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What Are HIPAA Email Rules?

HIPAA Email Rukes

HIPAA email rules are regulatory standards established by the Department of Health and Human Services that govern how healthcare organizations handle protected health information through electronic messaging systems. These rules include privacy standards for PHI disclosure, security standards for electronic data protection, and breach notification standards for incident reporting when email communications involve unauthorized access or disclosure. Healthcare providers often struggle to understand which specific HIPAA email rules apply to their email communications and how to implement compliance measures effectively. Clear understanding of regulatory requirements helps organizations develop appropriate policies while avoiding costly violations and maintaining patient trust.

Privacy Standards for Email Communications

Use and disclosure limitations restrict how healthcare organizations can share PHI through email without patient authorization. These standards permit email communications for treatment, payment, and healthcare operations while requiring authorization for marketing, research, and other purposes. Individual control provisions give patients rights to restrict email disclosures, access email records about themselves, and request corrections to inaccurate information shared electronically. Healthcare organizations must provide clear procedures for patients to exercise these rights. Minimum necessary standards require healthcare organizations to limit email disclosures to only the PHI needed for the intended purpose. Complete medical records should not be shared via email unless the entire record is necessary for the specific communication.

Security Standards for Electronic Information Systems

Access control requirements mandate that healthcare organizations implement procedures to verify user identity before allowing access to email systems containing PHI. These procedures must include unique user identification, emergency access procedures, and automatic logoff capabilities. Audit control standards require healthcare organizations to implement hardware, software, and procedural mechanisms that record and examine access to email systems containing PHI. These controls must capture user identification, access attempts, and system activities. Integrity protections ensure that PHI transmitted through email is not improperly altered or destroyed. Healthcare organizations must implement measures to detect unauthorized changes to email content and maintain data accuracy throughout transmission and storage.

Transmission Security Requirements

Encryption implementation helps protect PHI during email transmission between healthcare organizations and external recipients. While not explicitly required, encryption serves as a reasonable protection when risk assessments indicate potential vulnerabilities in email communications. Network controls protect email infrastructure from unauthorized access and cyber threats. These controls include firewalls, intrusion detection systems, and secure network configurations that prevent attackers from intercepting email communications containing PHI. End-to-end protection measures ensure that PHI remains secure throughout the entire email communication process from sender to recipient. Healthcare organizations must evaluate their email systems to ensure adequate protection during all phases of message handling.

HIPAA Email Rules & Breach Notification Standards

Incident assessment rules require healthcare organizations to evaluate email security incidents within 60 days to determine whether they constitute breaches requiring notification. These assessments must consider the nature of PHI involved, unauthorized recipients, and actual or potential harm. Patient notification requirements mandate that healthcare organizations inform affected individuals about email breaches within 60 days of discovery. Notifications must include specific details about the breach, types of information involved, and recommendations for protective actions. Media notification obligations apply when email breaches affect 500 or more individuals in the same state or jurisdiction. Healthcare organizations must provide press releases or other media notifications to warn the public about significant breaches.

Administrative Requirements for Compliance Programs

Policy development standards require healthcare organizations to create written procedures governing email usage, PHI protection, and incident response. These policies must address all applicable HIPAA email rules and provide clear guidance for workforce members. Training obligations mandate that healthcare organizations educate workforce members about HIPAA email rules and their responsibilities for PHI protection. Training must be provided to all personnel with access to email systems and updated regularly to address new requirements.

Officer designation requirements mandate that healthcare organizations appoint privacy and security officers responsible for developing and implementing email compliance programs. These individuals must have appropriate authority and expertise to ensure regulatory compliance.

Business Associate Requirements

Contract obligations require healthcare organizations to execute business associate agreements with email service providers that access PHI. These agreements must include specific provisions about PHI protection, breach notification, and compliance monitoring.Oversight responsibilities require healthcare organizations to monitor business associate compliance with HIPAA email rules through audits, security assessments, and performance reviews. Organizations cannot rely solely on contracts without verifying actual compliance. Liability allocation between healthcare organizations and business associates depends on their respective roles in PHI protection and which party controls specific aspects of email security. Clear contractual provisions help define responsibility for different compliance obligations.

Enforcement and Penalty Provisions

Investigation procedures allow the Office for Civil Rights to review healthcare organization email practices and system configurations during compliance reviews. These investigations can include on-site visits, document reviews, and interviews with personnel. Penalty structure establishes monetary sanctions for violations of HIPAA email rules, based on factors like culpability level, violation severity, and organizational size. Penalties range from thousands to millions of dollars depending on these factors and previous compliance history. Corrective action authority allows OCR to require specific changes to email policies, training programs, or system configurations to address identified deficiencies. These requirements often include ongoing monitoring and reporting obligations.

Implementation Guidance and Best Practices

Risk assessment procedures help healthcare organizations evaluate their email systems and identify potential vulnerabilities requiring additional protections. These assessments should consider technology capabilities, usage patterns, and potential threats to PHI security. Documentation requirements ensure that healthcare organizations maintain records demonstrating compliance with HIPAA email rules including policies, training records, and incident reports. These documents support audit preparation and demonstrate good faith compliance efforts. Performance monitoring helps healthcare organizations track their compliance with email rules and identify areas needing improvement. Regular assessments should review policy effectiveness, training adequacy, and incident response capabilities.

Picture of Erik Kangas

Erik Kangas

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

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Most Popular LuxSci Blog Posts of 2025

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

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

1. Improve Email Engagement and Marketing Results with Automated Workflows

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

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

2. Healthcare Email Threat Readiness Strategies

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

Read the full post: Healthcare Email Threat Readiness Strategies

3. HIPAA Compliant Email — 20 Tips in 20 Minutes

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

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

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

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

Read the full post: Is SendGrid HIPAA-Compliant?

5. LuxSci Shines in G2 Winter 2026 Reports

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

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

Looking Ahead to 2026

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

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HIPAA compliant email

LuxSci Welcomes Angel Mazariegos as Head of Finance

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

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

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

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

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

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

HIPAA Compliant Email

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

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

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

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

Why G2 Matters

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

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

What We Earned in Winter 2026

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

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

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

Awards Reflect Our Commitment to Customer Success

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

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

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

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

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

HIPAA Compliant Email

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

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

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

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

1. The Shared Responsibility Model

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

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

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

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

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

But, it’s not that simple.

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

3. Not All Solutions or Features Are HIPAA Compliant

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

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

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

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

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

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

5. Essential Security Features Cost Extra 

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

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

6. The Importance of Staff Training on HIPAA

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

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

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

LuxSci: Fully HIPAA Compliant – No Hidden Surprises

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

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

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LuxSci vs. Zix Webroot

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

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.

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 Email

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

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

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

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

1. The Shared Responsibility Model

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

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

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

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

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

But, it’s not that simple.

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

3. Not All Solutions or Features Are HIPAA Compliant

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

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

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

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

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

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

5. Essential Security Features Cost Extra 

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

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

6. The Importance of Staff Training on HIPAA

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

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

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

LuxSci: Fully HIPAA Compliant – No Hidden Surprises

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

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

Benefits of Email Communication in Healthcare

What Are the Benefits of Email Communication in Healthcare?

The benefits of email communication in healthcare include improved patient outcomes, reduced administrative costs, enhanced care coordination, and increased patient satisfaction through convenient, secure digital messaging platforms. Healthcare organizations implementing secure email systems experience improvements in medication adherence, appointment attendance, and chronic disease management while reducing telephone call volumes and administrative workload for clinical staff. These digital communication tools enable healthcare providers to maintain continuous contact with patients between visits, provide timely responses to health concerns, and deliver personalized education and support that strengthens patient engagement in their care management.

Relationship Building

Secure email platforms enable healthcare providers to establish deeper, more meaningful relationships with their patients through consistent, documented communication that extends beyond brief office visits. Patients can express their health concerns thoughtfully in writing, providing healthcare teams with detailed symptom descriptions and treatment questions that might be forgotten or rushed during in-person appointments. The benefits of email communication in healthcare become evident when patients feel more comfortable discussing sensitive health topics through written messages rather than verbal conversations, leading to more open and honest dialogue between providers and patients.

Response time flexibility allows healthcare providers to consider patient questions carefully and provide comprehensive, thoughtful answers without the time pressures associated with telephone conversations or office visits. Providers can research complex medical questions, consult with colleagues, and provide evidence-based responses that include educational resources and detailed explanations. This measured approach to communication enables healthcare teams to deliver higher-quality information and guidance compared to quick verbal exchanges that may lack depth or clarity.

Documentation benefits create permanent records of all patient communications that can be referenced during future appointments, shared with consulting specialists, or reviewed by other healthcare team members involved in patient care. These written records eliminate miscommunication issues that can occur with telephone conversations and provide clear evidence of medical advice, treatment instructions, and patient responses to interventions. Healthcare providers can track communication patterns over time to identify patient concerns, monitor treatment adherence, and adjust care plans based on documented patient feedback and questions.

Continuity of care improves when healthcare providers can maintain consistent contact with patients regardless of schedule conflicts, geographic distance, or other barriers that might prevent in-person visits. Email communication enables providers to follow up on treatment responses, check on patient recovery progress, and provide support for chronic disease management without requiring patients to schedule separate appointments for routine check-ins.

Operational Efficiency from the Benefits of Email Communication in Healthcare

Administrative workflow optimization occurs when routine patient inquiries can be handled through secure email rather than time-consuming telephone calls that interrupt clinical activities and require immediate staff attention. Reception staff experience reduced call volumes when patients can submit prescription refill requests, appointment scheduling inquiries, and general health questions through email systems that allow for batched processing during designated times. The benefits of email communication in healthcare extend to scheduling efficiency, as patients can request appointments, receive confirmations, and make changes through automated systems that operate beyond standard business hours.

Cost savings accumulate through reduced staff time spent on telephone communications, decreased appointment scheduling overhead, and improved resource allocation for patient care activities. Healthcare organizations report time savings when routine patient communications shift from telephone calls to secure email systems. These time savings translate to increased availability for patient care activities, reduced overtime costs, and improved staff productivity across administrative and clinical functions.

Revenue optimization results from improved appointment attendance rates when patients receive email reminders and have convenient options for rescheduling conflicts before they become no-shows. Billing efficiency improves when patients can receive statements, ask billing questions, and submit payment information through secure email channels that reduce administrative processing time. Insurance verification and prior authorization communications become more streamlined when documentation can be shared electronically rather than through time-consuming telephone calls and fax transmissions.

Practice scalability benefits emerge as email communication systems can handle increasing patient volumes without proportional increases in administrative staff or telephone infrastructure. Healthcare organizations can serve larger patient populations more efficiently while maintaining high-quality communication standards through automated systems that provide consistent, documented interactions with all patients regardless of practice size or growth patterns.

Clinical Quality Improvements and Patient Safety Benefits

Care coordination enhancement enables healthcare teams to share important patient information quickly and securely between providers, specialists, and other healthcare professionals involved in patient treatment. Email communication facilitates rapid consultation between primary care providers and specialists, enabling timely treatment decisions without delays associated with telephone tag or appointment scheduling. The benefits of email communication in healthcare include improved care transitions when patients move between different providers or healthcare settings, as complete communication histories can be shared electronically to ensure continuity and prevent important information from being lost.

Medication adherence monitoring becomes more effective when patients can report side effects, ask questions about their prescriptions, and receive guidance about proper medication administration through secure email channels. Healthcare providers can identify medication compliance issues early through patient communications and provide immediate support or adjustments before problems escalate to require emergency interventions. Prescription management improves when patients can submit refill requests electronically and receive confirmations or medication changes through documented channels that create clear records of all prescription-related communications.

Patient safety enhancements result from improved communication accuracy when important medical information is documented in writing rather than communicated verbally where misunderstandings can occur. Email systems enable healthcare providers to include detailed instructions, medication dosages, and follow-up requirements that patients can reference repeatedly to ensure proper compliance with treatment plans. Laboratory results and diagnostic test findings can be communicated through secure email with accompanying explanations that help patients understand their results and next steps in their care.

Preventive care compliance increases when healthcare providers can send personalized reminders about screenings, vaccinations, and wellness visits through email systems that track patient responses and follow-up requirements. Population health management becomes more effective when healthcare organizations can communicate with entire patient groups about health promotion activities, disease prevention strategies, and community health initiatives through targeted email campaigns.

Patient Empowerment from the Benefits of Email Communication in Healthcare

Convenient communication access eliminates many barriers that prevent patients from seeking timely healthcare guidance, particularly for working adults who cannot easily make telephone calls during business hours or patients with mobility limitations that make office visits challenging. Email communication enables patients to ask health questions, report concerning symptoms, and seek medical advice when they need it most rather than waiting for appointment availability or business hours. The benefits of email communication in healthcare become particularly valuable for patients managing chronic conditions who need frequent communication with their healthcare teams but cannot visit offices regularly.

Health education delivery through email platforms enables healthcare providers to share personalized educational materials, treatment instructions, and wellness resources that patients can access repeatedly and share with family members or caregivers. Educational content can be customized based on individual patient needs, diagnoses, and health literacy levels to ensure understanding and retention. Interactive educational resources sent through email can include videos, articles, and self-assessment tools that engage patients actively in learning about their health conditions and treatment options.

Decision-making support improves when patients have time to review treatment options, research their conditions, and formulate questions through email communication rather than making quick decisions during brief office visits. Healthcare providers can share decision aids, risk assessments, and treatment comparisons through secure email that enable patients to make informed choices about their care. Family involvement becomes easier when patients can share healthcare communications with family members or caregivers who help with decision-making and treatment management.

Self-advocacy skills develop when patients learn to communicate effectively about their health concerns, ask appropriate questions, and take active roles in their healthcare management through regular email interactions with their providers. These communication skills transfer to in-person appointments where patients become more prepared, engaged, and effective advocates for their health needs.

Technology Integration and Future Healthcare Innovation

Electronic health record integration ensures that all email communications become part of comprehensive patient medical records that support clinical decision-making and care coordination across multiple providers and healthcare settings. Automated documentation capabilities eliminate manual data entry requirements while maintaining complete communication histories that meet regulatory requirements and support quality improvement initiatives. The benefits of email communication in healthcare expand when integration capabilities enable providers to access complete patient communication histories during appointments, emergency situations, or care transitions.

Artificial intelligence applications can analyze email communication patterns to identify patients at risk for non-adherence, deteriorating health conditions, or care gaps that require proactive intervention. Natural language processing technologies can help prioritize urgent patient messages, identify concerning symptoms that require immediate attention, and route communications to appropriate healthcare team members based on content analysis. Machine learning algorithms can identify communication preferences and optimize message timing and content to improve patient engagement and response rates.

Telemedicine integration creates seamless communication workflows where email consultations can transition to video appointments when interaction becomes necessary for assessment or treatment. Secure messaging platforms can schedule and coordinate virtual visits, share pre-appointment questionnaires, and provide post-visit follow-up communications that support comprehensive telehealth experiences. Remote monitoring data from wearable devices and home health equipment can be communicated through integrated email systems that alert healthcare providers to concerning changes requiring intervention.

Population health analytics utilize email communication data to identify trends, measure intervention effectiveness, and guide public health initiatives across large patient populations. Healthcare organizations can analyze communication volumes, response rates, and patient engagement patterns to optimize their outreach strategies and resource allocation for population health impact. Quality improvement programs can use email communication data to measure patient satisfaction, identify areas for service enhancement, and demonstrate the benefits of email communication in healthcare to stakeholders and accrediting organizations.

Implementation Success Factors and Best Practices

Staff training programs ensure that healthcare teams understand how to use secure email systems effectively while maintaining professional communication standards and regulatory compliance requirements. Training should cover appropriate email etiquette, privacy protection measures, and workflows for managing patient communications efficiently without compromising quality or safety. Healthcare organizations must establish clear policies about response time expectations, appropriate content for email communication, and escalation procedures for urgent patient concerns that require immediate attention rather than email responses.

Patient education initiatives help individuals understand how to use secure email systems effectively, what types of health concerns are appropriate for email communication, and what security measures protect their private health information during electronic transmission. Educational materials should cover email security practices, account protection measures, and instructions for accessing and navigating patient portal systems. Healthcare organizations implementing secure email should provide multiple training formats including written instructions, video tutorials, and in-person assistance to accommodate different learning preferences and technology comfort levels.

Security protocols must be rigorously maintained to protect patient privacy and comply with healthcare regulations governing electronic communication of protected health information. Multi-factor authentication, encryption standards, and access controls ensure that only authorized individuals can view patient communications while audit trails track all system usage for compliance monitoring. Security assessments, staff training updates, and technology upgrades maintain protection against evolving cybersecurity threats that could compromise patient information or system integrity.

Quality monitoring procedures track email communication effectiveness through patient satisfaction surveys, provider feedback, and outcome measurements that demonstrate the benefits of email communication in healthcare across different patient populations and clinical scenarios. Healthcare organizations should establish metrics for response times, patient engagement rates, and clinical outcomes associated with email communication programs to guide improvement efforts and demonstrate return on investment to organizational leadership and regulatory bodies.