We recently rolled out new email reporting features, taking deliverability depth and analysis to new levels. If you’re a current LuxSci customer and haven’t checked them out, now’s the time. If you’re new to LuxSci, learn more below, and don’t hesitate to reach out for more info – or a demo.
LuxSci secure communications solutions have always featured rich reporting on email deliverability, including volumes and percentages for emails:
in queue
opened
clicked
failed
secured
With our latest release, we made these powerful statistics easier to consume and analyze with an improved user interface for more efficiency and greater ease-of-use. Users can simply select the type of report they’d like and customize it using a range of filtering selections. This is great for diving deeper into your email performance to make adjustments on-the-fly, and to spot trends or opportunities for better engagement that you may have missed before.
New UI – Email Deliverability Statistics
Get more granular, ID trends in real time with Split Reporting
As part of this release, we are pleased to introduce our Split Reporting feature, which empowers users to drill down on email deliverability statistics across a range of parameters, including:
subject
from address
recipient domains
marketing ID or campaign
custom field
For example, users can analyze email deliverability statistics by subject to determine which ones are performing best, by use case to track results by campaign, or to track performance by recipient email domains. With split reporting, users also can analyze email volumes across queued, delivered, opened, failed and clicked parameters, and determine click-through rates (CTR) to measure effectiveness and ROI of campaigns.
New Feature Example – Split Reporting by Recipient Domain
If you’d like to learn more, reach out and connect with us today!
Secure email is not the same as “email with encryption turned on.” True secure email requires enforced automated encryption, a signed BAA, access controls, audit logs, and documented processes — not just a feature toggle.
Standard email platforms like Gmail and Microsoft 365 rely on opportunistic TLS by default, which can silently fall back to unencrypted delivery if the recipient’s server doesn’t support encryption.
HIPAA’s encryption safe harbor means a misdirected but properly encrypted email is a non-event. The same email sent unencrypted is a presumed breach unless a risk assessment shows otherwise.
A signed Business Associate Agreement (BAA) with your email provider is non-negotiable — without one, you cannot legally send or store PHI through that provider.
The proposed 2025 HIPAA Security Rule update, planned for finalization in 2027, would make encryption of ePHI in transit and at rest a mandatory requirement rather than “addressable,” raising the stakes for organizations still relying on opportunistic TLS.
Best for: Healthcare IT Directors, Compliance Officers, Privacy Officers, and Marketing Managers at provider, payer, and supplier organizations that handle protected health information (PHI).
In healthcare IT, the term “secure email” gets thrown around loosely. Vendors slap the label on anything with a padlock icon, and internal teams often assume that because their provider offers TLS, they’re covered. They’re not, and the gap between what’s assumed and what’s actually required is where data breaches occur and HIPAA violations happen.
This guide breaks down exactly what secure email means from a technical and regulatory standpoint, why the email platform your staff uses every day probably isn’t compliant out of the box, and what to look for when evaluating a provider that needs to protect PHI at scale. If you want the full picture of what compliance requires beyond email specifically, our HIPAA Compliance Checklist is a useful companion read.
What Is Secure Email?
Secure email refers to an email system that protects the confidentiality, integrity, and availability of message content — specifically PHI — through a combination of technical safeguards and contractual protections. It’s not a single feature. It’s a stack of controls working together.
At minimum, secure email in a healthcare context includes:
Enforced encryption in transit, so messages can’t fall back to plaintext delivery
Encryption at rest, so stored messages remain protected on the server
Authentication protocols (SPF, DKIM, DMARC) that prevent spoofing and impersonation
Access controls and audit logs that track who accessed what, and when
A signed Business Associate Agreement (BAA) with the email provider
The distinction that trips up most organizations is this: encryption is a component of secure email, not the whole picture. A provider can offer encryption and still fail to meet HIPAA requirements if that encryption isn’t enforced, if there’s no BAA in place, or if audit logging doesn’t exist. Secure email is the combination of all these pieces functioning as a system, which is why it needs to be evaluated holistically rather than checked off feature by feature.
For healthcare provider, payer, and supplier organizations, this matters because email remains one of the highest-volume channels for PHI exposure, from clinical referrals to patient billing statements to routine staff communication. Getting the definition right is the first step toward closing the compliance gap.
Why Standard Email Is Not HIPAA-Compliant
Many healthcare organizations run on Gmail (Google Workspace) or Microsoft 365, and most assume they’re protected because encryption exists somewhere in the stack. That assumption is the single most common — and most dangerous — misconception in healthcare email security.
Here’s the problem: standard email services use opportunistic TLS by default. TLS is attempted between mail servers, but if the receiving server doesn’t support it, the message is delivered anyway — unencrypted, in plaintext. Neither the sender nor the recipient typically sees a warning. The email just goes through.
This isn’t a hypothetical edge case. IT professionals managing healthcare email infrastructure have flagged this exact issue directly: opportunistic TLS is often enabled by default and creates a false sense of security, since it offers no guarantee that a given message, including one containing PHI, won’t be transmitted in plaintext if the recipient’s mail server doesn’t support encryption. Organizations assume they’re protected simply because TLS is technically “on,” without realizing it isn’t enforced.
That gap has real consequences under HIPAA. The Security Rule currently treats transmission encryption as an “addressable” safeguard, meaning covered entities can, in theory, implement an equivalent alternative measure instead. In practice, regulators and auditors from the Office for Civil Rights (OCR) expect enforced encryption as the standard of care. “Addressable” has never meant optional — it means an organization needs a documented, defensible reason if it isn’t doing enforced encryption, and few reasons hold up under scrutiny. Finally, under OCR’s proposed changes to the HIPAA Security Rule for ePHI, scheduled for final publication in July 2027, email encryption moves from addressable to mandatory.
Beyond the encryption gap, standard consumer and even most business email plans typically lack:
A BAA that’s actually offered and signed (available on some enterprise tiers, but not automatic)
Audit logging sufficient to meet HIPAA Security Rule requirements
Built-in encryption at rest guarantees for stored messages
None of this means Gmail or Microsoft 365 are inherently insecure products. It means their default configuration is built for general business use, not for an environment where every misrouted or intercepted message carries breach notification liability. Making either platform HIPAA-appropriate requires layering on additional tools, policies, and critically, a provider relationship that includes a signed BAA covering the exact services in use.
The Technical Components of Secure Email
Secure email is built upon five technical layers. Understanding each one, and where it fails in standard email, clarifies exactly what a compliant solution needs to deliver.
Encryption in Transit (TLS)
Transport Layer Security (TLS) encrypts the connection between mail servers as a message travels from sender to recipient. There are two flavors, and the difference between them is the crux of most healthcare email compliance failures:
Opportunistic TLS attempts an encrypted connection but falls back to unencrypted delivery if the receiving server doesn’t support it. This is the default across most consumer and business email platforms.
Enforced TLS requires an encrypted connection for delivery to succeed. If encryption can’t be established, the message fails to send rather than going out in plaintext, or a link to secure portal can be sent to securely access the information.
HIPAA’s Security Rule lists encryption as addressable, but enforced TLS has become the de facto standard that auditors and OCR expect from covered entities and business associates handling PHI over email. As one healthcare IT professional put it while debating this exact tradeoff internally: the goal is to require TLS for all outbound email and then document the remaining controls around it, treating enforced TLS as the technical baseline, with policy and process built on top.
Encryption at Rest
Transit encryption only protects a message while it’s moving. Once it lands on a mail server — sender’s outbox, recipient’s inbox, backups, archives — it needs to remain encrypted in storage. This is encryption at rest, and it’s where many organizations underestimate their exposure.
Encryption in transit alone offers zero control over a message after it’s been delivered. If the destination server isn’t itself encrypting stored data, or if a backup snapshot is taken without encryption, PHI sitting in an inbox is exposed regardless of how securely it arrived. HIPAA’s Security Rule requires safeguards for ePHI both in transit and at rest, a compliant secure email provider needs to guarantee both, not just one.
End-to-End Encryption (S/MIME, PGP)
End-to-end encryption (E2EE) encrypts message content itself, not just the connection it travels over — meaning even the email provider can’t read the content. Two standards dominate here:
S/MIME uses certificate-based encryption and is common in enterprise environments, such as healthcare, particularly where organizations already manage a public key infrastructure.
PGP (Pretty Good Privacy) uses a public/private key model and is more common in technical or security-conscious communities, though it’s less frequently deployed at scale in healthcare due to key management complexity.
E2EE isn’t a baseline requirement for every PHI-containing email, enforced TLS plus encryption at rest satisfies most use cases. But it becomes necessary for especially sensitive communications, cross-organization data sharing where you don’t control the recipient’s infrastructure, or when a business associate agreement specifically requires it.
Authentication (SPF, DKIM, DMARC)
These three protocols work together to prevent domain spoofing and email impersonation, a growing attack vector against healthcare organizations specifically, given how often phishing campaigns impersonate providers, payers, or patients.
SPF (Sender Policy Framework) specifies which mail servers are authorized to send email on behalf of a domain.
DKIM (DomainKeys Identified Mail) adds a cryptographic signature verifying a message wasn’t altered in transit.
DMARC (Domain-based Message Authentication, Reporting & Conformance) tells receiving servers what to do when SPF or DKIM checks fail, and provides reporting visibility.
Without these configured correctly, an organization’s domain can be spoofed to send convincing phishing emails to patients or staff, creating a security failure that compounds the compliance risk of email interception.
Digital Signatures
Digital signatures verify sender identity and confirm a message hasn’t been tampered with between sending and receipt. Paired with encryption, they close the loop on message integrity, confirming not just that content was protected, but that it came from who it claims to have come from and arrived unaltered.
Standard Email vs. Secure Email: Feature Comparison
Feature
Standard Email
Secure Email (HIPAA-Compliant)
Encryption in Transit
Opportunistic TLS — attempted but not enforced
Enforced TLS — connection fails if encryption unavailable, can include delivery via secure portal option
Encryption at Rest
Not guaranteed; provider-dependent
Required — server-side encryption of stored messages
End-to-End Encryption
Not available
Supported via S/MIME and/or PGP
Digital Signatures
Not available
Included — verifies sender identity and message integrity
Authentication (SPF / DKIM / DMARC)
Optional, rarely enforced
Required — spoofing and impersonation protection
Business Associate Agreement (BAA)
Not provided on standard plans
Required — must be signed before sending PHI
Audit Logs
Basic or none
Full audit trail — required under HIPAA Security Rule
Access Controls
Basic password only
Role-based access, MFA, admin controls
Misdirected Email
Reportable HIPAA breach
Non-reportable if properly encrypted (safe harbor)
HIPAA Compliant by Default
No
Yes
What Makes Email HIPAA-Compliant Specifically
Technical safeguards alone don’t make email HIPAA-compliant. Compliance is a combination of technology, contracts, and documented processes — all four need to be in place simultaneously. This includes:
A signed BAA with your email provider – Any vendor that transmits, processes, or stores PHI on your behalf is a business associate under HIPAA, and business associates are legally required to sign a BAA before handling that data. Email providers have persistent access to ePHI — even end-to-end encrypted messages pass through their infrastructure at some point — which makes this requirement absolute, not situational. If a provider won’t sign a BAA, using them to send or store PHI isn’t a compliance risk you can mitigate; it’s a violation from the start.
Encryption as an addressable safeguard – Under 45 CFR §164.312(e)(2)(ii), the HIPAA Security Rule lists encryption of ePHI in transit as “addressable” rather than strictly “required.” In practice, this doesn’t mean optional, it means an organization must implement it, or document and justify an equivalent alternative safeguard. Enforced encryption has become the expected standard, and with the newly proposed HIPAA Security Rule planned for July 2027 publication, NPRM would formalize that expectation by making encryption of ePHI in transit and at rest mandatory rather than addressable. Organizations still relying on opportunistic TLS as their “equivalent alternative” should treat this as a closing window.
Access controls and audit logs – HIPAA requires the ability to track who accessed PHI, when, and what they did with it. This means role-based access permissions, multi-factor authentication, and a complete, retained audit trail — not just for compliance reporting, but for identifying and responding to incidents quickly.
The encryption safe harbor – This is one of the most consequential, and most underused, provisions in HIPAA. If PHI is sent via properly encrypted email and ends up misdirected to the wrong recipient, it is not a reportable breach under the Breach Notification Rule, because the encrypted content is considered unreadable and therefore not “unsecured PHI.” The exact same misdirection with unencrypted email is a reportable breach, triggering notification obligations to the individual and to HHS/OCR. Encryption isn’t just a security best practice here, it’s the line between a non-event and a formal breach investigation.
HITRUST certification as a trust signal – When evaluating vendors, HITRUST CSF certification is a strong external indicator that a provider’s security controls have been independently assessed against a recognized healthcare-specific framework. It’s not a HIPAA requirement in itself, but it meaningfully reduces the diligence burden on your side when vetting a provider.
Types of Healthcare Email That Must Be Secure
Not all internal debate here is about “should we secure email” — it’s about scope. Which specific email flows actually carry PHI, and therefore need to run through a compliant channel? In practice, the answer is broader than most teams initially assume.
The common thread: if a message references anything that could identify a patient in connection with health information — a name next to a diagnosis, an account number tied to a service date, an annual test reminder — it needs to move through a secure channel, regardless of whether it’s clinical, financial, or administrative in nature.
How to Evaluate a Secure Email Provider for Healthcare
Vendor evaluation in this category tends to go one of two ways: teams either take a provider’s “HIPAA-compliant” label at face value, or they get buried in RFP questions without knowing which answers actually matter. Ask these key questiosn to focus the evaluation on what’s operationally and legally significant.
“Does the provider sign a BAA? This is the first filter, not the last. If a vendor won’t sign a BAA — or offers a heavily limited one — everything else is irrelevant. Some organizations go a step further and negotiate indemnity or make-whole clauses into the BAA itself, seeking financial protection beyond the baseline liability allocation.
What encryption methods are supported? Confirm specifically whether the provider offers TLS only, or also supports S/MIME and/or PGP for end-to-end encryption where needed. TLS-only coverage is sufficient for most standard PHI communication; organizations with cross-border data sharing or especially sensitive use cases may need E2EE options available.
Is encryption enforced or opportunistic? This is the single most important technical question to ask directly, in those terms. A vendor that describes its encryption vaguely, without distinguishing enforced from opportunistic delivery, hasn’t answered the question. Push for specifics.
How are large attachments handled? Lab results, imaging files, and clinical documents often exceed standard attachment size limits. Confirm the provider has a secure, compliant method for large file transfer that doesn’t force users onto an unencrypted workaround.
What audit logging and reporting capabilities exist? You need visibility into delivery, access, and any failed encryption attempts, not just a generic sent/received log. Ask whether logs are retained for a period consistent with your organization’s HIPAA documentation requirements.
Do they support high-volume transactional email? Appointment reminders, billing notices, and patient communications at scale require infrastructure built for volume without sacrificing per-message compliance. Confirm the provider’s platform is built for this your specific pattern, not just person-to-person messaging.
Is the platform US-based with US data residency? For many healthcare organizations, where data physically resides — and under which jurisdiction — is a material factor in vendor risk assessment, particularly for payers and larger provider organizations with strict data governance policies.”
One operational factor worth weighing alongside these questions: secure email portals — the kind that require recipients to click through to a separate web page to read a message — solve the encryption problem but often create a real adoption problem. IT teams have reported a direct conflict between phishing-awareness training and portal-based workflows: staff and patients trained not to click suspicious links in emails are, understandably, reluctant to click the “secure link” a portal email contains. This is a legitimate reason many organizations increasingly prefer platforms that enforce encryption transparently in the background — like LuxSci’s SecureLine encryption technology — rather than routing every message through a separate portal experience.
Secure Email Checklist for Healthcare Organizations
Every safeguard covered in this guide comes down to a handful of concrete, verifiable actions. Use the checklist below as a working reference for what needs to be in place across your legal agreements, technical controls, and internal processes. This is not a one-time setup task, but something worth revisiting as your email volume, vendors, and regulations evolve. Share it across your compliance and IT teams as a starting point for an internal audit.
Legal and Contractual – BAA signed with email provider and all third-party vendors handling PHI.
Encryption – Forced TLS, not opportunistic only for emails in transit and all stored data encrypted with AES-256 bit encryption.
Access and Audit – Unique user IDs, role-based access, and login monitoring with advanced MFA enabled for all email accounts; audit logs active and maintained.
People and Processes – Staff trained in PHI handling, established breach response plan, annual email security policy review.
What Should I Do Now?
Secure email isn’t a single setting you switch on — it’s a combination of enforced encryption, a signed BAA, access controls, and documented process working together. Get any one piece wrong, and the rest doesn’t hold up under an OCR audit or a breach investigation.
If your organization is still relying on opportunistic TLS, an unsigned or incomplete BAA, or a patchwork of workarounds to move PHI through email, now is the time to close that gap, especially with the proposed 2025 HIPAA Security Rule update poised to make encryption a mandatory requirement rather than an addressable one in 2027.
Below are three ways you can continue your journey to securing your healthcare email:
Email can be HIPAA compliant, but only when the right safeguards are in place — enforced encryption, a signed BAA with your email provider, access controls, audit logs, and staff training on PHI handling. Standard email without these safeguards is not compliant.
2. Do I need to sign a BAA with my email provider?
Yes. Email providers have persistent access to ePHI — even encrypted messages pass through their servers — making them Business Associates under HIPAA. A signed BAA is required. If your provider won’t sign one, you cannot legally use them to send or store PHI.
3. What is the difference between opportunistic TLS and enforced TLS — and which does HIPAA require?
Opportunistic TLS attempts encryption but falls back to plaintext if the recipient’s server doesn’t support it. Enforced TLS stops delivery rather than sending unencrypted. HIPAA’s Security Rule treats transmission encryption as an addressable specification, in practice, enforced TLS is the standard auditors and OCR expect. The proposed 2025 HIPAA Security Rule NPRM would make encryption of ePHI in transit a mandatory requirement in 2027.
4. What happens if I send PHI in an unencrypted email?
It is an impermissible disclosure under HIPAA’s Privacy Rule and triggers the Breach Notification Rule, requiring you to notify the individual and HHS/OCR within 60 days. Penalties range from $100 to $50,000 per violation. Had the email been properly encrypted, the same incident would qualify for HIPAA’s encryption safe harbor, meaning no notification required.
5. Is Gmail or Microsoft 365 HIPAA compliant for sending patient emails?
Neither is compliant in their default configuration. Both use opportunistic TLS, meaning PHI can be sent in plaintext if the recipient’s server doesn’t support encryption. A signed BAA is available on enterprise plans but doesn’t close the technical gap alone. A purpose-built HIPAA-compliant email platform is the reliable solution.
If you’ve been waiting for the final word on the new HIPAA Security Rule before you touch your email encryption strategy, you now have an official reason to keep waiting.
Our advice: Don’t do it.
What is the new HIPAA Security Rule for ePHI?
The Department of Health and Human Services’ Office for Civil Rights had targeted May 2026 for a final rule implementing the most significant update to the HIPAA Security Rule in over two decades. The proposal eliminates the “addressable” standard and makes encryption of ePHI in transit and at rest mandatory for every covered entity and business associate. That deadline came and went quietly. Now we know why: an updated federal regulatory agenda shows OCR’s timeline has moved to July 2027, with the rule-making downgraded from “final rule stage” to “long-term action.” OCR is still working through more than 4,700 public comments on the January 2025 proposal.
For an industry that had been expecting a tighter deadline, a year-plus delay is the kind of news that invites a collective exhale — and a shelved project plan. At LuxSci, we think that would be a mistake, for three reasons:
The current rule already requires you to address encryption. “Addressable” was never “optional.” It has always meant you must implement the safeguard, implement an equivalent alternative, or document in writing why neither is reasonable for your organization. Most healthcare organizations have never done that documentation rigorously, and OCR’s existing enforcement authority applies today, not in 2027.
Breach costs haven’t waited for the rule.IBM’s 2025 Cost of a Data Breach Report puts the average healthcare breach at $7.42 million, still the highest of any industry. At the same time, email remains the number one attack vector into healthcare organizations. None of that risk is paused by a regulatory delay.
Delay is not withdrawal.OCR has not signaled it’s abandoning the encryption mandate, only that it’s taking longer to finalize it. Organizations that build now toward the standard already proposed will be ahead (and more secure) regardless of exactly when, or in what final form, the rule lands. Organizations that wait risk a compressed scramble once it does.
What should healthcare IT and compliance leaders actually do with this news?
Reevaluate your ePHI security posture, recalibrate its urgency, and use the extra runway to do the job right, instead of racing against a deadline. This includes:
Getting a real inventory of where ePHI moves by email today, inbound and outbound, and where encryption is inconsistent or absent.
Closing the documentation gap on “addressable” now, while you have time to do it well rather than defensively.
Pushing your email vendor for concrete answers on encryption standards, MFA enforcement, audit logging, and breach notification — the same technical controls the proposed rule would make mandatory.
Building (or updating) a written, enforcement-ready posture: policies, vendor agreements, certifications and verifications, test results, and training records that would hold up under an OCR investigation today, not just in a future compliance deadline.
Get LuxSci’s new Definitive Guide on the new HIPAA Security Rule
From Addressable to Mandatory: Email Encryption Under the New HIPAA Security Rule provides the latest update on the rule, what it means for healthcare email encryption, and what you can do now to properly prepare for what’s coming in 2027. The guide also includes an interactive scorecard that lets you evaluate your current email set up and vendor across seven security and compliance dimensions in under two minutes, no email address required.
If you want a second set of eyes on where your organization stands, our team offers a free 30-minute compliance assessment of your current email environment against the proposed rule’s requirements.
Most healthcare organizations view email as a utility, a necessary tool for sending messages between staff, communicating with patients, sending out newsletters, connecting workflows, and so on. Historically, IT teams focused on keeping it running, security teams worried about phishing, and compliance teams made sure sensitive emails were encrypted.
Today, however, that view is rapidly becoming outdated.
Email has evolved into one of healthcare’s most critical digital infrastructure components, and also one of it’s biggest security threats. It’s a core channel for patient engagement, care coordination, revenue cycle operations, digital marketing, remote monitoring, and increasingly, AI-powered communications. The organizations that recognize this shift are building communications platforms designed for security, performance, automation, and growth. With the new HIPAA Security Rule requiring email encryption on the horizon, those companies that don’t may find themselves constrained by systems that were never intended to support modern healthcare.
Email Is No Longer Just a Messaging Tool
Healthcare organizations now depend on email to support dozens of mission-critical workflows every day.
Patients receive appointment reminders, registration instructions, imaging results, billing notifications, Explanation of Benefits (EOBs), prescription updates, preventive care reminders, patient education, and post-discharge follow-up. Marketing teams deliver personalized wellness campaigns and service line promotions. Clinical systems generate transactional notifications. Revenue cycle teams rely on secure digital communications to accelerate payments and reduce paper costs.
For many organizations, mission-critical patient communications flow through email every month.
When viewed collectively, email is more than a simple communications channel. It has become operational infrastructure with high levels of security needed and increasing compliance requirements.
The Stakes Continue to Rise
As healthcare becomes more digital, every communication carries greater business and clinical importance.
A delayed billing email may postpone payment. A failed appointment reminder can increase no-show rates. An undelivered care management message may impact patient outcomes. A misconfigured security policy can expose protected health information (PHI). Poor deliverability can undermine expensive patient engagement initiatives before they ever reach the inbox.
These are no longer isolated IT issues. Email can affect revenue, patient satisfaction, operational efficiency, compliance, and organizational reputation.
Today’s healthcare leaders require email infrastructure to provide the same reliability and visibility they demand from electronic health records, identity management systems, and other core infrastructure.
AI Is Raising the Bar Even Higher
There’s little doubt that artificial intelligence (AI) promises to transform patient communications.
Healthcare organizations everywhere are exploring AI-generated patient education, personalized outreach, intelligent scheduling, multilingual communications, and automated follow-up programs.
But AI also increases the importance of the underlying communications infrastructure.
Generating more personalized emails means little if organizations cannot:
Automatically protect PHI.
Apply consistent security policies.
Maintain complete audit trails.
Deliver messages reliably.
Integrate with EHRs, RCM and CRM platforms, and customer data platforms.
Demonstrate compliance during an audits.
In many ways, AI amplifies both the opportunities and the risks. Your email platform can help determine whether AI initiatives succeed or create new compliance and operational challenges.
Infrastructure Matters More Than Features
Healthcare buyers have traditionally evaluated email platforms based on individual features such as encryption, spam filtering, or secure portals.
Those capabilities remain important, but they no longer tell the whole story.
Today’s healthcare organizations should be evaluating communications platforms the same way they evaluate any mission-critical infrastructure.
Questions increasingly include:
Can it support both transactional and marketing communications?
Does it automatically enforce security policies without relying on user decisions?
Can it integrate with EHRs, CRM systems, CDPs, and business applications?
Will it scale during peak communication periods?
Does it provide detailed audit logging and reporting?
Can it adapt as regulatory expectations evolve?
Does it maintain high deliverability at enterprise scale?
Does it support single-tenant dedicated infrastructure for high performance and increased security?
These infrastructure characteristics often determine long-term success far more than any single feature comparison.
Email and the Future Of Secure Healthcare Communications
Healthcare is steadily moving toward a world where nearly every patient interaction is digital, personalized, and data-driven.
Healthcare leaders often ask whether they need a more secure email solution. That may be the wrong question.
The better question is whether their communications infrastructure is ready for where healthcare is headed over the next decade.
If you want talk about the future of your healthcare email infrastructure, reach out today and schedule a 30-minute assessment call with our experts.
HIPAA email archiving is the systematic process of capturing, storing, and preserving electronic communications containing Protected Health Information in compliance with federal privacy and security regulations. Healthcare organizations use archiving systems to automatically collect email messages that contain patient data, maintain them in secure storage environments, and provide controlled access for authorized users.
The archiving process ensures that patient communications remain available for clinical care, regulatory compliance, and legal discovery while protecting the confidentiality and integrity of health information throughout extended retention periods. Medical practices and healthcare systems rely on email archiving to meet documentation requirements while managing the growing volume of electronic communications.
Why HIPAA Email Archiving is Required
Healthcare organizations require HIPAA email archiving to meet federal documentation standards and state medical record preservation laws. The HIPAA Privacy Rule establishes requirements for maintaining records related to patient information management, while state regulations often mandate specific retention periods for medical communications. Email messages containing treatment discussions, care coordination details, or patient scheduling, are all part of the medical record and must be preserved according to applicable legal timeframes.
Risk mitigation drives archiving implementation as healthcare organizations face increasing litigation and regulatory scrutiny. Medical malpractice cases frequently involve examination of communication records between providers, patients, and care teams. Organizations without proper archiving systems may face discovery sanctions or inability to defend against claims when relevant communications cannot be retrieved. Email archiving provides defensible documentation that supports clinical decision-making and protects against liability exposure.
Operational continuity benefits from archived communication access when healthcare providers need historical context for patient care decisions. Archived emails can reveal previous treatment discussions, specialist recommendations, or patient preferences that inform current care plans. Quick retrieval of communication history helps avoid duplicating previous conversations and ensures care teams have complete information when making treatment decisions.
Audit preparedness is achievable through systematic email archiving that preserves communication documentation for regulatory reviews. The Office for Civil Rights and other oversight agencies may request access to communication records during HIPAA compliance investigations. Organizations with properly implemented archiving systems can respond quickly to audit requests and demonstrate their commitment to patient information protection.
How Does HIPAA Email Archiving Differ From Standard Email Backup?
Security controls within HIPAA email archiving systems exceed those found in standard backup solutions. Archiving platforms implement encryption for data at rest and in transit, role-based access controls that limit user permissions, and audit logging that tracks all system interactions. Standard email backups may lack these specialized security features needed to protect patient information according to HIPAA Security Rule requirements.
Data organization in healthcare archiving systems focuses on patient-centric indexing and retrieval capabilities. The systems can organize archived communications by patient identifiers, treatment episodes, or healthcare provider relationships. Standard backup systems store emails chronologically or by user account without the specialized indexing needed for clinical or legal searches involving patient information.
To accommodate complex healthcare documentation requirements, HIPAA archiving platforms deliver robust HIPAA email retention features. The systems can apply different retention schedules based on message content, patient age, or state regulations while maintaining legal hold capabilities for litigation. Standard backup solutions lack the policy management tools needed to handle varied retention requirements across different types of healthcare communications.
Search functionality in healthcare archiving systems includes patient privacy protections and access controls that prevent unauthorized information disclosure. Users can search for communications related to specific patients or clinical topics while the system maintains audit trails of all search activities. Standard backup search tools do not include the privacy controls and audit capabilities required for handling patient information.
Components Supporting HIPAA Email Archiving Systems
Capture mechanisms within archiving systems automatically identify and collect email communications containing patient information as they flow through healthcare email infrastructure. Journal-based capture methods create copies of all email messages at the server level, ensuring complete collection without relying on user actions. Content analysis tools can identify messages containing ePHI through keyword detection, pattern recognition, and sender/recipient analysis to ensure appropriate archiving coverage.
Storage architecture for HIPAA email archiving incorporates multiple layers of data protection and redundancy. Primary storage systems maintain active archives with fast access capabilities for recent communications, while secondary storage tiers provide cost-effective long-term preservation for older messages. Geographic replication protects against data loss from natural disasters or facility damage while maintaining compliance with data residency requirements.
Access control systems manage user permissions and authentication requirements for archived email access. Role-based permissions ensure that healthcare workers can only access communications relevant to their job functions and patient care responsibilities. Multi-factor authentication adds security layers that protect against unauthorized access attempts while maintaining usability for legitimate users.
Audit and monitoring capabilities track all interactions with archived email communications to create compliance documentation. The systems log user access attempts, search queries, message exports, and administrative actions to provide complete audit trails. Automated reporting features help healthcare organizations monitor archiving system usage and identify potential security incidents or policy violations.
How to Select HIPAA Email Archiving Solutions
Compliance certification evaluation helps healthcare organizations identify archiving vendors that understand healthcare regulatory requirements. Vendors with HITRUST CSF certification, SOC 2 Type II reports, or similar security validations demonstrate their commitment to protecting healthcare information. Business Associate Agreement willingness and terms indicate vendor readiness to accept HIPAA compliance responsibilities for archived patient data.
Scalability assessment ensures that archiving solutions can accommodate current email volumes and future growth projections. Healthcare organizations examine storage capacity, user licensing models, and system performance under peak usage conditions. The evaluation includes reviewing vendor infrastructure capabilities and support for geographic expansion or practice acquisitions that may increase archiving requirements.
Integration requirements vary based on existing healthcare IT infrastructure and workflow needs. Archiving solutions need compatibility with current email platforms, electronic health record systems, and practice management applications. API availability and integration support affect how seamlessly archived communications can be accessed from within existing clinical workflows.
Total cost analysis encompasses software licensing, implementation services, ongoing maintenance, and storage expenses over the expected system lifespan. Healthcare organizations compare subscription models, per-user pricing, and storage-based fees while considering long-term retention requirements. The analysis includes potential cost savings from reduced legal discovery expenses and improved compliance management efficiency.
Implementation Challenges
Historical data migration requires careful planning to transfer existing email communications into new archiving systems while maintaining data integrity and compliance protections. Healthcare organizations need strategies for handling legacy email formats, preserving original timestamps and metadata, and ensuring complete transfer of patient communications. The migration process must maintain security controls throughout the transition period.
User training programs need development to help healthcare staff understand archiving system functionality and their responsibilities for communication compliance. Training covers proper email practices, archiving system search capabilities, and procedures for handling legal holds or audit requests. Change management support helps staff adapt to new workflows and archiving requirements without disrupting patient care operations.
Performance optimization is highly important as archiving systems handle increasing volumes of healthcare communications. Email traffic in large healthcare systems can be substantial, requiring archiving platforms that maintain capture rates and search responsiveness under heavy loads. Organizations need monitoring tools and vendor support to optimize system configurations for their specific usage patterns.
Policy development and enforcement require clear guidelines about archived communication access, retention schedules, and disposal procedures. Healthcare organizations need policies that address who can access archived communications, under what circumstances searches are permitted, and how to handle requests for patient communication records. Enforcement mechanisms ensure that archiving policies are followed consistently across the organization.
How to Maximize Email Archiving Investment
Workflow integration maximizes archiving value by making historical communications easily accessible within existing clinical applications. Healthcare organizations can implement single sign-on authentication and embed archiving search capabilities within electronic health record systems. Integration reduces the time healthcare workers spend switching between systems while maintaining security controls for patient information access.
Advanced search capabilities help healthcare organizations extract maximum value from archived communications through sophisticated query tools and analytics. Machine learning features can identify communication patterns, flag potential compliance issues, or surface relevant historical context for current patient care decisions. Analytics capabilities provide insights into communication volumes, response times, and collaboration patterns that support quality improvement initiatives.
Legal discovery preparation benefits from archiving systems that streamline the identification and production of relevant communications during litigation. Healthcare organizations can use search and filtering tools to quickly locate communications related to specific patients, time periods, or clinical events. Export capabilities and legal hold management reduce the time and cost associated with responding to discovery requests.
Compliance monitoring automation helps healthcare organizations maintain ongoing oversight of their email archiving practices and identify potential issues before they become violations. Automated reports can track archiving coverage, identify gaps in communication capture, and monitor user access patterns for unusual activity. Proactive monitoring supports continuous improvement in archiving practices and compliance management
Effective patient engagement is increasingly becoming a top priority for many healthcare organizations – and for good reason.
First and foremost, the more a patient or customer is engaged in their healthcare journey, the better their health outcomes and quality of life. With increased communication and engagement, patients are more likely to have potential conditions diagnosed sooner, take preventative measures to prevent illnesses, and educate themselves on ways to manage and improve their health.
However, the benefits don’t end there and aren’t restricted to the patient. Engaged patients pay bills faster, are more open to new products and services, and report higher levels of satisfaction with the companies that contribute to their health and well being. For healthcare providers, payers, and suppliers, this results in higher revenue, more opportunities for growth, and the attainment of long-term organizational goals.
Digital Patient Engagement Is Easier than Ever
Fortunately, advances in technology and their rapid adoption by patients and customers (expedited by the COVID-19 pandemic) have made it easier for healthcare organizations to achieve successful digital interactions and engagement. Healthcare companies have more tools and channels than ever before to help conduct personalized engagement campaigns that meet patients on their terms, making it easier to capture their attention. Secure email takes it even further with the ability to include protected health information in messages to personalize
Despite these advancements, however, there are still several barriers that prevent healthcare companies from engaging with patients and reaping the associated benefits. Fortunately, each barrier can be overcome to help patients and customers feel more included and instrumental in their healthcare journeys.
With this in mind, this post discusses the main barriers to digital patient engagement and how to overcome them to drive better healthcare outcomes for your patients and growth for your organization.
The Main Barriers To Digital Health Engagement
The four key barriers to digital health engagement that we’ll explore in this post are as follows:
Low Health Literacy
Privacy And Security Concerns
Age And Cultural Differences
Lack Of Personalization
Let’s review each barrier in turn, while offering potential solutions that will contribute to greater digital health patient engagement for your healthcare organization.
Low Health Literacy
The first barrier to successful digital health patient engagement is your patients having insufficient health or medical knowledge. Healthcare is laden with terminology, including medical conditions, pharmaceuticals, the human anatomy, and many patients simply don’t understand enough to get more involved with their healthcare journey. Worse still, few patients will admit they don’t understand, as people are often embarrassed at their lack of knowledge.
Consequently, if your digital health patient engagement campaigns are heavy with medical jargon and lack personalization, patients won’t act on the information to drive better outcomes.
Solution: Create Educational Health Content
Develop simple educational resources for your patients that apply to their unique needs and condition. This will help them understand their state of health and make better sense of subsequent communications they’ll receive from you and their other healthcare providers.
This educational content could be in the form of periodic email newsletters, giving you a great reason to keep in touch with your patients. Alternatively, they could take the form of blog posts or articles on a patient portal, which could be supported by an email marketing campaign to let patients know about the article. In helping to increase your patients’ health literacy, you offer additional value as a healthcare provider, payer or supplier.
Additionally, keep the medical jargon in your email communications and other patient engagement channels to a minimum. Empathize with the fact that some patients won’t understand as much as others when it comes to healthcare provision and explain things as plainly as possible.
Data Privacy And Security Concerns
Unfortunately, due to its sensitivity and critical nature patient data, i.e., protected health information (PHI) is highly prized by cybercriminals. Subsequently, there have been many high-profile healthcare breaches, such as the Change Healthcare breach, in early 2024, which affected 100 million individuals, that make patients increasingly wary about sharing health-related information via email, text, or other digital communication channels.
That said, their wary attitude is the right one to adopt, but not at the expense of enhancing engagement and improving their health outcomes.
Solution: Invest In HIPAA Compliant Communication Tools
Ensure that the digital tools you use to engage with patients possess the security features required for HIPAA compliance. The Health Insurance Portability and Accountability Act (HIPAA) provides a series of guidelines that healthcare organizations must comply with to best safeguard PHI. Consequently, solutions that promote their commitment to HIPAA compliance, such as LuxSci, will understand the privacy, security, and regulatory needs of healthcare companies and have developed their tools accordingly.
Most importantly, a HIPAA compliant vendor will sign a Business Associates Agreement (BAA), the legal documentation that outlines your respective responsibilities regarding the protection of PHI. Safe in the knowledge that the patient data under your care is secure, you can concentrate your efforts on personalizing your digital communication campaigns for maximum effect.
Age And Cultural Differences
Ineffective patient engagement efforts (or a complete lack of engagement, altogether) can reinforce cliches about the use of digital tools within particular patient groups. The reality, however, is that many healthcare organizations don’t account for age differences and channel preferences in their patient engagement strategies.
Subsequently, if you only engage with patients on a single communication channel, you risk alienating others because it’s not their medium of choice.
Solution: Adopt a Multi-Channel Engagement Strategy
Instead of focusing on one communication medium, diversify your approach and adopt a multi-channel engagement strategy. This could encompass email, SMS, and phone outreach, for instance. This covers the more proverbial bases and gives you a chance to engage with patients on their preferred terms.
Lack Of Personalization
One of the main reasons that healthcare organizations fail to engage with their patients is that they adopt a “one-size-fits-all” approach, attempting to craft communications that appeal to as many people as possible. Unfortunately, this has the opposite of the desired approach, not connecting anyone in particular and engaging few patients as a result.
Solution: Personalize Your Patient Engagement Campaigns with PHI
With a HIPAA compliant solution, you can use PHI to personalize patient engagement, leveraging their health data to craft messaging that reflects their specific condition, needs, and where they are along their healthcare journey. PHI also can be used to segment patients into subgroups, grouping them by specific commonalities such as age, gender, health condition, and lifestyle factors.
Successful Digital Health Patient Engagement with LuxSci
With more than 20 years of experience in delivering secure digital healthcare communication solutions to some of the world’s leading healthcare providers, payers and suppliers, LuxSci is a trusted partner for organizations looking to boost their patient engagement efforts, while protecting patient data and remaining compliant at all times.
LuxSci’s suite of HIPAA compliant solutions include:
Secure Email:HIPAA compliant email solutions for executing highly scalable, high volume email campaigns that include PHI – millions of emails per month.
Secure Forms: Securely and efficiently collect and store ePHI without compromising security or compliance – for onboarding new patients and customers and gathering intelligence for personalization.
Secure Marketing: proactively reach your patients and customers with HIPAA compliant email marketing campaigns for increased engagement, lead generation and sales.
Secure Text Messaging: enable access to ePHI and other sensitive information directly to mobile devices via regular SMS text messages.
Interested in discovering more about LuxSci can help you upgrade your cybersecurity posture for PHI and ensure HIPAA compliance? Contact us today!
Patient engagement occurs across three levels: consultation, involvement, and partnership. These progressive levels describe how patients interact with healthcare systems and participate in their care decisions. Healthcare organizations design communication strategies, technologies, and care models to move patients through these engagement levels, ultimately improving health outcomes and patient satisfaction while reducing costs.
The Consultation Level of Patient Engagement
The consultation level marks the starting point for patient engagement in most healthcare settings. At this level, patients receive information about their health conditions and treatment options from healthcare providers. Communication flows primarily from provider to patient, with limited opportunity for patient input. Patients ask basic questions about their care but generally follow provider recommendations without substantial discussion. Healthcare organizations implement patient portals and educational materials to support information sharing at this level. Appointment reminders and basic health tracking tools help patients follow prescribed care plans. The consultation level of patient engagement meets minimum standards for informed consent but doesn’t fully utilize patient knowledge and capabilities in the care process.
The Involvement Level of Patient Engagement
As patients move to the involvement level of engagement, they become more active participants in their healthcare decisions. Providers seek patient input about preferences and priorities when developing treatment plans. Patients regularly track health metrics and report symptoms between appointments using digital tools and paper logs. Care teams establish two-way communication channels through secure messaging and follow-up calls. Patients receive education about their conditions that enables them to make more informed choices about treatment options. Healthcare organizations measure involvement through metrics like patient portal usage, appointment attendance, and treatment plan adherence. The involvement level of patient engagement creates more personalized care experiences while improving clinical outcomes through better treatment adherence and earlier problem identification.
The Partnership Level of Patient Engagement
The partnership level is the most advanced form of patient engagement, where patients function as true collaborators with their healthcare team. Patients and providers make decisions jointly, with providers offering medical expertise while respecting patient values and preferences. Care planning becomes a shared activity with mutually established goals and responsibilities. Patients access and contribute to their health records, adding context to clinical data. Healthcare organizations include patient advisors in program development and quality improvement initiatives. Technology platforms support robust data sharing between patients and providers, integrating patient-generated health data with clinical systems. The partnership level of patient engagement transforms the traditional healthcare hierarchy into a collaborative relationship that recognizes patients’ expertise about their own health experiences.
Factors Influencing Patient Engagement Levels
Several factors determine which level of patient engagement an individual can achieve at any given time. Health literacy affects patients’ ability to understand medical information and participate in decision-making. Cultural backgrounds influence expectations about patient-provider relationships and appropriate levels of involvement. Digital access and technology skills impact how effectively patients can use engagement tools. Chronic conditions often motivate higher engagement levels as patients develop expertise managing long-term health issues. Healthcare system design either facilitates or creates barriers to engagement through appointment scheduling, communication policies, and information accessibility. Provider communication styles and willingness to share decision-making power affect how comfortable patients feel increasing their engagement level.
Measuring Patient Engagement Across Levels
Healthcare organizations use various metrics to assess patient engagement at each level. Survey tools like the Patient Activation Measure (PAM) quantify patients’ knowledge, skills, and confidence in managing their health. Digital platform analytics track how patients interact with portals, mobile apps, and communication tools. Care plan adherence rates indicate how actively patients follow recommended treatments and lifestyle changes. Patient-reported outcome measures capture health improvements resulting from engagement activities. Healthcare utilization patterns often shift as engagement levels increase, with fewer emergency visits and more appropriate preventive care. These measurement approaches help organizations track progress in their patient engagement initiatives and identify areas needing improvement.
Strategies for Advancing Patient Engagement
Healthcare organizations implement targeted strategies to help patients advance through engagement levels. Communication training for clinical staff develops skills in shared decision-making and patient activation. Technology selection focuses on tools accessible to diverse patient populations with varying digital literacy. Care team redesign creates roles dedicated to patient education and self-management support. Process improvements reduce barriers to engagement by simplifying scheduling, communication, and information access. Population segmentation allows for personalised engagement approaches based on patient characteristics and needs. Incentive structures for both providers and patients reward activities that increase engagement levels. Through these strategic approaches, healthcare organizations create environments where patients can progress toward more active participation in their healthcare.
Benefits of Advancing Patient Engagement Levels
Moving patients to higher engagement levels creates substantial benefits for individuals and healthcare systems. Patients experience improved health outcomes as they become more knowledgeable and confident managing their conditions. Clinical quality measures improve through better treatment adherence and more effective care planning. Healthcare costs often decrease with reductions in unnecessary services and better chronic disease management. Patient satisfaction increases when care aligns more closely with individual preferences and priorities. Provider satisfaction improves through more productive interactions and shared responsibility for health outcomes. Healthcare organizations that successfully advance patient engagement across all three levels position themselves for success in value-based payment models that reward better outcomes and patient experiences.
Artificial intelligence (AI) has been the hottest topic in technology for the past few years now, with a focus on how it’s transforming business and the way we work. While we’d seen glimpses of AI’s capabilities before, the release of ChatGPT (containing OpenAI’s groundbreaking GPT-3.5 AI model) put the technology’s limitless potential on full display. Soon, stakeholders in every industry looked to find ways to integrate AI into their organizations, so they could harness its huge productivity and efficiency benefits.
The problem? Hackers and bad actors are using AI too, and it’s only strengthening their ability to carry out data breaches, including AI-based email security threats.
While AI brings considerable advantages to all types of businesses, unfortunately, its vast capabilities can be used for malicious purposes too. With their unparalleled ability to process data and generate content, cybercriminals can use a variety of AI tools to make their attacks more potent, increasing their potential to get past even the most secure safeguards.
With all this in mind, this post discusses how AI is helping cyber criminals massively scale their efforts and carry out more sophisticated, widespread attacks. We’ll explore how malicious actors are harnessing AI tools to make AI-based email cyber attacks more personalized, potent, and harmful, and cover three of the most common threats to email security that are being made significantly more dangerous with AI. This includes phishing, business email compromise (BEC) attacks, and malware. We’ll also offer strategic insights on how healthcare organizations can best mitigate AI-enhanced email threats and continue to safeguard the electronic protected health information (ePHI) under their care.
How Does AI Increase Threats To Email Security?
AI’s effect on email security threats warrants particular concern because it enhances them in three ways: by making email-focused attacks more scalable, sophisticated, and difficult to detect.
Scalability
First and foremost, AI tools allow cybercriminals to scale effortlessly, enabling them to achieve exponentially more in less time, with few additional resources, if any at all.
The most obvious example of the scalable capabilities of generative AI involves systems that can create new content from simple instructions, or prompts. In particular, large language models (LLMs), such as those found in widely used AI applications like ChatGPT, allow malicious actors to rapidly generate phishing email templates and similar content that can be used in social engineering attacks, with a level of accuracy in writing and grammar not seen before. Now, work that previously would take email cybercriminals hours can be achieved in mere seconds, with the ability to make near-instant improvements and produce countless variations.
Similarly, should a social engineering campaign yield results, i.e., getting a potential victim to engage, malicious actors can automate the interaction through AI-powered chatbots, which are capable of extended conversations via email. This increases the risk of a cybercriminal successfully fooling an employee at a healthcare organization to grant access to sensitive patient data or reveal their login credentials so they can breach their company’s email system.
Additionally, AI allows cybercriminals to scale their efforts by automating aspects of their actions, and gathering information about a victim, i.e., a healthcare organization before launching an attack. AI tools also can scan email systems, metadata, and publicly available information on the internet to identify vulnerable targets, and their respective security flaws. They can then use this information to pinpoint and prioritize high-value victims for future cyber attacks.
Sophistication
In addition to facilitating larger and more frequent cyber attacks, AI systems allow malicious actors to make them more convincing. As mentioned above, generative AI allows cybercriminals to create content quickly, and craft higher-quality content than they’d be capable of through their own manual efforts.
Again, using phishing as an example, AI can refine phishing emails by eliminating grammatical errors and successfully mimicking distinct communication styles to make them increasingly indistinguishable from legitimate emails. Cybercriminals are also using AI to make their fraudulent communications more context-aware, referencing recent conversations or company events and incorporating data from a variety of sources, such as social media, to increase their perceived legitimacy.
In the case of another common email attack vector, malware, AI can be used to create constantly evolving malware that can be attached to emails. This creates distinct versions of malware that are more difficult for anti-malware tools to stop.
More Difficult to Detect
This brings us to the third way in which AI tools enhance email threats: by making them harder to detect and helping them evade traditional security measures.
AI-powered email threats can adapt to a healthcare organization’s cybersecurity measures, observing how its defenses, such as spam filters, flag and block malicious activity before automatically adjusting its behavior until it successfully bypasses them.
After breaching a healthcare organization’s network, AI offers cybercriminals several new and enhanced capabilities that help them expedite the achievement of their malicious objectives, while making detection more difficult.
These include:
Content Scanning: AI tools can scan emails, both incoming and outgoing, in real-time to identify patterns pertaining to sensitive data. This allows malicious actors to identify target data in less time, making them more efficient and capable of extracting greater amounts of PHI.
Context-Aware Data Extraction: similarly, AI can differentiate between regular text and sensitive data by recognizing specific formats (e.g., medical record numbers, insurance details, social security numbers, etc.)
Stealthy Data Exfiltration: analyzing and extracting PHI, login credentials, and other sensitive data from emails, while blending into normal network traffic.
Distributed Exfiltration: instead of transferring large amounts of data at once, which is likely to trigger cyber defenses, hackers can use AI systems that slowly exfiltrate PHI in smaller payloads over time, better blending into regular network activity.
AI and Phishing
Phishing attacks involve malicious actors impersonating legitimate companies, or employees of a company, to trick victims into revealing sensitive patient data. Typical phishing attack campaigns rely on volume and trial and error. The more messages sent out by cybercriminals, the greater the chance of snaring a victim. Unfortunately, AI applications allow malicious actors to raise the efficacy of their phishing attacks in several ways.
First, AI allows scammers to craft higher-quality messaging. One of the limitations of phishing emails for healthcare companies is that they’re often easy to identify, since they are replete with mis-spelled words, poor grammar, and bad formatting. AI allows malicious actors to overcome these inadequacies and create more convincing messages that are more likely to fool healthcare employees.
On a similar note, because healthcare is a critical industry, it’s consistently under threat from cybercriminals, which are also known as advanced persistent threats (APTs) or even cyber terrorists. By definition, such malicious actors often reside outside the US and English isn’t their first language.
While, in the past, this may have been obvious, AI now provides machine translation capabilities, allowing cybercriminals to write messages in their native language, translating them to English, and refining them accordingly. Consequently, scammers can craft emails with fewer tell-tale signs that healthcare organizations can train their employees to recognize.
Additionally,as alluded to earlier, AI models can produce countless variations of phishing messages, significantly streamlining the trial-and-error aspect of phishing campaigns and allowing scammers to discover which messaging works best in far less time.
Lastly, as well as enhancing the efficacy of conventional phishing attacks, AI helps improve spear phishing campaigns, a type of fraudulent email that targets a particular organization or employee who works there, as opposed to the indiscriminate, “scatter” approach of regular phishing.
While, traditionally, spear phishing requires a lot of research, AI can scrape data from a variety of sources, such as social media, forums, and other web pages, to automate a lot of this manual effort. This then allows cybercriminals to carry out the reconnaissance required for successful attacks faster and more effectively, increasing their frequency and, subsequently, their rate of success.
AI and Business Email Compromise (BEC) Attacks
A business email compromise (BEC) is a type of targeted email attack that involves cybercriminals gaining access to or spoofing (i.e., copying) a legitimate email account to manipulate those who trust its owner into sharing sensitive data or executing fraudulent transactions. BEC attacks can be highly effective and, therefore, damaging to healthcare companies, but they typically require extensive research on the target organization to be carried out successfully. However, as with spear phishing, AI tools can drastically reduce the time it takes to identify potential targets and pinpoint possible attack vectors.
For a start, cybercriminals can use AI to undertake reconnaissance tasks in a fraction of the time required previously. This includes identifying target companies and employees whose email addresses they’d like to compromise, generating lists of vendors that do business with said organization, and even researching specific individuals who are likely to interact with the target.
Once a target is acquired, malicious actors can use AI tools in a number of terrifying ways to create more convincing messaging. By analyzing existing emails, AI solutions can quickly mimic the writing style of the owner of the compromised account, giving them a better chance of fooling the people they interact with.
By the same token, they can use information gleaned from past emails to better contextualize fraudulent messages, i.e., adding particular information to make subsequent requests more plausible. For example, requesting data or login credentials in relation to a new project or recently launched initiative.
Taking this a step further, cybercriminals could supplement a BEC attack with audio or video deepfakes created by AI to further convince victims of their legitimacy. Scammers can use audio deepfakes to leave voicemails or, if being especially brazen, conduct entire phone conversations to make their identity theft especially compelling.
Meanwhile, scammers can create video deepfakes that relay special instructions, such as transferring money, and attach them to emails. Believing the request came from a legitimate source, there’s a chance employees will comply with the request, boosting the efficacy of the BEC attack in the process. Furthermore, the less familiar an employee is with attacks of this kind, the more likely they are to fall victim to them.
In short, AI models make it easier to carry out BEC attacks, which makes it all the more likely for cybercriminals to attempt them.
AI and Malware
Malware refers to any kind of malicious software (hence, “mal(icous) (soft)ware”), such as viruses, Trojan horses, spyware, and ransomware, all of which can be enhanced by AI in several ways.
Most notable is AI’s effect on polymorphic malware, which has the ability to constantly evolve to bypass email security measures, making malicious attachments harder to detect. Malware, as with any piece of software, carries a unique digital signature that can be used to identify it and confirm its legitimacy. Anti-malware solutions traditionally use these digital signatures to flag instances of malware, but the signature of polymorphic malware changes as it evolves, allowing it to slip past email security measures.
While polymorphic malware isn’t new, and previously relied on pre-programmed techniques such as encryption and code obfuscation, AI technology has made it far more sophisticated and difficult to detect. Now, AI-powered polymorphic malware can evolve in real-time, adapting in response to the defense measures it encounters.
AI can also be used to discover Zero Day exploits, i.e., previously unknown security flaws, within email and network systems in less time. Malicious actors can employ AI-driven scanning tools to uncover vulnerabilities unknown to the software vendor at the time of its release and exploit them before they have the opportunity to release a patch.
How To Mitigate AI-Based Email Security Threats
While AI can be used to increase the effectiveness of email attacks, fortunately, the fundamentals of mitigating email threats remains the same; organizations must be more vigilant and diligent in following email security best practices and staying on top of the latest threats and tools used by cybercriminals.
Let’s explore some of the key strategies for best mitigating AI-based email threats and better safeguarding the ePHI within your organization.
Educate Your Employees: ensure your employees are aware of how AI can enhance existing email threats. More importantly, demonstrate what this looks like in a real-world setting, showing examples of AI-generated phishing and BEC emails compared to traditional messages, what a convincing deepfake looks and sounds like, instances of polymorphic malware, and so on.
Additionally, conduct regular simulations, involving AI-enhanced phishing, BEC attacks, etc., as part of your employees’ cyber threat awareness training. This gives them first-hand experience in identifying AI-driven email threats, so they’re not caught off-guard when they encounter them in real life. You can schedule these simulations to occur every few months, so your organization remains up-to-date on the latest email threat intelligence.
Enforce Strong Email Authentication Protocols: ensure that all incoming emails are authenticated using the following:
Sender Policy Framework (SPF): verifies that emails are sent from a domain’s authorized servers, helping to prevent email spoofing.
DomainKeys Identified Mail (DKIM): preserves the integrity of the message’s contents by adding a cryptographic signature, mitigating compromise during transit, e.g., stealthy or distributed data exfiltration.
Domain-based Message Authentication, Reporting & Conformance (DMARC): enforces email authentication policies, helping organizations detect and block unauthorized emails that fail SPF or DKIM checks.
By verifying sender legitimacy, preventing email spoofing, and blocking fraudulent messages, these authentication protocols are key defenses against AI-enhanced phishing and business email compromise (BEC) attacks.
Access Control: while AI increases the risk of PHI exposure and login credential compromise, the level of access that a compromised or negligent employee has to patient data is another problem entirely. Subsequently, data breaches can be mitigated by ensuring that employees only have access to the minimum amount of data required for their job roles, i.e. role-based access control (RBAC). This reduces the potential impact of a given data breach, as it lowers the chances that a malicious actor can extract large amounts of data from a sole employee.
Implement Multi-Factor Authentication (MFA): MFA provides an extra layer of protection by requiring users to verify their identity in multiple ways. So, even in the event that a cybercriminal gets ahold of an employee’s login credentials, they still won’t have sufficient means to prove they are who they claim to be.
Establish Incident Response and Recovery Plans: unfortunately, by making them more scalable, sophisticated, and harder to detect, AI increases the inevitability of security breaches. This makes it more crucial than ever to develop and maintain a comprehensive incident response plan that includes strategies for responding to AI-enhanced email security threats.
By establishing clear protocols regarding detection, reporting, containment, and recovery, your organization can effectively mitigate, or at least minimize, the impact of email-based cyber attacks enhanced by AI. Your incident response plan should be a key aspect of your employee cyber awareness training, so your workforce knows what to do in the event of a security incident.
Get Your Copy of LuxSci’s 2025 Email Cyber Threat Readiness Report
To learn more about healthcare’s ever-evolving email threat landscape and how to best ensure the security and privacy of your sensitive data, download your copy of LuxSci’s 2025 Email Cyber Threat Readiness Report.
You’ll discover:
The latest threats to email security in 2025, including AI-based attacks
The most effective strategies for strengthening your email security posture
The upcoming changes to the HIPAA Security Rule and how it will impact healthcare organizations.
