What is a HIPAA Compliant Message?

HIPAA Compliant Email, HIPAA Email Marketing
Erik Kangas
September 25, 2024

A HIPAA compliant message securely transmits protected health information while meeting the Security Rule requirements for confidentiality, integrity, and availability. These messages include proper encryption during transmission, verification of recipient identity, access controls, and audit logging capabilities. Healthcare organizations must implement appropriate protections and establish usage policies governing how staff communicate protected health information to maintain compliance with HIPAA regulations.

Requirements for Secure Messaging

A HIPAA compliant message must incorporate several protections to safeguard patient information. Encryption during transmission prevents unauthorized interception of message contents while traveling between sender and recipient. Authentication mechanisms verify the identity of both senders and recipients before allowing access to message contents. Access controls restrict message viewing to authorized individuals with legitimate need for the information. Audit logging creates records of message sending, receipt, and viewing activities with timestamps and user identification. Message integrity protections prevent undetected alterations during transmission or storage. Organizations must implement these safeguards across all platforms used for sending HIPAA compliant messages, including email systems, patient portals, and secure messaging applications.

Message Content Considerations

]The content within a HIPAA compliant message must follow several guidelines to maintain regulatory compliance. Messages should include only the minimum necessary information required for the intended purpose, avoiding excessive disclosure of patient details. Identifiable patient information must be clearly separated from general communication content for proper protection. Message subjects and headers should avoid revealing protected health information that might be visible in notification previews. Disclaimers typically appear at message ends stating confidentiality requirements and instructions for unintended recipients. Healthcare organizations develop content templates that help staff compose a HIPAA compliant message with appropriate structure and security notices. Proper content structuring ensures information remains protected throughout its communication lifecycle.

Acceptable Messaging Platforms

Healthcare organizations can send HIPAA compliant messages through various platforms that meet security requirements. Secure email systems with encryption and access controls provide one common method for protected communications. Patient portal messaging offers a controlled environment where both providers and patients access information through authenticated sessions. Secure text messaging applications designed for healthcare use encrypt communications between clinical staff members. Telehealth platforms include messaging components that maintain security during virtual visits. Fax transmissions to verified numbers remain acceptable for many healthcare communications when received by authorized recipients. Regardless of platform choice, organizations must verify that protections, Business Associate Agreements, and usage policies align with HIPAA requirements for their selected communication channels.

Patient Authorization Requirements

HIPAA compliant messages containing protected health information must adhere to patient authorization requirements. Communications for treatment, payment, and healthcare operations generally proceed without specific patient permission. Messages for other purposes often require documented patient authorization before sending. Patient preferences for communication methods should be recorded and respected for all messages. Some patients may authorize unencrypted communications after being informed of the risks, though organizations should document these preferences carefully. Authorization requirements apply regardless of the security measures implemented for message transmission. Healthcare organizations must train staff to recognize which communications require patient authorization and how to properly document these permissions.

HIPAA Compliant Messaging Documentation

Healthcare organizations must maintain documentation about their HIPAA compliant messaging practices. Policies should clearly define what constitutes appropriate message content and which communication channels may be used for different information types. Procedure documents need to outline steps for sending protected information through various platforms. Training records demonstrate that staff understand proper messaging protocols and security requirements. Technology configurations for messaging systems should be documented to demonstrate appropriate security settings. Audit logs from messaging platforms provide evidence of compliance with access and monitoring requirements. This documentation helps organizations demonstrate their compliance efforts during regulatory reviews or investigations of potential violations.

Messaging Security Breach Prevention

Preventing security breaches represents a crucial aspect of maintaining HIPAA compliant messaging systems. Staff education about phishing threats and social engineering helps prevent credential theft that could lead to unauthorized message access. Message recall capabilities allow addressing accidental disclosures before they become reportable breaches. Automatic lockout after failed login attempts prevents password guessing attacks against messaging accounts. Message expiration and automatic deletion policies reduce the risk window for stored communications. Regular security assessments identify potential vulnerabilities in messaging systems before they can be exploited. Healthcare organizations combine these preventive measures with monitoring systems that detect potential messaging security incidents early, allowing rapid response before patient information becomes compromised.

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Know the Biggest Email Threats Facing Healthcare Right Now

July 16, 2025
Pete Wermter

Due to its near-universal adoption, speed, and cost-effectiveness, email remains one of the most common communication channels in healthcare. Consequently, it’s one of the most frequent targets for cyber attacks, as malicious actors are acutely aware of the vast amounts of sensitive data contained in messages – and standard email communication’s inherent vulnerabilities.

In light of this, healthcare organizations must remain aware of the evolving email threat landscape, and implement effective strategies to protect the electronic protected health information (ePHI) included in email messages. Failing to properly secure email communications jeopardizes patient data privacy, which can disrupt operations, result in costly HIPAA compliance violations, and, most importantly, compromise the quality of their patients’ healthcare provision.

With all this in mind, this post details the biggest email threats faced by healthcare organizations today, with the greatest potential to cause your business or practice harm by compromising patient and company data. You can also get our 2025 report on the latest email threats, which includes strategies on how to overcome them.

Ransomware Attacks

Ransomware is a type of malware that encrypts, corrupts, or deletes a healthcare organization’s data or critical systems, and enables the cybercriminals that deployed it to demand a payment (i.e., a ransom) for their restoration. Healthcare personnel can unwittingly download ransomware onto their devices by opening a malicious email attachment or clicking on a link contained in an email.

In recent years, ransomware has emerged as the email security threat with the most significant financial impact. In 2024, for instance, there were over 180 confirmed ransomware attacks with an average paid ransom of nearly $1 million.

Email Client Misconfiguration

While a healthcare organization may implement email security controls, many fail to know the security gaps of their current email service provider (ESP) or understand the value of a HIPAA compliant email platform, leaving data vulnerable to email threats, such as unauthorized access and ePHI exposure, and also, subsequently, a greater risk of compliance violations and reputation damage.

Common types of email misconfiguration include:

Lack of enforced TLS encryption: resulting in emails being transmitted in plaintext, rendering the patient data they contain readable by cybercriminals in the event of interception during transit.
Improper SPF/DKIM/DMARC setup: failure to configure or align these email authentication protocols correctly gives malicious actors greater latitude to successfully spoof trusted domains.
Disabled or lax user authentication: a lack of authentication measures, such as multi-factor authentication (MFA), increases the risk of unauthorized access and ePHI exposure.
Misconfigured secure email gateways: incorrect rules or filtering policies can allow phishing emails through or block legitimate messages.
Outdated or unsupported email client software: simply neglecting to download and apply the latest updates or patches from the email client’s vendor can leave vulnerabilities, which are well-known to cybercriminals, exposed to attack.

Social Engineering Attacks

A social engineering attack involves a malicious actor deceiving or convincing healthcare employees into granting unauthorized access or exposing patient data. Relying on psychological manipulation, social engineering attacks exploit a person’s trust, urgency, fear, or curiosity, and encompass an assortment of threats, including phishing and business email compromise (BEC) attacks, which are covered in greater depth below.

Phishing

As mentioned above, phishing is a type of social engineering attack, but they are so widespread that it warrants its own mention. Phishing sees malicious actors impersonating legitimate companies, or their employees, to trick victims into revealing sensitive patient data.

Subsequently, healthcare organizations can be subjected to several different types of phishing attacks, which include:

General phishing: otherwise known as bulk phishing or simply ‘phishing’, these are broad, generic attacks where emails are sent to large numbers of recipients, impersonating trusted entities to steal credentials or deliver malware.
Spear phishing: more targeted attacks that involve personalized phishing emails crafted for a specific healthcare organization or individual. These require more research on the part of malicious actors and typically use relevant insider details gleaned from their reconnaissance for additional credibility.
Whaling: a form of spear phishing that specifically targets healthcare executives or other high-level employees.
Clone phishing: when a cybercriminal duplicates a legitimate email that was previously received by the target, replacing links or attachments with malicious ones.
Credential phishing: also known as ‘pharming’, this involves emails that link to fake login pages designed to capture healthcare employees’ usernames and passwords under the guise of frequently used legitimate services.

Domain Impersonation and Spoofing

This category of threat revolves around making malicious messages appear legitimate, which can allow them to bypass basic email security checks. As alluded to above, these attacks exploit weaknesses in email client misconfigurations to trick the recipient, typically to expose and exfiltrate patient data, steal employee credentials, or distribute malware.

Domain spoofing email threats involve altering the “From” address in an email header to make it appear to be from a legitimate domain. If a healthcare organization fails to properly configure authentication protocols like SPF, DKIM, and DMARC, there’s a greater risk of their email servers failing to flag malicious messages and allowing them to land in users’ inboxes.

Domain impersonation, on the other hand, requires cybercriminals to register a domain that closely resembles a legitimate one. This may involve typosquatting, e.g., using “paypa1.com” instead of “paypal.com”. Alternatively, a hacker may utilize a homograph attack, which substitutes visually similar characters, e.g., from different character sets, such as Cyrillic. Malicious actors will then send emails from these fraudulent domains, which often have the ability to bypass basic email filters because they aren’t exact matches for blacklisted domains. Worse still, such emails can appear authentic to users, particularly if the attacker puts in the effort to accurately mimic the branding, formatting, and tone used by the legitimate entity they’re attempting to impersonate.

Insider Email Threats

In addition to external parties, employees within a healthcare organization can pose email threats to the security of its PHI. On one hand, insider threats can be intentional, involving disgruntled employees or third-party personnel abusing their access privileges to steal or corrupt patient data. Alternatively, they could be the result of mere human error or negligence, stemming from ignorance, or even fatigue.

What’s more, insider threats have been exacerbated by the rise of remote and flexible conditions since the onset of the COVID-19 pandemic, which has created more complex IT infrastructures that are more difficult to manage and control.

Business Email Compromise (BEC) Attacks

A BEC attack is a highly targeted type of social engineering attack in which cybercriminals gain access to, or copy, a legitimate email account to impersonate a known and trusted individual within an organization. BEC attacks typically require extensive research on the targeted healthcare company and rely less on malicious links or attachments, unlike phishing, which can make them difficult to detect.

Due to the high volume of emails transmitted within the healthcare industry, and the sensitive nature of PHI often included in communications to patients and between organizations, the healthcare industry is a consistent target of BEC attacks.

BEC attacks come in several forms, such as:

Account compromise: hijacking a real employee’s account and sending fraudulent messages.
Executive fraud: impersonating high-ranking personnel to request urgent financial transactions or access to sensitive data.
Invoice fraud: pretending to be a vendor asking for the payment of a fraudulent invoice into an account under their control.

Supply Chain Risk

Healthcare organizations increasingly rely on third-party vendors, including cloud service providers, software vendors, and billing or payment providers to serve their patients and customers. They constantly communicate with their supply chain partners via email, with some messages containing sensitive patient data; moreover, some of these organizations will have various levels of access to the PHI under their care.

Consequently, undetected vulnerabilities or lax security practices within your supply chain network could serve as entry points for email threats and malicious action. For instance, cybercriminals can compromise the email servers of a healthcare company’s third-party vendor or partner, and then send fraudulent emails from their domains to deploy malware or extract patient data.

Another, somewhat harrowing, way to understand supply chain risk is that while your organization may have a robust email security posture, in reality, it’s only as strong as that of your weakest third-party vendor’s security controls.

Download LuxSci’s Email Cyber Threat Readiness Report

To gain further insight into the biggest email threats to healthcare companies in 2025, including increasingly prevalent AI threats, download your copy of LuxSci’s Email Cyber Threat Readiness Report.

You’ll also learn about the upcoming changes to the HIPAA Security Rule and how it’s set to impact your organization going forward, and the most effective strategies for strengthening your email security posture.

Grab your copy of the report here and begin the journey to strengthening your company’s email threat readiness today.

What is the Best HIPAA Compliant Email?

July 10, 2025
Erik Kangas

The best HIPAA compliant email contains strong security features with ease of use and reasonable pricing. Top options include properly configured Google Workspace or Microsoft 365 accounts with Business Associate Agreements in place. Look at HIPAA compliant email platforms that offer encryption, access controls, audit logging, and secure mobile access while fitting their practice size, budget, and technical capabilities.

HIPAA Compliant Email Features

Healthcare professionals require email systems with particular security capabilities to protect client communications. Any HIPAA compliant email must include automatic encryption that works without requiring clients to create accounts or remember passwords. You need detailed access logs that document when messages were sent, received, and viewed. Message recall capabilities help address accidental disclosures before they become compliance issues. Calendar integration supports secure appointment scheduling and reminders. Mobile access controls ensure therapists can communicate safely from smartphones and tablets during off-hours or between office locations. Document sharing features allow secure exchange of intake forms and treatment plans. These capabilities help therapists maintain compliant communications while managing their practice efficiently.

Popular HIPAA Compliant Email Platforms

Several email providers offer solutions well-suited to mental health professionals. Hushmail for Healthcare includes features designed for therapists with web-based secure forms for client intake and customizable email templates. Paubox delivers encrypted email that works without requiring recipients to take extra steps, making it ideal for client communications. Virtru integrates with existing Gmail or Outlook accounts to add HIPAA compliant protections without changing email addresses. Google Workspace and Microsoft 365 provide affordable options when properly configured with appropriate security settings and covered by Business Associate Agreements. Smaller therapy practices often prefer these mainstream platforms for their familiarity and integration with other practice tools.

Security Considerations for Healthcare Communications

Secure healthcare communications require thoughtful security approaches due to their sensitive nature. HIPAA compliant email should include protections against phishing attacks that might target patient information. Data loss prevention tools identify and secure messages containing sensitive information even when users forget to enable encryption. Account recovery procedures must balance security with practicality for small practices. Multi-factor authentication prevents unauthorized access even if passwords are compromised.

For example, healthcare personnel handling substance use disorder information need email systems that comply with both HIPAA and 42 CFR Part 2 requirements. Solutions should accommodate supervision relationships where communications may need controlled sharing with supervisors.

Client Experience and Usability Factors

The best HIPAA compliant email solutions balance security with positive client experiences. Buyers should evaluate how encryption affects the client’s process for reading and responding to messages. Some solutions require clients to create accounts or install software, while others deliver protected messages that open with minimal friction. Mobile compatibility matters as many clients prefer communicating from smartphones. Branding options allow therapists to maintain professional appearance in all communications. Automated responses help set appropriate expectations about response timing and emergency protocols. Client-facing secure forms streamline intake processes while maintaining compliance.

HIPAA Compliant Email Implementation for Medical Practices

Implementing secure email requires planning tailored to medical practice workflows. Solo practitioners need solutions with straightforward setup and minimal ongoing maintenance. Group practices benefit from centralized administration that enforces consistent security policies across all therapists. Practice management integration connects secure email with scheduling, billing, and documentation systems.

Transition planning helps migrate existing communications to new secure platforms without disrupting client relationships. Documentation templates ensure compliance with both HIPAA and professional ethical standards for electronic communications. Training materials must address both technical operation and appropriate clinical use cases. When implementing HIPAA compliant email practice admins should create workflow procedures that incorporate secure communication into their practice routines.

Cost Considerations For Selecting Email Services

Healthcare providers must balance security requirements with budget realities when selecting HIPAA compliant email. Pricing models vary significantly, with some services charging per user while others offer flat-rate plans better suited to solo practitioners. Additional fees may apply for features like secure forms, extra storage, or advanced security controls. Implementation costs include time spent on configuration, training, and client education about new communication methods. Some platforms offer discounted rates for professional association members or multi-year commitments. Buyers should calculate the total cost of ownership beyond monthly subscription fees, including technical support and compliance documentation. Affordable HIPAA compliant email options exist for practices of all sizes, but require thoughtful evaluation of both immediate pricing and long-term value.

Integrating Email with Broader Practice Security

HIPAA compliant email represents one component of comprehensive practice security. Email solutions should complement electronic health record systems while maintaining appropriate boundaries between clinical documentation and communications. Device management policies ensure therapists access email securely across computers, tablets, and smartphones. Backup procedures preserve communications while maintaining security protections. Incident response planning prepares therapists for addressing potential security issues or breaches. Regular security reviews evaluate whether email practices continue to meet evolving compliance requirements. By integrating email security with broader practice safeguards, therapists create communication systems that protect client information throughout its lifecycle.

Why is High Email Deliverability Essential for Healthcare Companies?

June 30, 2025
Pete Wermter

With email communication playing a critical role in the customer engagement strategies of virtually every organization, high email deliverability rates are vital to success across all industries. In the healthcare sector, however, the stakes can be far higher. An undelivered email isn’t merely an inconvenience or a lost sales opportunity; it could mean a missed appointment, a delay in a prescription refill, or a failure to get a patient critical healthcare information. Or worse, the email could end up in the hands of an unintended recipient, including bad actors and cybercriminals.

With this in mind, this post details why high email deliverability is essential for healthcare companies, as well as how your organization benefits from reliable and rapid email delivery.

Speed and Efficiency

The primary reason that high email deliverability is crucially important to healthcare organizations is to best guarantee essential communications that directly impact an individual’s healthcare journey reach them promptly. These transactional emails can include appointment reminders, prescription renewals, product order confirmations, test results, explanation of benefits notices, payment reminders, and invoices. Administrative notifications related to software or systems that a patient might use, such as a password reset for an online portal, also fall under the category of transactional emails.

When transactional emails are delayed or fail to reach people altogether, they can compromise a patient’s ability to access care, adhere to treatment plans, stay informed on key facets of their healthcare journey, and, ultimately, achieve optimal health outcomes.

When a patient fails to receive an expected email, such as a prescription confirmation, for example, it can leave them feeling confused and unsure of what to do next. For individuals who are sick, elderly, or managing chronic conditions, this can cause unnecessary stress, anxiety, and even compromise adherence to care plans.

In contrast, high email delivery rates create the opposite effect, helping patients get the communications and information they need. This increases their trust in your company and gives them a firmer sense of control over their healthcare journey.

Compliance with HIPAA Regulations

While the above point stresses the importance of reliable email delivery for the patient’s and customer’s benefit, healthcare companies also have a vested interest in ensuring communications reach the intended recipient for regulatory and patient privacy reasons.

To comply with the Health Insurance Portability and Accountability Act (HIPAA), emails that contain sensitive patient data, i.e., electronic protected health information (ePHI), must be securely delivered to the intended recipient. If, on the other hand, a communication containing ePHI fails to reach the intended recipient patient, that represents a failure in secure communications and a potential HIPAA violation for your organization.

After all, where did the patient’s data go? Was it delivered to the wrong person? Was it blocked by a spam filter and is left sitting unencrypted on a server somewhere?

If you can’t answer these questions, you could be exposed to a data breach, and it could result in a HIPAA violation, meaning your organization incurrs the associated consequences, including financial penalties and reputational damage. Conversely, deploying a fully HIPAA compliant email solution, such as LuxSci, supported by a dedicated infrastructure and designed for high email delivery enables your organization to include patient data in communications with confidence and ensure you messages land in the recipient’s inbox.

Greater Levels of Personalization and Engagement

Finally, high email deliverability rates are essential for healthcare organizations because they help drive greater levels of engagement with patients and customers. Higher email deliverability means better inbox placement, leading to more emails being opened, more links being clicked, and more conversions for your communications and campaigns.

In the case of healthcare retailers, for example, this equates to converting more prospects into customers and, consequently, maximizing the ROI of email marketing campaigns, in some cases with up to 80% better results.

While healthcare marketers, understandably, focus most of their efforts on crafting attention-grabbing headlines, personalizing the message content, and the email’s design elements, these factors are rendered irrelevant if the message fails to reach the recipient in the first place! When you take this into account, high email deliverability is a crucial component in optimizing the ROI of email communications and campaigns, and an all too often overlooked component at that.

Get Your Copy LuxSci’s Achieving High Email Deliverability Best Practices Paper

To learn more about the importance and value of high email deliverability for healthcare companies, download your copy of LuxSci’s latest Best Practices Paper: How to Achieve High Email Deliverability in Healthcare. You’ll discover:

How to opitmize performance for the different types of healthcare emails.
Powerful strategies for increasing your company’s email deliverability rates.
How small increases in email deliverability can have considerable effects on your marketing ROI

Grab your copy of the report here, and learn how to enhance your email deliverability rates today.

Is There a HIPAA Compliant Email?

June 26, 2025
Erik Kangas

Yes, HIPAA compliant email is available through specialized platforms and services designed specifically for healthcare organizations that need to transmit protected health information securely. HIPAA compliant email solutions include encryption, access controls, audit logging, and other security features required to meet regulatory standards for protecting patient information during electronic communication. Healthcare providers, payers, and suppliers can choose from various HIPAA compliant email options that range from standalone secure messaging platforms to integrated solutions that work with existing healthcare systems. Understanding available HIPAA compliant email solutions helps organizations select appropriate tools for their communication needs while maintaining regulatory compliance and protecting patient privacy.

Types of HIPAA Compliant Email Solutions

Several categories of HIPAA compliant email solutions serve different organizational needs and technical requirements. Cloud-based secure email platforms provide hosted solutions that require minimal technical infrastructure while offering enterprise-grade security features. These platforms handle encryption, server maintenance, and security updates, allowing healthcare organizations to focus on patient care rather than email system management. On-premises HIPAA compliant email systems give organizations direct control over their email infrastructure and data storage locations. Hybrid solutions combine cloud convenience with on-premises control, allowing organizations to customize their email security approach based on specific requirements. Email encryption gateways work with existing email systems to add HIPAA compliance features without requiring complete system replacement.

Security Features in HIPAA Compliant Email Platforms

HIPAA compliant email platforms include end-to-end encryption that protects messages and attachments from unauthorized access during transmission and storage. Transport Layer Security protocols secure connections between email servers, while message-level encryption ensures that only intended recipients can read email content. Digital signatures verify sender authenticity and message integrity, preventing tampering or impersonation. Multi-factor authentication requires users to provide additional verification beyond passwords before accessing email accounts. Access controls limit which users can send emails to external recipients and which types of information can be included in different message categories. Automatic data loss prevention features scan outgoing emails for protected health information and apply appropriate security measures or block transmission of potentially sensitive content.

Business Associate Agreements and Vendor Requirements

Healthcare organizations using HIPAA compliant email services need business associate agreements with their email providers to ensure regulatory compliance. These agreements specify how email vendors will protect patient information, limit data use to authorized purposes, and report security incidents or unauthorized disclosures. Email providers operating as business associates must implement appropriate safeguards and allow healthcare organizations to audit their security practices. Vendor selection criteria should include security certifications, compliance track records, and technical capabilities that meet organizational requirements. Service level agreements define uptime expectations, support response times, and data recovery procedures. Due diligence processes help verify that email providers have appropriate security controls and compliance programs before entering into business relationships.

Implementation Challenges and Solutions

Healthcare organizations implementing HIPAA compliant email often encounter workflow disruptions as staff adapt to new security procedures and software interfaces. Training programs help users understand proper email security practices and organizational policies for handling protected health information. Change management strategies address resistance to new procedures and ensure that staff members understand the importance of email security compliance. Technical integration challenges arise when connecting HIPAA compliant email systems with existing healthcare applications and databases. Application programming interfaces enable custom integrations that streamline workflows while maintaining security standards. Migration planning addresses data transfer from legacy email systems and ensures that historical communications remain accessible when needed.

Cost Considerations for HIPAA Compliant Email

HIPAA compliant email solutions involve various cost components including software licensing, implementation services, ongoing support, and staff training expenses. Per-user subscription models allow organizations to scale email security based on their actual usage patterns. Enterprise licensing agreements may provide cost advantages for larger healthcare organizations with many email users. Hidden costs can include system integration expenses, data migration fees, and productivity losses during implementation periods. Return on investment calculations should consider potential savings from avoiding HIPAA violation penalties, reduced risk of data breaches, and improved operational efficiency from streamlined secure communication processes. Long-term cost analysis helps organizations budget appropriately for ongoing email security requirements.

Selecting the Right HIPAA Compliant Email Solution

Healthcare organizations should evaluate HIPAA compliant email options based on their specific communication patterns, technical infrastructure, and regulatory requirements. Feature comparisons help identify which platforms offer the security capabilities and integration options needed for particular use cases. Pilot testing allows organizations to evaluate user experience and system performance before making long-term commitments. Vendor demonstrations provide opportunities to assess ease of use, administrative features, and customer support quality. Reference checks with similar healthcare organizations offer insights into real-world performance and implementation experiences. Decision frameworks that consider security requirements, usability needs, and budget constraints help organizations select HIPAA compliant email solutions that will serve their long-term communication and compliance objectives effectively.

How To Overcome Email Encryption Challenges in Healthcare

April 14, 2025
Pete Wermter

Encryption is a critical security measure for protecting electronic protected health information (ePHI) included within email communications, and a key technical safeguard under the HIPAA Security Rule. However, despite its efficacy in helping protect sensitive patient data from malicious actors, encryption can be difficult to successfully implement.

Technical complexity, user resistance, and compatibility issues across different email systems can emerge as persistent problems, leading to frustration, risky workarounds, and, ultimately, increased risk of ePHI exposure and compliance violations. Without thoughtful deployment and support, encryption can become a barrier to successful secure email communication in healthcare, as opposed to a measure that underpins it.

To help you ensure secure, HIPAA compliant email communication, this post discusses the main encryption challenges you’re likely to encounter, how they can diminish your email security posture, and the measures you can take to overcome them.

What Is Email Encryption?

Before we discuss the most frequent email encryption challenges faced by healthcare organizations, here’s a quick refresher on what email encryption is and why it’s so important for securing sensitive patient data.

Email encryption is the process of scrambling the content of a message to make it unreadable as it’s sent to recipients or stored in a database. Only the intended recipient, who has the encryption key, can decrypt the email and access the data within.

Consequently, in the event an encrypted message is intercepted by malicious actors in transit or exfiltrated from a data store during a security breach, they won’t be able to make sense of it. This renders any ePHI included in the message unintelligible and, therefore, worthless, adding another layer of security that preserves patient privacy – and keeps your business safe.

Common Email Encryption Challenges

Let’s move on to detailing some of the most frequent encryption challenges that must be overcome by healthcare organizations to ensure secure email communication and HIPAA compliance.

Decrypting Messages Is Too Difficult

The more difficult or drawn out it is for recipients to decrypt their email messages, the more likely they’ll simply go unread or end up deleted. If the decryption process is too cumbersome, which could include requiring a user to log into a separate site (i.e., a web portal), verify their identity multiple times, create a new account, or install additional software, it adds complexity. This can drive users to seek workarounds or cut corners, such as having information sent to them through unsecured channels, which puts your company at risk.

Similarly, email clients, browsers, and security settings may impact the decryption process, causing compatibility issues that prevent users from accessing their messages. Within a healthcare setting, where timely communication is crucial, such obstacles can disrupt workflows, slow down patient care, and lead to HIPAA compliance violations if users resort to unencrypted alternatives.

Encryption that Requires Manual Intervention

Some email encryption tools require users to manually encrypt messages. If users forget to apply encryption or misconfigure settings, sensitive patient data could be exposed, leading to compliance violations and ePHI exfiltration.

For employees who handle ePHI and need to send encrypted emails, remembering to enable encryption (vs. automated encryption) is an extra step that introduces the risk of human error into the process. To offer a related, and more relatable, example: how many times have you forgotten to include an attachment when sending an email, even when referencing the attachment in the message? It’s all too easily done. In the same way, an inexperienced, tired, or distracted user could simply neglect to turn on or correctly configure encryption before sending an email, putting patient data at risk.

Increased IT and Administrative Overhead

The two email encryption challenges outlined above contribute to a third overarching difficulty for healthcare organizations: an increased workload for its IT, security and operations teams.

First of all, IT, security and operations must establish and continuously enforce encryption policies, configuring rules that ensure sensitive patient data is encrypted while non-sensitive, business communication continues to flow unobstructed. Misconfigured policies can cause over-encryption, resulting in user inaccessibility and disruptions, or under-encryption, leading to exposure of ePHI and HIPAA compliance violations.

Second, IT support teams must troubleshoot user issues: namely employees and external recipients who are unfamiliar with encryption protocols and need support in overcoming difficulties in message decryption. These could be caused by compatibility issues between different email clients or systems, expired or missing digital certificates, incorrect key exchanges, or confusion surrounding accessing encrypted messages through portals or attachments.

Lastly, IT and governance teams must keep up-to-date with changing regulatory updates and email security threats. As compliance requirements evolve, healthcare organizations must reassess encryption standards, upgrade outdated protocols, and ensure that their workforce adheres to best practices. Without an adequate strategy and the right systems in place, managing encryption can become a constant drain on IT bandwidth, taking personnel away from other aspects of their work that contribute to patient care.

Effective Strategies For Email Encryption

Having discussed the most common encryption challenges and how they can impact a company’s email security posture, let’s look at some of the most powerful mitigation strategies, which will improve the email encryption experience for both senders and recipients.

Balance Security With Ease of Use

To overcome the challenges of user inaccessibility, human error, and excessive administrative overhead, healthcare organizations must balance the ease of use of their encryption solutions with the level of security they provide.

While opting for the most secure encryption protocols intuitively seems like the best option, extra security often comes at the expense of usability, which can render the encryption irrelevant if users decide to circumvent it altogether, as outlined earlier. Instead, it’s essential to evaluate the sensitivity of message content and select a corresponding level of encryption.

Moving onto practical technical examples, Transport Layer Security (TLS) is a widely used email encryption standard, thanks to its ease of implementation and use, i.e., once activated, no further action is required by the user to encrypt the message content. However, TLS only encrypts ePHI in transit, i.e., when being sent to recipients, which may prove insufficient for highly sensitive patient data.

In contrast, encryption protocols such as Secure/Multipurpose Internet Mail Extensions (S/MIME), AES-256 and Pretty Good Privacy (PGP) provide more comprehensive encryption, safeguarding the ePHI contained in email communications both in transit and at rest, i.e., when stored in a database. Now, while this makes them more effective at securing patient data and achieving HIPAA compliance, these standards are more complicated to implement and to use than TLS encryption.

S/MIME requires users to obtain and install digital certificates from a Certificate Authority (CA), which verifies their respective identities and provides the public key for encryption. Consequently, both the sender and recipient must have valid certificates; if either party’s certificate is revoked or expires, they won’t be able to encrypt or decrypt the message, respectively.

With PGP, meanwhile, users must manually generate and exchange public/private keys. This offers greater flexibility than S/MIME but requires careful key management, which can be confusing for non-technical users. If a recipient doesn’t have the sender’s public key, they won’t be able to decrypt the message. Additionally, both S/MIME and PGP require a public key infrastructure (PKI), which can add considerable administrative overhead, particularly in regards to the management of certificates, public keys, and user credentials.

Accounting for this, healthcare organizations can balance security with accessibility by employing a tiered encryption strategy: using TLS for lower-risk communication while opting for S/MIME or PGP for more sensitive communications.

Enable Automatic Encryption

Subsequently, the challenge of balancing security with accessibility can be remediated by deploying an email delivery platform that not only removes the need for manual user intervention but also automatically applies the appropriate encryption standard based on message content and delivery conditions. Rather than relying on users to choose the correct method—or worse, bypass encryption altogether—modern email solutions like LuxSci can intelligently enforce encryption without affecting the user experience.

Many healthcare companies rely on TLS encryption because it eliminates the need for encryption keys or certificates, additional log-ins, etc. For this reason, it’s often referred to as ‘invisible encryption’ for its lack of effect on the user experience.

However, to be most effective, both the sender’s and recipient’s email servers must support enforced TLS (i.e., TLS 1.2 and above). In the event the recipient’s email server doesn’t support TLS, the email message will be delivered unencrypted or fail to send altogether, depending on the server configurations. Additionally, once the email is delivered to the recipient’s inbox, unless the recipient’s email infrastructure encrypts messages at rest, it will be stored in an unencrypted format.

Consequently, while TLS is ideal for email messaging that doesn’t contain highly sensitive ePHI, it’s insufficient for all healthcare communication. To ensure the secure and HIPAA compliant inclusion of patient data in emails, healthcare organizations should opt for an email solution that supports automated, policy-based encryption, which can upgrade to S/MIME or PGP when necessary. This offers the combined benefits of optimal ePHI security, minimal administrative burden, and removing the need for staff intervention.

Invest in Employee Education

While a flexible encryption policy and deploying email solutions that support automation will go a long way towards overcoming email encryption challenges, these efforts can still be undermined if users aren’t sufficiently educated on their benefits and use. For this reason, it’s crucial that healthcare companies take the time to educate their employees on both the how and why of email encryption.

Even the most advanced encryption systems can fail if employees don’t understand how to use them properly, as well as what to look out for in their day-to-day email use. Some aspects of email encryption, such as recognizing secure message formats or troubleshooting delivery issues, may still require user awareness. With this in mind, employee training programs should focus on recognizing when additional encryption measures are necessary, how to ask for assistance, the dangers of unsecured channels, and how to report suspicious activity in addition to the practical aspects of using your email delivery platform.

Overcome Email Encryption Challenges with LuxSci

LuxSci is a leader in secure healthcare communication, offering HIPAA compliant solutions that empower organizations to connect with patients securely and effectively. With over 20 years of expertise, we’ve facilitated the delivery of billions of encrypted emails for healthcare providers, payers, and suppliers.

Luxsci’s proprietary SecureLine encryption technology is specially designed to help healthcare organizations overcome frequent encryption challenges and better ensure HIPAA compliance with powerful, flexible encryption capabilities. Its features include:

Comprehensive email encryption: ensuring the encryption of patient data in transit and at rest.
Automated encryption: “set it and forget it” email encryption guarantees security and HIPAA compliance – with no action required on the part of users once configured.
Flexible encryption: dynamically determining the optimal level of email encryption, as per the recipient’s security posture, job role and supported encryption methods. This makes sure messages are delivered securely while maintaining HIPAA compliance.

Ready to take your healthcare email engagement to the next level? Contact LuxSci today!

Is Outlook a HIPAA Compliant Email?

September 30, 2024
Erik Kangas

Outlook can be HIPAA compliant email when properly configured within Microsoft 365 (formerly Office 365) and covered by a Business Associate Agreement with Microsoft. Standard consumer Outlook.com accounts do not meet HIPAA requirements for protecting patient information. Healthcare organizations must implement security settings, create robust email policies, and train staff on proper handling of patient information to maintain HIPAA compliant email communications through Outlook.

Microsoft 365 Business Associate Agreement

Healthcare organizations cannot use standard Outlook.com accounts for communicating protected health information. Only Outlook within Microsoft 365 qualifies for HIPAA compliant email usage with proper configuration. Microsoft offers Business Associate Agreements for Microsoft 365 customers, establishing Microsoft’s responsibilities for protecting healthcare information under HIPAA regulations. This agreement specifically includes Outlook among covered services. Organizations must execute this BAA before storing or transmitting any protected health information through Outlook. The agreement details security responsibilities, breach notification procedures, and other HIPAA compliance requirements. Personal “Outlook.com” accounts operate under different terms of service that don’t address healthcare data protection, making them unsuitable for clinical communications.

Required Security Configurations

Making Outlook HIPAA compliant email requires enabling several security features available in Microsoft 365 admin controls. Multi-factor authentication verifies user identities beyond password checks for stronger account protection. Message encryption settings ensure patient data stays secure during transmission. Data loss prevention rules identify emails containing health information and apply appropriate protection policies automatically. Archive and retention policies maintain records according to regulatory requirements. Audit logging tracks email access, sending, and receiving activities. Organizations configure these settings through the Microsoft 365 admin center rather than relying on default settings. When properly implemented, these security measures change standard Outlook into a platform suitable for healthcare communications.

HIPAA Compliant Email Content Protection Features

Microsoft 365 includes several Outlook features specifically designed to protect sensitive information in emails. Message encryption allows sending protected content to recipients inside or outside the organization. Information Rights Management prevents forwarding, copying, or printing of sensitive emails. Sensitivity labels classify messages based on content type and apply appropriate protections. Data loss prevention policies scan outgoing messages for patient information patterns and can block transmissions that violate security rules. S/MIME capabilities provide further encryption and digital signatures to verify message authenticity. Transport rules can apply protection automatically based on message content or recipients. Healthcare organizations use these protection features to maintain HIPAA compliant email practices while allowing necessary communications.

Mobile Access Security

Healthcare staff frequently access email through mobile devices, creating additional compliance considerations. Organizations using Outlook for HIPAA compliant email must address mobile access security. Mobile application management policies control how Outlook functions on smartphones and tablets. Conditional access rules limit email retrieval to approved devices with proper security configurations. App protection policies prevent copying patient information between Outlook and unauthorized applications. Remote wipe capabilities allow removing email data from lost or stolen devices. Organizations develop clear guidelines about which devices may access protected information through Outlook mobile apps. Balancing convenience with security requires thoughtful policies that address how modern healthcare professionals communicate.

Retention and Archive Management

HIPAA compliant email through Outlook includes proper retention and archiving of messages containing protected health information. Microsoft 365 retention policies allow organizations to preserve emails for required time periods while preventing premature deletion. Legal hold features maintain emails relevant to investigations or litigation regardless of user deletion attempts. eDiscovery tools help locate specific messages when needed for compliance verification or patient care. Archive mailboxes store older messages while maintaining appropriate security and search capabilities. Organizations establish retention schedules based on message content types and regulatory requirements. Proper archiving practices help healthcare entities demonstrate compliance while maintaining access to historical communications when needed.

HIPAA Compliant Email Staff Training

Technical controls alone cannot ensure Outlook functions as HIPAA compliant email without proper user behavior. Organizations develop comprehensive training programs covering appropriate email usage for healthcare information. Staff learn to recognize what constitutes protected health information and when it requires secure handling. Usage guidelines explain when Outlook encryption should be activated and how to verify message security before sending. Outlook configuration guides help users understand security feature operation. Organizations document that staff have completed training and understand email policies. Periodic refreshers address changing regulations and emerging security threats. With clear guidelines and regular education, healthcare staff learn to use Outlook appropriately for patient communications while maintaining compliance with HIPAA regulations.

What are the Infrastructure Requirements For HIPAA Compliant Email?

April 3, 2025
Pete Wermter

Healthcare providers, payers, and suppliers increasingly rely on email communication for a wide variety of purposes pertaining to their patients’ and customer’s healthcare journeys. However, ensuring email messaging is both effective and HIPAA compliant requires the right infrastructure, including dedicated environments, high throughput and low latency, end-to-end encryption, scalability and compliance monitoring.

The Health Insurance Portability and Accountability Act’s (HIPAA) regulations mandate a series of data security and privacy requirements to safeguard the electronic protected health information (ePHI) contained in emails, which is a good place to start. At the same time, however, healthcare organizations must also consider deliverability best practices to ensure their messages successfully reach the intended recipients.

With all this in mind, this post discusses the infrastructure requirements for HIPAA compliant email. We’ll explore the differences between transactional and marketing emails, as well as infrastructure and compliance considerations for each.

What Are Transactional Emails?

Transactional emails are messages that correspond to a previous interaction between a healthcare organization and an individual. A patient or customer will trigger the delivery of a transactional email by taking a specific action – with the transaction email being confirmation of the action.

Examples of transactional emails include:

Explanation of Benefits
Billing statements
Invoices
Appointment confirmations and reminders
Order updates and shipping notifications
Password resets and security notifications
Plan renewal confirmation
Payment failure notifications
In-home care communications

Healthcare companies can also use transactional emails to communicate relevant instructions, next steps, or follow-up actions.

What Are Marketing Emails?

Marketing emails contain content designed to influence the recipient into taking a particular action, usch as ordering a new product or sign up for a new service. Subsequently, they often contain informational materials intended to educate the individual so they can make a more informed decision.

Examples of marketing emails include:

New product or service launches
Promotional offers
Loyalty reward notifications
Customer reviews and testimonials
Educational materials or campaigns
Preventative care outreach
Event Invitations
Re-engagement messages (e.g., “We Miss You!..”)

With the proper data safeguards and the effective use of ePHI, marketing emails can be personalized to be made more relevant to the recipient. This then allows patients or customers to be segmented into subgroups according to particular commonalities, e.g., age, gender, lifestyle factors, medical conditions, etc.

Opt-in Rules for HIPAA-Compliant Email Communication

One significant difference between marketing and transactional emails is that recipients must explicitly opt-in to receive marketing emails.

HIPAA requires explicit patient consent for marketing emails if they contain ePHI, requiring individuals to opt-in to receive email marketing communications from a healthcare organization. Neglecting to allow people to opt-in to your marketing communications leaves your company open to the consequences of HIPAA non-compliance, which include financial penalties and reputational damage.

Conversely, healthcare organizations aren’t required to obtain opt-ins to send transactional emails, but these communications are still subject to other HIPAA regulations, such as encryption and audit logging.

Additionally, marketing emails must comply with the CAN-SPAM Act: US legislation that governs commercial email communication and protects individuals from deceptive sales and marketing practices. The CAN-SPAM Act requires healthcare organizations to provide an opt-out mechanism in the event they no longer wish to receive marketing emails. Subsequently, you must always allow individuals to opt out of marketing emails to stay compliant.

Email Infrastructure Requirements For HIPPA-Compliance

As the vast majority of healthcare organizations need to send marketing and transactional emails, they must have the appropriate infrastructure to facilitate the optimal delivery of both types of emails. Consequently, for HIPAA compliant email, they need to establish the appropriate infrastructure configurations for each, according to their differing purposes, sending patterns, and compliance considerations.

Let’s look at the infrastructure requirements for each email type in turn, before looking at considerations that pertain to both types of email.

Key Transactional Email Infrastructure Considerations

Transactional emails are sent to a sole patient or customer, with the information therein only intended for that specific individual. Additionally, they can be highly time-sensitive: for example, a password reset or similar emails related to logins and service use must be immediate, while order confirmations need to be delivered ASAP to reassure clients of a company’s reliability and trustworthiness.

Accounting for this, the infrastructure requirements for transactional emails include:

High Speed and Low Latency: servers that are optimized for high IOPS (input/output operations per second) and minimal processing delays to ensure near-instant delivery
Dedicated IPs: this helps healthcare companies maintain a strong sender reputation to avoid blacklisting, being labelled as spam, etc. This is crucial for reliable, fast delivery.
High Availability and Redundancy: this includes load balancers, failover servers, and geographically distributed data centers to ensure comprehensive disaster recovery and more robust business continuity protocols.

Key Marketing Email Infrastructure Considerations

In contrast to transactional messages, marketing emails must often be sent out in high volumes, which could be as many as hundreds of thousands or millions per month. As a result, marketing email campaigns have different computational demands, i.e., CPU and storage, than transactional messages intended for a single person.

Subsequently, the infrastructure requirements for marketing emails include:

High Volume and Scalability: marketing messages require a larger throughput to facilitate the bulk delivery of email. Additionally, servers should scale easily to accommodate increasingly larger campaigns without suffering bottlenecks.
Queueing and Throttling: marketing email infrastructure must prevent sending surges that could trigger spam filters or overload recipient servers, which often results in blacklisting.
Dedicated vs. Shared Infrastructure: it’s important to consider whether to opt for private versus shared infrastructure, depending on the size of your organization and the scale of your campaigns. Large senders often use dedicated IPs for better control, while smaller companies or campaigns might use shared pools with strict sender reputation management.

Key Infrastructure Considerations for Both Types of Email

Lastly, there are infrastructure requirements that apply to both types of email that will help facilitate their fast and reliable delivery, respectively. These include:

Separate Infrastructure: consider hosting your transactional and marketing emails on separate servers. This benefits transactional emails in particular, as there are several factors inherent to marketing email campaigns, such as bounced emails and being flagged as spam, that affect an email IP’s reputation. Separate infrastructure maintains the integrity of a healthcare company’s IP address for transactional emails, ensuring they are delivered unimpeded.
Encryption: the ePHI in all email communications must be encrypted in transit, i.e., when sent to individuals, and at rest, i.e., when stored in a database. This helps safeguard the patient data within the message, regardless of its nature.
HIPAA Compliance Monitoring: remaining aware of what ePHI is included in email communications. This keeps data exposure to a minimum and mitigates the unintentional inclusion of patient data in email communications.
Logging and Auditing: this not only allows you to track email activity, but you also can measure the efficacy of your email communications, who accessed ePHI, and what they did with it. This is an essential part of HIPAA compliance and will be subject to tighter regulation when the updates to HIPAA’s Security Rule come into effect in late 2025.

HIPAA-Complaint Email Solutions From LuxSci

LuxSci offers HIPAA compliant email solutions designed to optimize the reliability and deliverability of both transactional and marketing emails.

LuxSci’s Secure High Volume Email solution offers:

Dedicated, high-performance infrastructure to ensure fast and reliable delivery.
Scalable infrastructure for high-volume email campaigns, ensuring reliability even as sent emails venture into the hundreds of thousands or millions.
Dedicated IPs and reputation management tools to prevent blacklisting and deliverability issues.
Logging, tracking, and audit trails for HIPAA compliance and security monitoring.

LuxSci’s Secure Email Marketing platform provides:

Hypersegmentation for personalized patient and customer engagement.
Detailed tracking and reporting capabilities for performance monitoring and compliance auditing.
Automated campaign scheduling for reduced administrative overhead.
Opt-in and list management tools to ensure compliance with HIPAA and CAN-SPAM.

Discover how our solutions can meet your evolving email infrastructure requirements today.

What Are HIPAA Email Laws?

June 5, 2025
Erik Kangas

HIPAA email laws are federal privacy and security regulations that govern how healthcare organizations handle Protected Health Information (PHI) in electronic communications. The HIPAA Privacy Rule and Security Rule establish requirements for protecting patient information when transmitted via email, including encryption standards, access controls, and audit procedures. Healthcare organizations must implement appropriate safeguards to prevent unauthorized disclosure of patient information through email communications while maintaining compliance with federal regulations. Email communication in healthcare requires careful attention to privacy laws that protect patient confidentiality. Understanding HIPAA email laws helps healthcare organizations communicate effectively while avoiding violations and penalties.

How Do HIPAA Email Laws Protect Patient Information?

Patient information receives protection through strict limitations on email usage and disclosure requirements under federal privacy regulations. Healthcare organizations cannot freely share patient data via email without implementing security measures that prevent unauthorized access or interception. HIPAA email laws require covered entities to assess risks associated with email communications and implement safeguards appropriate to their operational environment. Encryption requirements form a cornerstone of email protection under HIPAA regulations, though the Security Rule treats encryption as an addressable specification rather than a mandatory requirement. Organizations must evaluate whether encryption is reasonable and appropriate for their email communications containing patient information. Most healthcare organizations implement email encryption to protect against data breaches and demonstrate compliance with federal security standards. Access control provisions limit who can send, receive, or access emails containing patient information within healthcare organizations. Staff members need unique user credentials and role-based permissions that restrict email access to information necessary for their job functions. Automatic logoff features prevent unauthorized access when devices are left unattended. Audit requirements mandate that healthcare organizations monitor and log email system activity to track potential security incidents or privacy violations. HIPAA email laws require documentation of who accessed patient information, when access occurred, and what actions were performed. Organizations must maintain these audit logs and review them for suspicious activity or compliance gaps.

What Email Practices Violate HIPAA Laws?

Sending unencrypted emails containing patient information to external recipients violates HIPAA security standards in most circumstances. Healthcare organizations cannot email lab results, treatment summaries, or other PHI to patients using standard email without encryption protection. External communications require additional security measures to prevent unauthorized interception during transmission. Using personal email accounts for work-related patient communications creates multiple compliance violations under HIPAA regulations. Healthcare workers cannot forward patient information to personal Gmail, Yahoo, or other consumer email accounts that lack appropriate security controls. Personal email usage also creates challenges for audit logging and organizational oversight of patient information handling. Sharing patient information with unauthorized recipients through email represents a serious privacy violation that can result in substantial penalties. Staff members cannot email patient details to family members, colleagues outside the care team, or external parties without proper authorization. Accidental disclosure through incorrect email addresses or reply-all mistakes can also constitute HIPAA violations. Inadequate access controls that allow broad email system access violate HIPAA requirements for limiting PHI exposure to minimum necessary levels. Organizations cannot provide all staff members with access to patient email communications regardless of their job responsibilities. Role-based restrictions must limit email access to information required for specific work functions.

How Can Healthcare Organizations Comply With HIPAA Email Laws?

Risk assessment procedures help healthcare organizations evaluate their email systems and identify compliance gaps that need attention. Organizations examine current email practices, security controls, and staff training to determine where improvements are needed. The assessment process guides development of policies and procedures that address specific risks identified within the organization’s email environment. Staff education programs ensure that healthcare workers understand their responsibilities under HIPAA email laws and know how to handle patient information appropriately. Training covers email security best practices, encryption requirements, and procedures for reporting potential violations.

Healthcare organizations need ongoing education to keep staff current with evolving regulations and technology changes. Technology implementation supports compliance through automated security features that protect patient information without requiring constant user intervention. Healthcare organizations can deploy email encryption systems, data loss prevention tools, and access management platforms that enforce HIPAA email laws. Automated systems reduce reliance on staff compliance and provide consistent protection for patient communications. Policy enforcement mechanisms ensure that HIPAA email laws are followed consistently across healthcare organizations. Clear policies define acceptable email practices, specify security requirements, and outline consequences for violations. Organizations need monitoring procedures to verify policy compliance and corrective action processes to address violations when they occur.