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LuxSci vs. Zix Webroot: Choosing the Right HIPAA Compliant Email Provider

LuxSci vs. Zix Webroot

There are many crucial factors to consider when developing and executing successful healthcare communication campaigns. First and foremost, you must ensure the protected health information (PHI) under your organization’s care is handled securely, as mandated by Health Insurance Portability and Accountability Act (HIPAA) regulations, which begins with selecting the right HIPAA compliant email provider for your company’s needs.

With the right email services provider (ESP) in place, healthcare providers, payers, and suppliers can confidently use PHI in their patient and customer engagement campaigns – safe in the knowledge they’re aligned with HIPAA’s tight regulatory guidelines.

To help you choose the best HIPAA compliant email provider for your healthcare organization’s email outreach objectives, this post compares two of the most well-known HIPAA compliant services on the market: LuxSci and Zix Webroot (from here, simply referred to as Zix). 

Comparing each email provider’s performance on several criteria, we’ll help you decide which solution best fits the needs of your healthcare organization and will help you better engage with your patients and customers. 

LuxSci vs. Zix: Evaluation Criteria

In our evaluation of LuxSci vs. Zix, we’ll be using the following criteria: 

  • Data Security and Compliance: undoubtedly the most important factor when it comes to ensuring HIPAA-compliant email communication within healthcare organizations, this reflects the extent to which each platform secures sensitive patient data as per HIPAA’s regulations. 
  • Performance and Scalability: the email platform’s ability to facilitate high-volume email communication campaigns, which also, subsequently, encompasses the platform’s throughput and how well they’re able to scale in line with an organization’s needs. 
  • Infrastructure: if the email service provider has the necessary security infrastructure in place to both adequately safeguard PHI and support bulk email marketing campaigns.
  • Marketing Capabilities: if the platform provides features that allow you to personalize and refine your patient engagement strategies.
  • Ease of Use: how easy each email service is to use; a deceptively important factor in light of the urgent need for employee cyber threat awareness training. 
  • Other HIPAA-Compliant Products: if the platform offers complementary features that aid healthcare organizations with their broader patient engagement, and growth, objectives. 

Now that we’ve covered the criteria by which we’ll be assessing each email platform, let’s compare LuxSci vs Zix to determine which is the best fit for your company’s needs. 

LuxSci vs. Zix: How Do They Compare?

Data Security and Compliance

LuxSci prides itself on being a fully HIPAA-compliant email service provider, offering end-to-end, flexible, and automated encryption, giving it an advantage in the protection of patient data in the event of its exfiltration by cyber criminals. Additionally, LuxSci is HITRUST-certified, illustrating its additional commitment to data privacy legislation and the securing of PHI. 

Zix is also fully HIPAA-compliant and, consequently, enables the use of PHI to personalize your email communications. That said, Zix doesn’t offer as many encryption options as LuxSci. Most notably, Zix doesn’t enforce Transport Layer Security (TLS) encryption or enable automated encryption. The absence of these features means that a healthcare organization’s security teams must perform more manual oversight when it comes to encryption of PHI, increasing the chance of human error.

Performance and Scalability

While Zix supports large email campaigns and provides detailed reporting functionality, LuxSci is the more prudent choice for high-volume email marketing campaigns. 

LuxSci maintains the necessary infrastructure to ensure the reliable delivery of hundreds of thousands to millions of emails per month (i.e., throughput – 1000s of emails per hour), all while adhering to HIPAA’s strict guidelines on preserving patient privacy.

Infrastructure

In the same way that LuxSci have advantages over Zix on data security capabilities, it performs well in this category too, which makes sense, as the two factors are interwoven. 

While offering a range of customary multi-tenancy infrastructure setups, Zix doesn’t accommodate dedicated, or single-tenancy, infrastructure options – for companies who can’t afford to depend on the security postures of the companies with whom they share servers. Zix, in line with its ability to facilitate large patient or customer engagement campaigns, provides enterprise-scale scalability. 

Zix also provides high availability and robust disaster recovery capabilities, so healthcare organizations can retain their operational capabilities in the event of a cyber attack. Or, alternatively, an unforeseen physical disaster that compromises a company’s infrastructure (power outages, fires, storms, intentional damage, etc.).

That said, LuxSci possesses all these features in addition to more comprehensive single-tenancy options, scalability, and secure email hosting.

Marketing Capabilities

As with our comparisons of LuxSci against email platforms like Paubox and Virtru, it’s somewhat futile to compare each platform’s marketing capabilities – as neither LuxSci or Zix are marketing platforms, in the vein of Adobe Campaign or Oracle Eloqua, for example. 

That said. LuxSci provides a HIPAA compliant marketing solution, offering automation, for streamlining email marketing campaigns, and, personalization options, for more engaging email communication campaigns. 

Ease of Use

Both LuxSci and Zix perform admirably in this category, but the edge goes to Zix, as LuxSci implementations often involve the complexities that come with large-scale, high volume use cases.

LuxSci, however, is known for offering best-in-class customer support backed by HIPAA security experts, honed as a result of over 25 years of facilitating and supporting email communication strategies for healthcare organizations of all sizes. 

Other HIPAA-compliant Products

With secure texting functionality, secure forms for HIPAA compliant data collection, and secure file sharing, LuxSci ranks well in this category.  Zix, in contrast, provides only secure file sharing – though, because of Zix Webroot’s capabilities, offers superior secure file sharing to LuxSci. 

Get Your Copy of LuxSci’s Vendor Comparison Guide

To discover how LuxSci and Zix stack up against the other leading email providers on the market when it comes to HIPAA compliance, take a look at our Vendor Comparison Guide.  Evaluating 12 email delivery platforms, the guide offers comprehensive insights on what to consider when selecting a HIPAA compliant provider, and how to choose the best solution for you.

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Pete Wermter

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

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HIPAA Security Rule Email Encryption Requirements

HIPAA Compliant Email

Your Email Platform Is Becoming Critical Healthcare Infrastructure

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.

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HIPAA Security Rule Update

The HIPAA Security Rule Missed Its May Deadline — Here’s What We Know

The proposed HIPAA Security Rule update has become one of the most closely watched healthcare compliance developments in recent years. Designed to strengthen cybersecurity protections for electronic protected health information (ePHI), the proposal could significantly reshape how healthcare organizations approach risk management, ePHI encryption, and mandatory email encryption requirements.

A final rule was expected as early as May 2026. However, that deadline has now passed without publication from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR).

So, what happens next—and what should healthcare IT directors, CISOs, and compliance officers do now?

Where Things Stand Today

The HIPAA Security Rule Notice of Proposed Rulemaking (NPRM) was published on January 6, 2025, with the goal of strengthening cybersecurity protections for ePHI in response to escalating ransomware attacks, healthcare breaches, and growing concerns about cyber resilience across the healthcare sector.

The proposal generated thousands of public comments from healthcare providers, payers, business associates, technology vendors, and industry groups. OCR has spent much of the past year reviewing this feedback and evaluating the operational and financial impact of the proposed changes.

Although the Spring Unified Regulatory Agenda identified May 2026 as a target date for a final rule, that milestone came and went without publication. As of June 2026, the proposed HIPAA Security Rule update remains under review.

While some organizations may be tempted to take a wait-and-see approach, the missed deadline should not be interpreted as a signal that the initiative has stalled. If anything, the proposal offers valuable insight into the future direction of healthcare cybersecurity regulation.

The Growing Focus on Mandatory Email Encryption

One of the most discussed aspects of the proposed HIPAA Security Rule update is encryption.

Under the current HIPAA Security Rule, encryption is generally classified as an “addressable” implementation specification. Organizations can choose alternative safeguards if they document and justify their decisions through a risk analysis process.

The proposed changes would significantly reduce that flexibility. Instead, many security safeguards, including encryption controls, would become more prescriptive and difficult to avoid.

While the final language has not yet been released, healthcare organizations should pay close attention to the proposal’s clear message: protecting ePHI through encryption is increasingly viewed as a baseline cybersecurity requirement.

This is particularly important for email communications.

Email remains one of the most widely used communication channels in healthcare, supporting everything from patient engagement and care coordination to billing, scheduling, and marketing communications. As regulators continue to focus on reducing data breach risks, mandatory email encryption is emerging as a likely area of increased scrutiny.

What Healthcare Organizations Should Do Now

The current delay creates an opportunity, not a reason to postpone action.

Healthcare organizations can begin preparing for likely requirements today by evaluating the security controls highlighted throughout the proposed rule.

Key areas to review include:

  • Encryption of ePHI across systems and communications channels
  • Comprehensive asset inventories and ePHI data mapping
  • Enhanced risk analysis and risk management processes
  • Multifactor authentication (MFA)
  • Vulnerability scanning and penetration testing
  • Incident response planning and testing
  • Backup and recovery procedures
  • Email security and secure email encryption practices

Organizations that proactively strengthen these areas now will be better prepared regardless of the final rule’s implementation timeline.

Why Secure Email Encryption Should Be a Priority

For many healthcare organizations, email remains one of the largest compliance and security risks.

Human error, misdirected messages, phishing attacks, and inconsistent encryption practices continue to contribute to breaches involving protected health information. As a result, secure email encryption is increasingly becoming a foundational component of healthcare cybersecurity strategies.

Organizations that rely on manual encryption processes or employee judgment alone may find it difficult to meet evolving regulatory expectations.

Instead, healthcare organizations should look for solutions that automate encryption decisions, reduce user error, and provide flexibility based on the sensitivity of the communication.

At LuxSci, we have long believed that security and usability must work together. We are 100% focused on secure healthcare communications, helping healthcare providers, payers, and suppliers protect sensitive data while improving patient and customer engagement. Our proven secure email solutions, used by leading companies including Athenahealth, 1-800 Contacts, and Hinge Health, help organizations protect ePHI with automated encryption capabilities that support both compliance and operational efficiency. Our unique SecureLine encryption technology enables organizations to apply the appropriate level of protection while maintaining a seamless experience for patients, customers, and staff.

For organizations already using Microsoft 365 or Google Workspace, LuxSci Secure Email Gateway can add HIPAA-compliant email security and encryption without requiring users to change their existing workflows. This approach helps reduce risk, while preserving productivity and user adoption.

The Bottom Line

The HIPAA Security Rule final rule may have missed its anticipated May deadline, but the cybersecurity challenges driving the proposal remain very real.

The OCR is still expected to make the rule change, which could require mandatory encryption of ePHI by early 2027.

The time to prepare is now!

Healthcare organizations should view the proposed HIPAA Security Rule update as an advance warning of where regulatory expectations are heading. Stronger cybersecurity controls, enhanced risk management, ePHI encryption, and mandatory email encryption requirements are all likely to remain central themes in future compliance efforts.

The organizations that begin preparing now will not only be better positioned for future regulatory changes, but will also strengthen their ability to protect patient data, reduce risk, and build trust in an increasingly challenging threat landscape.

At LuxSci, we’re proud to support the healthcare industry’s ongoing digital transformation through secure healthcare communications. Our HIPAA-compliant solutions for secure email, email marketing, and forms empower organizations to safely use and protect PHI, while delivering better patient experiences and outcomes.

Ready to strengthen your healthcare cybersecurity strategy?

Learn more about LuxSci and our complete suite of HIPAA compliant email and marketing solutions, or schedule a consultation with one of our healthcare communication experts today.

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LuxSci G2

LuxSci Awarded 20 Badges in the G2 Summer 2026 Reports

We’re excited to announce that LuxSci has again been recognized by G2 with 20 badges in its just-released Summer 2026 Reports, highlighting our continued leadership in secure healthcare communications and HIPAA compliant email solutions.

The new LuxSci G2 recognitions span several categories, including:

  • Best Estimated ROI
  • Best Support
  • High Performer
  • Leader

These latest LuxSci G2 awards reflect what matters most to our customers: delivering secure, HIPAA compliant healthcare communications backed by responsive support and measurable business results.

As one of the most trusted providers of HIPAA compliant email, marketing, and forms solutions, we’re proud to see our commitment recognized across multiple product categories and customer satisfaction metrics.

Recognition Built on Customer Experience

LuxSci’s G2 rankings are based on verified customer feedback and real-world user experiences, making these badges especially meaningful to our team.

This year’s Summer Reports recognized LuxSci for consistently delivering value to healthcare organizations looking to securely engage patients and customers while maintaining compliance with HIPAA requirements.

Among the highlights, the LuxSci G2 recognition includes:

  • Best Estimated ROI, reflecting the measurable value customers achieve through secure healthcare communications and personalization
  • Best Support, reinforcing LuxSci’s long-standing reputation for responsive, knowledgeable customer service
  • High Performer badges across multiple categories for customer satisfaction and product performance
  • Leader recognition for delivering secure, scalable communications solutions trusted by healthcare organizations

At LuxSci, we believe secure communications should also drive better engagement, stronger outcomes and operational efficiency. These recognitions reinforce our focus on helping healthcare providers, payers and suppliers personalize communications while protecting sensitive patient data.

Supporting the Future of Personalized Healthcare Engagement

LuxSci’s secure healthcare communication and patient engagement solutions empower organizations to safely communicate with patients and customers through:

  • HIPAA-compliant high volume email
  • Secure email marketing
  • Secure forms and data collection
  • Flexible encryption with SecureLine technology

Our solutions are designed to help healthcare organizations improve engagement, streamline workflows and personalize the healthcare journey while maintaining the highest standards of security and compliance.

These latest LuxSci G2 recognitions also build on LuxSci’s broader reputation for security, performance and customer success. Security and trust remain foundational to everything we do, alongside our commitment to delivering smart, responsive support for our customers.

Thank You to Our Customers

We’re grateful to our customers for their continued trust, collaboration and feedback. Their reviews and insights help shape our products and drive ongoing innovation across the LuxSci product set.

To learn more about LuxSci’s secure healthcare communications solutions, contact our team to schedule a secure email assessment or demo.

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Best HIPAA Compliant Email Providers

Who Are The Best HIPAA Compliant Email Providers?

The best HIPAA compliant email providers protect messages in transit and at rest, verify identity with layered controls, and record activity in a way auditors can trust while connecting cleanly with clinical systems. When selecting among the best HIPAA compliant email providers, look for default encryption, reliable authentication, clear logging, and contracts that match HIPAA Privacy and Security Rule expectations so staff can communicate without extra steps.

Why the Best HIPAA Compliant Email Providers Matter in Practice

Email drives everyday healthcare tasks from scheduling and follow ups to sharing discharge details. A service earns its place when protection is automatic and invisible during busy moments. Transport Layer Security should be the baseline for server to server delivery, with message level encryption available when a thread leaves trusted paths so only intended recipients can read the content. Identity deserves equal attention through multi factor sign in, phishing resistant authenticators for sensitive roles, and session rules that make sense on shared workstations. Domain protections like SPF DKIM and DMARC reduce spoofing so patients and partner clinics can trust sender identity, which cuts confusion and keeps conversations in the right hands.

Encryption and Role-Based Access

Strong protection should never slow care. Default rules that apply encryption without user action prevent lapses, while admin policies decide when to escalate from transport protection to content encryption based on recipient or message context. Role based access narrows who can open attachments that carry imaging or lab data, and time bound sessions reduce risk on nursing stations where several people might use the same terminal across a shift. When a platform can prove these controls operate as configured, it stands closer to the standard set by the best HIPAA compliant email providers without demanding constant attention from clinical teams.

Contract Assurances Without Surprises

Patient information requires clear agreements that spell out responsibilities before a single message is sent. A Business Associate Agreement should describe data handling, incident reporting timelines, and how information returns or is deleted when the relationship ends. Contract language needs to align with administrative and technical safeguards referenced in 45 CFR 164.308 and 45 CFR 164.312 so there is no gap between what the law expects and what the vendor delivers. Independent examinations such as SOC 2 Type II or HITRUST provide added assurance that controls operate consistently, while incident procedures and appropriate insurance show the vendor has prepared for difficult days. These pieces lower uncertainty and bring a provider closer to the standard you expect from the best HIPAA compliant email providers.

Integrations That Put Messages Into the Chart

Security works best when it lands in the clinical record without extra clicks. Direct links to electronic health records allow messages and attachments to post into the chart so staff are not copying and pasting under time pressure. Open APIs help route patient replies and flags to the right queue so action happens quickly, and single sign on keeps access simple as clinicians move from room to room. Mobile applications that retain encryption and authentication let providers answer urgent questions away from a desk, which shortens response time while keeping protections intact. A platform that quietly fits this pattern saves minutes every hour and reduces workarounds that create risk, a hallmark shared by the best HIPAA compliant email providers.

Evidence, Logging, and Retention at Scale

Privacy officers need clear visibility when questions arise. Immutable logs that capture access, message views, downloads, and policy changes allow teams to reconstruct events without guesswork. Searchable timelines answer who saw what and when, while retention settings that match record policy keep storage predictable and ready for discovery or legal holds. Alerts that point to unusual sign ins or large exports give early notice without overwhelming teams with noise. This combination turns security features into verifiable history that stands up during reviews, which is where many platforms falter and where mature services establish trust.

How the Best HIPAA Compliant Email Providers Support Audits

Audits move faster when evidence is easy to find. Administrators should be able to export logs for a defined window, filter by user or mailbox, and show exactly how encryption and access rules applied to a thread. Legal teams need clean exports that preserve headers and message bodies without altering content, while compliance staff look for consistent timestamps and clear event labels. When a platform delivers this clarity on demand, investigations remain focused on facts rather than tool limitations, and leadership gains confidence that controls are doing the work they were designed to do.

A Practical Way to Compare Options

Run a focused pilot inside one service line and track the steps that matter. Measure time to send a protected message, the rate at which patients open secure threads, and the ease with which staff can file conversations into the record. Note how many clicks it takes to apply content encryption and how often users need to call for help. Ask for references from similar healthcare organizations and listen for detailed stories about migration quality and support response during the first month. Review pricing beyond a seat line by including storage tiers, archive export charges, and support commitments over a multi year term so totals stay predictable. A platform that performs across these measures will stand out among the best HIPAA compliant email providers without any need to name vendors, and it will do so by making privacy steady and communication smooth rather than by promising features that never show up in daily work.

What is HIPAA compliant email?

How To Send HIPAA Compliant Emails

Knowing how to send HIPAA Compliant Emails is a critical requirement for healthcare providers, payers and suppliers dealing with protected health information (PHI). With fines reaching into the millions, non-compliance isn’t something you want to risk when engaging with our customers and prospects. Unfortunately, many organizations fall into the trap of believing they’re sending HIPAA compliant email because they’ve applied what we call “self-certification” strategies—without fully understanding what’s required to be compliant.

Are you 100% sure that you’re sending HIPAA compliant emails and understand HIPAA email rules?

In this blog post, we’ll delve into the risks of being non-compliant, explain why self-certification strategies often lead to problems, and provide a HIPAA-compliant email checklist to help ensure your organization avoids the pitfalls self-compliance.

The Importance of Sending HIPAA Compliant Emails

HIPAA (Health Insurance Portability and Accountability Act) was established to ensure the protection and privacy of patients’ PHI. This law mandates that any entity handling PHI must implement strict safeguards to prevent unauthorized access, breaches, and exposure of sensitive patient data.

In today’s digital world, where healthcare communications often take place over email and other digital platforms, maintaining HIPAA compliance becomes even more complex. It’s not enough to merely think you’re compliant; you must be able to prove it beyond a doubt.

What Is PHI and Why Does It Need to Be Protected?

As a quick reminder, PHI refers to any data that can be used to identify an individual and that relates to their past, present, or future health condition. This can include anything from personal identification info to medical records and billing information to email exchanges that reference patient care.

Examples of PHI include:

  • Names
  • Addresses
  • Birth dates
  • Social Security numbers
  • Medical history and diagnoses
  • Treatment plans & prescriptions
  • Medical device usage and services
  • Appointment information
  • Billing, payments and insurance information

The Risks of Not Being 100% Sure About HIPAA Compliance

In addition to losing sleep at night, the consequences of sending non-compliant emails can be significant. Non-compliance can result in hefty penalties, ranging from $100 to $50,000 per violation, depending on the severity and intent. In some cases, these fines can even surpass $1.5 million annually.

But it’s not just the fines—PHI exposure opens the door to a variety of serious risks, including the reputational damage that can stem from breaches of patient data that can impact peoples’ lives and the future of your business. Patients place immense trust in healthcare providers and organizations to safeguard their sensitive information, which stretches beyond HIPAA-compliance to overall data security and privacy. The loss of patient trust is difficult—if not impossible—to regain once compromised.

The Problem with DIY HIPAA Compliance

Simply put, self-certifying HIPAA compliance is a recipe for disaster. Many companies and healthcare organizations falsely believe that if they conduct an internal review or have implemented basic security measures, they’re fully compliant. But without the right expertise and the right HIPAA compliant infrastructure in place, especially encryption, it’s easy to overlook details.

Even if you have encryption in place or think your emails are safe, these minimal steps can create a false sense of security. True HIPAA compliance requires continuous monitoring, updating of policies, and regular training to address potential risks.

A Checklist for Sending HIPAA Compliant Email

Sending HIPAA compliant email means ensuring you’ve implemented the following safeguards:

1. Encryption Standards for HIPAA Compliance

All emails containing PHI must be encrypted both at rest and in transit—end-to-end. Ensure your email service provider offers high-grade encryption protocols, like TLS (Transport Layer Security), for sending and receiving messages, and flexible options, including dedicated cloud infrastuctures for the highest levels of data protection.

2. Secure Access and Authentication

Set up multi-factor authentication (MFA) and role-based access controls to limit who can access emails containing PHI.

3. Business Associate Agreements (BAA)

If you’re using a third-party email provider, you must have a signed BAA. This agreement ensures that the provider will uphold HIPAA’s security standards.

4. Data Backup and Recovery

Make sure your email system has a secure backup and recovery solution. Data breaches can happen, but having a recovery plan will minimize damage and maintain compliance.

5. Employee Training and Awareness

Ensure your employees are regularly trained on HIPAA guidelines. Human error is a leading causes of HIPAA violations, so proper education is key.

6. Regularly Audit Your HIPAA Compliance Strategy & Practices

HIPAA regulations evolve as technology advances. Conducting regular compliance audits ensures your security protocols are up to date with the latest best practices.

7. Avoiding Overconfidence in Your Own Processes

No matter how confident you are in your HIPAA strategy, bringing in an external auditor can provide an unbiased view of your compliance status and help identify overlooked vulnerabilities.

Don’t Let HIPAA Self-Certification Fool You!

HIPAA compliance is not something you can afford to be unsure about. The risks—both financially and reputationally—are too great. While it may be tempting to “self-certify” or assume your current measures are sufficient, doing so can leave your organization—and your patients and customers—vulnerable. Instead, ensure that you follow a comprehensive strategy that includes best-in-class email encryption, secure access, regular audits, employee training, and support from external experts.

Don’t take shortcuts when it comes to protecting sensitive health information and ensuring HIPAA compliance—get it right from the start.

If you’d like to get your questions on sending HIPAA compliant email answered, don’t hesitate to reach out to talk with one of our experts—and learn more about the healthcare industry’s leading HIPAA-compliant email, text and marketing solutions from LuxSci.

hands on a keyboard sending secure email

How to Secure SMTP Email Delivery with TLS

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

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

In particular:

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

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

Secure SMTP Email Delivery with TLS 

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

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

Using TLS requires that the server administrators:

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

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

The sending computer or server could be configured for:

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

How Secure is Email Delivery over SMTP TLS?

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

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

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

What About Replies to Secure Messages?

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

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

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

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

What are the Weaknesses of SMTP TLS?

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

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

The Latest Updates to Secure SMTP TLS

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

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

How Secure SMTP TLS Email Works with LuxSci

Inbound TLS

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

Outbound Opportunistic TLS

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

Forced TLS

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

Support for strong encryption

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

Does LuxSci Have Any Other Special TLS Features?

When using LuxSci SecureLine for outbound email encryption:

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

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

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

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

HIPAA Compliant

Is WordPress HIPAA Compliant?

WordPress itself is not HIPAA compliant out of the box, but it can be configured to create HIPAA compliant websites with additional security measures, proper hosting, and careful plugin selection. The basic WordPress installation lacks necessary security features for protected health information, but healthcare organizations can implement encryption, access controls, and security plugins to achieve compliance. Developing a HIPAA compliant WordPress site requires specialized knowledge and ongoing maintenance.

WordPress Core Platform Limitations

The standard WordPress installation lacks several features needed for HIPAA compliance. WordPress stores content in a database that doesn’t include encryption by default. User authentication systems in basic WordPress installations don’t meet healthcare security standards for password complexity or multi-factor authentication. The platform’s logging capabilities fall short of HIPAA audit requirements that track user actions and data access. Default form handling transmits information without encryption protections. These limitations mean healthcare organizations need significant modifications before using WordPress for patient information. Many healthcare providers work with developers experienced in both WordPress and healthcare regulations.

Hosting Considerations for WordPress

WordPress websites handling protected health information require HIPAA compliant hosting environments. Standard shared WordPress hosting lacks the security measures and business associate agreements needed for healthcare data. Organizations using WordPress for patient information typically choose dedicated hosting solutions with enhanced security features. The hosting provider must sign a business associate agreement accepting responsibility for data protection. Hosting environments need features like server-level encryption, network monitoring, and physical security controls. HIPAA compliant hosting providers offer WordPress-specific security configurations that address known platform vulnerabilities while maintaining compatibility with WordPress core functions.

Security Plugins and Configurations

WordPress security plugins help address compliance gaps in the standard installation. Authentication plugins add features like multi-factor authentication, password complexity requirements, and account lockout after failed attempts. Encryption plugins help protect data both in transit and at rest within the WordPress database. Firewall plugins block common attack patterns that could compromise patient information. Logging and monitoring plugins create audit trails of user activities and system events. Plugins themselves introduce potential security issues if not properly vetted and maintained. Healthcare organizations can establish a review process for all plugins used on HIPAA compliant WordPress sites.

Form Handling and Patient Data

Healthcare organizations may collect patient information through WordPress forms. Securing these forms requires other measures than standard WordPress capabilities. Form submissions containing protected health information need encryption during transmission using current security protocols. Data storage after form submission requires encryption and access controls. Many healthcare websites use specialized HIPAA compliant form handlers rather than standard WordPress form plugins. Patient portal functionality generally requires custom development or specialized WordPress extensions designed for healthcare use. Form data often integrates with separate electronic health record systems rather than staying within the WordPress database.

Theme and Plugin Security Risks

WordPress themes and plugins are seen as challenges for HIPAA compliance by entities. Third-party code may contain vulnerabilities that compromise protected health information. Healthcare organizations must carefully evaluate all themes and plugins before installation on compliant websites. Security scanning helps identify potential vulnerabilities in installed components. Plugin updates require testing in development environments before applying to live websites. Custom theme development often provides better security control than third-party themes with unknown code quality.

Maintenance and Compliance Documentation

HIPAA compliant WordPress websites require ongoing maintenance and documentation. Regular updates address security vulnerabilities in the WordPress core, themes, and plugins. System backups protect against data loss while maintaining appropriate encryption. Access reviews verify that user permissions remain appropriate over time. Security testing identifies new vulnerabilities as they emerge. Compliance documentation includes records of all security measures, risk assessments, and system changes. This attention ensures WordPress installations remain compliant as technology and regulations evolve.