed, successful logins, appointments scheduled, and other relevant metrics that tie back to your goals. Use this data to refine your email marketing strategy, trigger follow-up campaigns and marketing activity, and optimize future campaigns. Use APIs or webhooks to ensure your email campaign statistics are tied into marketing dashboards to get a holistic view of how your campaigns are performing.

6. Choose an Email Marketing Platform Designed for Healthcare

Finally, to use the tactics recommended above, it’s necessary to use a HIPAA-compliant email marketing platform. Segmenting audiences and personalizing content requires the use of protected health information. Therefore, it must be secured in compliance with HIPAA. You must select a platform that can protect data both at rest and in transit to utilize the power of your data fully.

LuxSci’s HIPAA-compliant Secure Marketing was designed to meet the needs of healthcare marketers and enables the use of PHI at scale. Contact our sales team to learn more about our capabilities and email marketing best practices.