What is a HIPAA Compliant Workspace?

HIPAA Email Marketing
Erik Kangas
December 4, 2024

A HIPAA compliant workspace combines physical, technical, and administrative precautions that protect patient information in healthcare environments. These workspaces include secure physical areas, configured computers and devices, appropriate access controls, and staff trained on privacy practices. Healthcare organizations implement these measures to maintain patient confidentiality while allowing employees to perform necessary work functions in accordance with HIPAA Privacy and Security Rules.

Physical Workspace Requirements

Healthcare organizations design physical workspaces to prevent unauthorized access to patient information. Office layouts position computer screens away from public view to prevent visual exposure of records. Secure areas with badge access or keypad entry restrict unauthorized personnel from entering spaces where protected health information is handled. Document storage includes locked cabinets for paper records when not in use. Clean desk policies ensure sensitive information isn’t left visible when workstations are unattended. Privacy screens on monitors prevent visual access from side angles in shared work environments. These physical controls work together to create the foundation for information privacy.

Technical Elements of a HIPAA Compliant Workspace

Computer systems in HIPAA compliant workspaces include security measures that protect electronic health information. Workstations require secure login procedures, with multi-factor authentication for accessing patient records. Automatic screen locking activates after short periods of inactivity. Encryption protects data stored on local devices and information transmitted across networks. Software includes current security patches and antivirus protection. Printers and fax machines receiving patient information reside in secure areas with output collection procedures. Organizations should implement standardized configurations across all workstations to maintain consistent security controls.

Administrative Controls and Policies

Policies guide how staff interact with protected health information in workspace environments. Authorization procedures determine which employees can access specific types of patient information based on job responsibilities. Training programs ensure staff understand privacy requirements and proper handling of health information. Workspace monitoring may include periodic walk-throughs to identify potential privacy issues. Document disposal procedures include shredding for paper records and secure deletion for electronic files. Healthcare entities should always document these administrative controls as part of their overall HIPAA compliance program.

Remote Work Considerations

Remote workspaces require extra considerations to maintain a HIPAA compliant workspace outside of traditional office environments. Home office setups need privacy measures to prevent family members from viewing patient information. Virtual private networks (VPNs) can create secure connections to healthcare systems when working remotely. Organizations often restrict downloading patient information to personal devices. Video conferencing tools for healthcare discussions must include appropriate security features. Remote work policies typically define acceptable work locations and security requirements. These measures help maintain compliance as healthcare work extends beyond traditional facilities.

Mobile Device Management

Mobile devices in HIPAA compliant workspaces require specific security controls. Smartphones and tablets accessing health information need encryption, passcode protection, and remote wiping capabilities. Mobile device management solutions help organizations enforce security policies on both organization-owned and personal devices used for work. Application controls limit which programs can access or store patient information. Policies typically address device usage in public settings to prevent unauthorized viewing.

Workspace Compliance Documentation

Healthcare organizations maintain documentation about their workspace security measures. Facility security plans outline physical safeguards and access restrictions. System security documentation describes technical controls for workstations and networks. Training records demonstrate that staff receive appropriate privacy instructions and education. Risk assessment reports identify potential workspace vulnerabilities and mitigation strategies. These documents show HIPAA compliant workspace efforts during audits or regulatory reviews. Regular updates are critical to keep documentation current as workspace environments and security requirements evolve.

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Understanding Business Associate Agreements (BAAs) and Shared Responsibility

September 9, 2025
Pete Wermter

Modern-day healthcare organizations rely on a growing array of partners and vendors to provide them with the tools they need to effectively serve patients and customers.

However, while new digital solutions and healthcare ecosystems often result in greater productivity and efficiency, they also increase the number of third parties a company must communicate with and share protected health information (PHI), requiring a business associate agreement (BAA). Unfortunately, this increases the risk of PHI being exposed, as it increases a healthcare organization’s supply chain network and the number of external organizations with access to their data, significantly raising the risk of a security breach.

This is where the concept of shared responsibility comes in.

In this article, we explore the shared responsibility model for data security, explaining the concept, the role of a BAA in shared responsibility, and why healthcare companies need to know how it works and where it factors into their HIPAA compliance efforts.

What Is The Shared Responsibility Model?

Shared responsibility is a core data security principle that divides the responsibility for protecting data between a company that collects the data and a vendor that supplies the infrastructure or systems used to process said data.

The shared responsibility model grew in prominence as more companies moved to cloud-based environments and applications. In the past, when companies kept their systems and data onsite, they had more control over who could access their data and, subsequently, a better ability to mitigate data security risks.

However, in adopting cloud-based infrastructure and applications, companies have to process and store their data in the cloud – often in shared infrastructure with other vendors using the same cloud – which consequently shifts some of the responsibility of information security to the cloud service provider (CSP) itself. This marked a profound shift in the way data was handled, transmitted, and stored – necessitating an evolved approach to data security.

This fundamental shift in the way companies consume infrastructure and use apps ushered in the shared responsibility model: Where the cloud vendor provides the infrastructure or application, including HIPAA compliant and high secure environments, but it’s still the responsibility of the client to configure and use it securely.

Business Associate Agreements (BAAs) and Shared Responsibility

By detailing the respective responsibilities of healthcare companies or Covered Entities (CEs) and their vendors or Business Associates (BAs) in securing PHI, a Business Associate Agreement is a prime example of shared responsibility.

For example, the Business Associate shoulders the responsibility of providing the data safeguards required by HIPAA to secure patient data, such as infrastructure, encryption, audit logging, and even physical onsite security.

The Covered Entity, meanwhile, is responsible for conducting risk assessments, defining access control policies and processes, configuring services accordingly, workforce training, and continuous monitoring.

Additionally, both parties have the obligation to report security incidents to each other, as well as being independently accountable to the U.S. Department of Health and Human Services (HHS).

Why Shared Responsibility Is Essential for HIPAA Compliance

For healthcare companies, having a firm grasp of the shared responsibility model for safeguarding and securing PHI, and how they fit within your overall security posture is essential (for two key reasons).

Security Gaps

Firstly, clearly understanding the shared responsibility decreases the likelihood of security gaps. If CEs are under the impression that the vendor handles all aspects of data security, they won’t be as vigilant. They’ll be less inclined to configure services, educate their staff accordingly, pay appropriate attention to vendor security alerts, etc.

But the same is also true for BAs: If they assume their client does most of the heavy lifting in securing the data disclosed to them, they could be remiss in their duties to protect it. Without shared responsibility, each side simply assumes the other is covering a safeguard, opening the door for security gaps that malicious actors can exploit.

Fortunately, by detailing both parties’ (CEs and BAs) responsibilities and liabilities regarding data protection, a BAA removes this ambiguity and, more importantly, reduces the risk of security gaps. It’s critical to know the details and work with vendors building products for compliance versus implementing a tick-box approach to compliance that places too much burden on the CE.

Covered Entities (CEs) Are Ultimately Accountable

Subsequently, the second reason why it’s essential for CEs to understand the shared responsibility model, and increase their cybersecurity readiness accordingly, is that it’s the CE that’s ultimately held accountable for data breaches.

Mistakenly thinking that a BAA automatically makes them compliant may result in healthcare companies underinvesting in training, monitoring, and incident response. Conversely, understanding that even with a BAA in place, they’re the ones primarily accountable for protecting PHI gives them a greater sense of urgency to properly implement HIPAA compliant security measures.

The Covered Entity’s Role Within Shared Responsibility

Let’s look at the ways that healthcare companies have to hold up their end in the shared responsibility model.

Choose Compliance-Conscious Vendors

First and foremost, companies have to choose the right vendors to supply them with HIPAA compliant services and solutions.

Look for companies that market themselves as HIPAA compliant and display a detailed understanding of HIPAA requirements, particularly the HIPAA Security Rule. Do your due diligence and perform deeper dives on potential vendors, researching their stated security features, reviews from existing clients, whether they have certifications like HITRUST – and if they’ve been involved in any data breaches.

Naturally, a core prerequisite of being a HIPAA compliant vendor is being willing to sign a BAA, so you can immediately rule out any vendors not willing to do so. For instance, some healthcare companies may assume they can use widely adopted solutions such as SendGrid, Mailchimp, but they don’t offer a BAA.

Once you’ve confirmed a vendor offers a BAA, look through it to establish its terms and determine if it covers the services you’re interested in.

Configuration

Another core component of shared responsibility is comprehensive configuration management. While the BA’s responsibility is to provide a secure solution that satisfies HIPAA requirements, it’s the CE’s responsibility to configure it securely to fit within their IT ecosystem.

Features that often require configuration include:

Access control: Role-based access, Zero Trust, Multi-Factor Authentication (MFA).
Encryption settings: Enabling encryption, choosing encryption type, enforcing forced TLS, enabling storage encryption.
Feature restrictions: Disabling default configurations that enable integration with non-compliant tools.
Audit logging: Enabling audit logging and configuring log formats.
Retention settings: How long to retain audit logs and who is permitted to review them.

Finally, establishing a patch management strategy, i.e., when and how your organization applies software updates, is an important element of configuration. While the vendor must release updates to fix security vulnerabilities discovered in their solutions, it’s up to healthcare companies to deploy the patches.

Training

Regardless of how many security features a vendor bakes into their solutions, once deployed by a healthcare company, the tool is only as secure as the practices of their least security-conscious employee. Consequently, companies must train their staff on how to properly use a solution to process protected health information and sensitive data. The more an employee is required to handle PHI, the more thorough and frequent their training should be.

Key aspects of comprehensive cybersecurity training include:

Common cyber threats: what the most prevalent cyber threats are and how to recognize them.
Incident response: how to report a suspected security incident, i.e., who to contact and when.
Specific solution training: how to securely use systems that process PHI
Scope awareness: knowing which services within your organization’s IT ecosystem are HIPAA-compliant and which are not

Reporting

Although both healthcare companies and BAs have notification obligations to the HHS in the event of a data breach involving PHI, it’s the CE that bears most of the investigative burden.

Firstly, while a BA may report a security incident, it’s the CE’s responsibility to conduct a risk assessment to determine the probability of compromise of PHI, assess risk, and determine whether an official notification of a breach to HHS is necessary.

Secondly, BAs must notify the CE without unreasonable delay and no later than 60 days after discovery. Although BAs often wait to complete internal investigations before notifying the CE, the CE’s 60-day clock starts upon the BA’s discovery, not upon the BA’s report. Therefore, BA delays can create compliance risks for the CE.

To prevent this, where possible, you can include stricter contractual reporting timelines in the BAAs. This constantly keeps your company in the loop, ensuring you have sufficient lead time to complete your own investigations and your HIPAA-regulated deadlines.

LuxSci – Secure Healthcare Communications

Developed specifically to fulfil the stringent regulatory and ever-evolving data security needs of the healthcare sector, LuxSci’s secure email, text, marketing and forms solutions help companies protect PHI and personalize communications.

Equally as importantly, instead of leaving you to “figure it out” – pushing additional responsibility back onto your company – LuxSci has a reputation for the best customer support in the business, offering onboarding, detailed documentation, secure default configurations, and ongoing support to help navigate the murky waters of HIPAA compliance, while getting best-in-class performance out of your solution.

Contact LuxSci today to learn more or get a demo.

Signing a BAA Does Not Automatically Make You HIPAA Compliant

August 26, 2025
Pete Wermter

For healthcare organizations, choosing the right product and service vendors is essential for achieving HIPAA compliance. One of the key prerequisites of a HIPAA-compliant vendor is the willingness to sign a Business Associate’s Agreement (BAA): a legal agreement that outlines both parties’ responsibilities and liabilities in securing protected health information (PHI).

However, despite what some healthcare organizations have been led to believe, simply signing a BAA with a vendor doesn’t guarantee your use of their product or service will be HIPAA-compliant. In reality, a BAA is just the beginning, and there are several subsequent actions both healthcare organizations and their supply chain partners must take to ensure the compliant use of PHI, especially over communications channels like email.

With this in mind, this post explores some of the reasons why signing a BAA on its own doesn’t ensure the security of PHI and protect your organization from HIPAA violations.

Business Associate Agreements (BAAs) Explained

As touched upon above, a BAA is a legally-binding document established between a covered entity (CE), i.e., healthcare organizations, and a business associate (BA), i.e, any company that handles PHI in providing a CE with products or services. For a BA to handle patient or customer data on behalf of a CE, following HIPAA regulations, there must be a BAA in place.

A BAA details:

Each party’s roles, responsibilities, and liabilities in securing PHI.
The permitted uses of PHI by the BA and, conversely, restrictions on any other use.
The BA’s responsibilities in implementing appropriate administrative, technical, and physical security measures to best protect PHI.
The BA’s obligations to report any unauthorized use, disclosure, or breach of PHI.
That the BA is required to assist with patient rights support, i.e., data access, amendments, and accounting of disclosures, when appropriate.
The BA’s obligations in making records available for audits or investigations.
The CE’s right to terminate the contract if the BA fails to fulfil their obligations in safeguarding PHI.

Additionally, if a BA employs a third-party company, i.e., a subcontractor, that will have access to a CE’s PHI, they are required to establish a BAA with that company. This then makes the subcontractor a “downstream BA” of the CE, and subject to the same obligations and restrictions placed on the original BA. This ensures the security protections mandated by HIPAA flow down the entire chain of custody for sensitive patient and customer data.

Compliance Considerations After Signing a Business Associate Agreement (BAA)

Now that we’ve covered what a BAA is and the role it plays in ensuring data privacy, let’s move on to exploring some of the key things you have to do following the singing of a BAA to ensure HIPAA compliance.

1. Both Parties Must Implement HIPAA-Required Data Risk Mitigation Measures

First and foremost, while a BAA details each party’s respective responsibilities in implementing measures to protect PHI, both still actually need to implement those required security features to achieve HIPAA compliance.

The measures required under HIPAA’s Security Rule, including encryption and access control, are designed to mitigate and minimize the impact of data breaches. So, if a company suffers a security breach and later audits show the required security policies and controls were not in place, they would be subject to the consequences of HIPAA violations, including fines and reputation damage.

Also, while a BAA stipulates that the BA is responsible for implementing the HIPAA-required safeguards for the PHI under their care, it doesn’t specify exactly which security measures they must implement. Subsequently, that’s left to the BA to interpret based on their understanding of HIPAA requirements, and how they conduct their required risk assessments.

For example, if you have a BAA with your email services provider, that alone may not be enough to keep your company or organization HIPAA compliant. That’s because the provider may not have the security measures your organization needs, and instead have a carefully worded BAA that will leave you vulnerable.

Let’s say your email marketing service provider is a “semi-HIPAA compliant” provider. In these cases, they may not offer email encryption, or the necessary access control measures your organization needs to send PHI and other sensitive information safely. The so-called HIPAA compliance may be limited only to data stored at rest on their servers only.

In short, although a BAA outlines each party’s commitment to securing data, both parties still have to follow through on implementing risk mitigation measures. Additionally, though a healthcare company has its BA’s assurances that they’ll have the appropriate safeguards in place, CEs often only have limited visibility into its ongoing security posture. As a result, asking the right questions and working with a proven HIPAA compliant provider are critical steps healthcare organizations must take to ensure full compliance.

2. CEs Must Stick to “In-Scope” Services

While a BA may provide a CE with a range of services, many limit the coverage of their BAAs to particular “in-scope” services. As a result, if a healthcare organization were to use a service outside the coverage of the BAA, i.e., an “out-of-scope” service, they’d risk exposing patient data and incurring HIPAA violations.

And, even when a service is in-scope, the BA is still required to configure it properly for it to be compliant. These configurations could include:

Enabling encryption
Establishing access control
Activating multi-factor authentication (MFA)
Turning on audit logging

With this in mind, it’s crucial to ensure that the “complete” service or tool – not just a part of it – is covered by a BAA before using it to process PHI. Similarly, check the terms of your BAA for configuration or security best practices that offer guidance on fully HIPAA compliant use, and make sure your responsibilities as a CE are 100% clear.

3. Staff Must Be Trained to Securely Handle PHI

Another key reason that signing a BAA doesn’t automatically result in HIPAA compliance is the likely need for both parties to educate their staff on how to securely handle sensitive data, such as PHI.

Firstly, as discussed above, only some of the services offered by a BA may be covered by its agreement. Subsequently, a healthcare organization’s employees need to be sufficiently trained on the use and disclosure of PHI, namely, the services in which they’re permitted to process PHI and which, in contrast, services are non-compliant.

By the same token, as well as implementing the stipulated safeguards, BAs are responsible for training their workforce on how to use and, where appropriate, configure them. This will help ensure the limited, correct use and disclosure of PHI as allowed by the BAA.

4. Reporting Requirements

A BAA stipulates that a BA must notify the CE in the event of improper or unauthorized use of PHI. More specifically, this includes:

Reporting immediately any use or disclosure not permitted by the terms of the BAA.
Notifying the CE of security incidents resulting in the potential exposure of PHI.

However, the commitment to reporting in the BAA and the ability to deliver on that commitment are two different things entirely. Firstly, the BA must implement the policies and infrastructure that allow for timely incident reporting. This includes conducting risk analysis, implemeting continuous monitoring, and developing a robust incident response plan.

Additionally, a key aspect of prompt, comprehensive reporting includes the BA ensuring that their staff are sufficiently trained to detect and report security events. As part of their training on the secure handling of PHI, a BA’s employees must be able to recognize common security issues and threats, such as improper email configurations and phishing attempts, and how to report them.

5. Subcontractor BAAs

While CEs must sign BAAs with their BAs for the compliant use and disclosure of PHI, they don’t have to sign such agreements with any subcontractors the BA may employ. Instead, it’s the responsibility of the BA to enter into their own business associate agreements with their subcontractors. As a result, the original security obligations are passed all the way down the data’s chain of custody.

While a CE can take certain measures to enforce this, such as requesting proof of subcontractor BAAs – or even the ability to review subcontractors before beginning engagement – ultimately, they have little control over their security postures. Ultimately, this means that they have to trust that the original service BA does their due diligence in selecting security-minded subcontractors, with the right PHI safeguards in place.

HIPAA Compliance Beyond a BAA with LuxSci

LuxSci’s secure healthcare communications solutions – including HIPAA compliant email, text, marketing and forms – are designed specifically with the stringent compliance requirements of the healthcare industry in mind.

LuxSci also provides onboarding, comprehensive documentation, and support to ensure your infrastructure configurations align with HIPAA requirements, so you can confidently include PHI in your healthcare engagement communications campaigns.

Contact LuxSci today to discover more about achieving compliance beyond obtaining a BAA.

How Hypersegmentation Drives Greater Healthcare Marketing Engagement

August 20, 2025
Pete Wermter

In healthcare marketing, effective engagement is crucial. It’s imperative that healthcare providers, payers, and suppliers know how to connect with their patients and customers, keeping them aware of all aspects of their healthcare journey – and empowering them to participate as much as possible.

This is where segmentation comes in.

Instead of sending out healthcare marketing email communications that appeal to as many people as possible, segmentation enables healthcare companies to appeal to specific individuals or groups. It opens the doors for scenarios in which patients and customers see a message in their inbox and think, ‘this message is for me’.

With that goal in mind, this post explores use cases and best practices in segmentation, why it’s so important for healthcare companies, and different ways that marketers can segment their audiences for optimal patient and customer engagement.

What is Segmentation?

Segmentation is the process of dividing your contact list, or audience, into smaller groups based on shared data, including protected health information (ePHI) characteristics. This could include demographics (age, gender, geographic location, etc.), medical conditions, risk factors, behaviors, and so on.

Why Segmentation is Essential in Healthcare Email Marketing

For healthcare organizations, segmentation is a highly effective, and essential, strategy for sending patients and customers personalized email messaging. Personalized emails are more relevant to the recipient, which greatly increases the chance of them capturing their attention and subsequent engagement.

This allows healthcare companies to successfully achieve the objective of their email campaigns, whether that’s reducing the number of appointment no-shows, increasing adherence to care plans, securing payments, or boosting sign-ups or sales. More importantly, patients and customers are more involved in their healthcare journey, staying on top of upcoming appointments, receiving applicable advice and recommendations, and becoming aware of products and services that may prove beneficial to their health, improving overall outcomes.

Additionally, dividing audiences into distinct groups gives healthcare organizations invaluable insights into the behaviour and needs of different segments at different stages of the healthcare journey.

For instance, an email campaign targeting a particular segment may reveal that they’re more likely to miss appointments than other groups. Similarly, segmentation may highlight that a certain high-risk group neglects to book recommended health screenings. Such insights enable healthcare providers, payers, and suppliers to improve their email engagement strategies, to drive more desirable outcomes and, ultimately more satisfied, loyal, and, above all, healthier patients and customers.

How Can Segmentation Aid HIPAA Compliance?

Another considerable benefit of segmentation for healthcare organizations is that it supports their HIPAA compliance efforts. Because segmentation necessitates setting precise rules that control which individuals receive particular emails, it greatly mitigates the risk of accidentally sending sensitive patient data to the wrong person.

Let’s say, for instance, that you want to conduct an email campaign targeting expectant mothers. By creating a segment comprised of pregnant patients or customers using the appropriate data field, you ensure that sensitive, pregnancy-related information is only sent to relevant parties. By reducing the likelihood of disclosing PHI to the wrong individuals, segmentation not only helps maintain regulatory compliance, but also preserves patient trust and confidence in your organization.

Different Ways to Segment Your Audience

Demographic Segmentation

This involves grouping individuals by shared demographic attributes such as:

Age
Gender
Location
Ethnicity
Education Level
Employment Status
Marital Status
Family Status
Socioeconomic Status (Income)
Spoken Languages / Preferred Language
Income
Insurance Coverage Type
Religious or Cultural Affiliations

Demographic information is a very powerful way to segment audiences to send them valuable, highly relevant information, for example:

Sending mammogram or prostate screening recommendations to women or men over a certain age.
Sending health alerts to people in a certain region or ZIP code in response to the emergence of a disease in their area (e.g., flu, a new COVID strain).
Making educational material easy to understand and informative.

Clinical Segmentation

Here, individuals are grouped according to medical criteria, such as:

Health conditions
Prescribed medications
Treatment plans
Recent surgeries or medical procedures
Recent lab test results
Hospitalization history
Vaccination status

This enables healthcare organizations to craft a wide range of specific communications that hone in on particular patients and customers, including:

Disease management and preventative care advice for people suffering from certain conditions, e.g, how diabetic patients can best monitor and manage their blood sugar.
Recovery guidance for post-operative patients.
Feedback requests for individuals on particular treatment plans, in an effort to optimize them.

Healthcare Journey Stage Segmentation

This divides individuals according to their position in their care journey within your organization.

For healthcare providers, new patients should receive onboarding materials, explanations of services and how to make the most of them, and similar materials that help them feel welcome and informed. Existing patients, meanwhile, can be further segmented into active, overdue (inactive), or high-risk groups – all of which have different needs and ways in which they should be communicated with:

Active patients: appointment reminders, educational materials, event and service recommendations, satisfaction surveys, etc.
Overdue and inactive patients: appointment or payment reminders, re-engagement communications, etc.
At risk patients: more frequent communications, care coordination messages, or support service referrals

Behavioral Segmentation

This method of segmentation is based on how recipients interact with emails or services, including:

How often they open emails.
If they click through on links.
If they use patient portals.
If they complete forms.
How often they attend scheduled appointments.

This segmentation empowers healthcare organizations to tailor the content type, frequency, and calls-to-action based on real engagement insights, and also carry out automated workflows based on each individual’s interaction with an email.

Supercharge Your Segmentation with LuxSci

LuxSci’s empowers healthcare organizations to effectively segment their contact lists into distinct target audiences for greater engagement in the following ways:

LuxSci Secure Marketing features powerful hypersegmentation capabilities for granular targeting that increase opens, clicks and conversions for your healthcare marketing campaigns.
LuxSci Secure High Volume Email enables companies to execute campaigns encompassing hundreds of thousands or millions of emails, targeting specific groups and audiences.
Easy integration with EHR, CDP, and CRM systems to leverages deeper levels data for highly targeting, highly personalized email campaigns.

Reach out today to learn how LuxSci can help you reach more patients and customers, drive more engagement and conversions, and improve overall outcomes.

How Automated Workflows Boost Engagement for Healthcare Marketing Campaigns

August 13, 2025
Pete Wermter

Due to the fact that it’s simple, instantaneous, cost-effective, and nearly universally adopted, email is an essential part of all healthcare marketing engagement strategies. However, consistent, personalized email engagement – particularly at scale – can be challenging.

Fortunately, Automated Workflows offer a solution, allowing healthcare companies to deliver the right messages to the appropriate individuals at the right time, based on their individual engagement with emails..

In this post, we’ll explore the concept of Automated Workflows, the considerable benefits they offer healthcare companies, and the variety of ways they can be used to increase engagement and result in greater satisfaction and better healthcare outcomes for your patients and customers.

What Are Automated Workflows?

An Automated Workflow is a sequence of actions, known as’ Steps’ in LuxSci Secure Marketing, that a Contact (i.e., a patient or customer) moves through over time, based on a series of pre-defined rules or triggers.

Each Step is programmed to automatically perform a specific function, such as sending an email or updating a Contact, when certain conditions are in place. These conditions could include:

A Contact opening a message.
A Contact clicking through on a link.
A specified amount of time having elapsed..
A data update via an API call

By evaluating conditions to initiate the appropriate Step, Automated Workflows facilitate more timely, consistent, and personalized communication with Contacts (patients and customers ). As a result, healthcare companies can effectively harness Automated Workflows to develop dynamic, personalized email engagement journeys that adapt according to your patients and customers’ needs and prior interactions.

What Are the Benefits of Automated Workflows?

Let’s look at the various advantages that Luxsci Automated Workflows offer.

Reduced Administrative Workload

Arguably, the most significant benefit of Automated Workflows is the extent to which they lower the administrative burden of email engagement campaigns for healthcare organizations.

First and foremost, Automated Workflows eliminate the need for an employee to manually send your Contacts messages. As well as the manual effort, it removes a great deal of thought from the process – as someone isn’t required to remember to send an email.

By the same token, this reduces the scope for human error, preventing the possibility of an employee neglecting to send an important message, sending it to the wrong person, or worse, accidentally exposing patient data, i.e., electronic protected health information (ePHI).

The effort that Automated Workflows reduce is typically repetitive work that staff are glad to be free of, giving them additional time to focus on tasks that provide greater value and better contribute to better patient care and/or the customer experience.

Enhanced Scalability

The time saved by employing Automated Workflows increases with the size of your Contact List and the scale of your engagement campaigns. In fact, enterprise-scale campaigns, with volumes of hundreds of thousands to millions of emails, are only feasible through the use of automation.

Similarly, Automated Workflows enable healthcare organizations to run differing, personalized email campaigns aimed at unique patient or customer segments. As well as automatically sending each message at the appropriate time, they provide tracking capabilities to determine the outcome of each message.

Increased Consistency in Communication

Because Automated Workflows remediate the risk of emails going unsent, they facilitate more timely and consistent communications with patients and customers. This makes healthcare providers, payers, and suppliers appear more reliable and consistent, building trust and greater levels of satisfaction from Contacts. More importantly, recipients are better able to track what’s happening with their healthcare and assume a more proactive role overall healthcare journey..

Finally, creating an Automated Workflow requires healthcare organizations to carefully consider how they communicate with different Contact segments. Namely, the likely journey, or communication path, different types of Contacts take, i.e., information they need to know at a particular stage in their healthcare journey, the optimal order in which information needs to be presented, etc. This allows healthcare companies to become more in-tune with their patients’ and customers’ needs, enabling them to craft more valuable email communications that boost engagement.

Personalized Healthcare Engagement

Perhaps the most significant benefit of Automated Workflows is that they enable adaptive, personalized engagement for healthcare marketing and communications campiagns. Instead of manually tracking where each Contact is in a given engagement sequence, or worse, merely having to guess, you know precisely where they are. Consequently, you’re acutely aware of their needs and the exact nature of the emails you need to send them next.

This, in turn, enables more effective Contact nurturing, i.e, strengthening your organization’s connection with each individual. When at its most effective, this may allow you to anticipate your Contacts’ needs, enabling you to send them communications, such screening or testing recommendations, educational materials, or product and service suggestions, that support their healthcare journey and enhance their quality of care.

Automated Workflow Use Cases

Automated Workflows are a powerful tool for increasing healthcare marketing and communications engagement because they can be applied to a wide range of use cases. Let’s take a look at some of the most common and impactful ways email automation can be used by healthcare companies.

New Product Announcements: keeping patients and customers in the loop on your company’s latest offerings, as well as improvements to existing products and services that are likely to be of interest, based on their data and past actions.
Personalized recommendations: suggesting products or services based on the recipient’s past purchases or engagement history.
Re-Engagement Campaigns: Automated Workflows can also be used to reconnect with Contacts with whom engagement has waned or was never completely established, sending them personalized messages to encourage specific actions or reignite interest.
New Member Onboarding: welcoming new patients or customers with a structured series of emails that introduces your services, provides technical assistance (where applicable), details subsequent steps, and explains how to get the most value from your products or services.
Appointment Reminers and Follow-Ups: sending reminders, care instructions, medication adherence advice, or details on how to book subsequent appointments, for instance, after a patient visit.
Patient Education Campaigns: taking patients through a structured curriculum on managing their medical condition or required lifestyle changes to improve their health..
Preventative Care Communications: proactively sending reminders for screenings, check-ups, vaccinations, etc., based on PHI such as a patient’s age, gender, health condition or lifestyle risk factors.

Milestone Communications: sending personalized messages to acknowledge birthdays, enrollment anniversaries, and other pertinent dates. These can also be combined with preventative care communications, to send recommendations or other advice, based on the contact’s age, for instance.
Feedback Collection: acquiring patient and customer feedback by sending follow-up surveys a set amount of time after a visit, procedure, purchase, etc.

How Automated Workflows Work in LuxSci Secure Marketing

To round off this post, let’s take a deeper look at how Automated Workflows work within LuxSci’s Secure Marketing solution. LuxSci’s Automated Workflows enhance your organization’s HIPAA compliant healthcare marketing and email campaigns by giving you complete control of:

When each email is sent
Which Contacts receive particular communications according to their behavior, needs, and other PHI-based attributes
Which engagement path or branch a Contact takes based on their email actions

Here’s a look at LuxSci’s Automated Workflows key capabilities in greater detail.

Smart Event-Based Branching and Conditions

You can branch Workflows to trigger targeted messaging based on a Contact’s attributes or certain engagement events, resulting in more relevant and effective healthcare journeys with more desirable outcomes.

User actions:
- Mailing list sign-ups
- Form completion
- Downloading a resource.
Time-based triggers:
- A set period after a visit or procedure
- A defined period of inactivity or lack of contact
- Milestones, e.g., birthdays, anniversaries.
Behavioral triggers:
- Email opens
- Clicking on links
- Visiting particular pages on a site or
- A lack of engagement with previous emails.
Transactional triggers:
- Purchasing a product or service
- Signing up for an event
- Order confirmations or shipping updates after a purchase.
API-triggered events
- Lab results or similar correspondence becoming available
- Changes to data in EHR systems, CDP platforms, or CRM systems..

Automated Segment Management

Automated Workflows can be used to dynamically add Contacts to segments based on demographics, past behavior, purchase history, and similar events. This enables more precise targeting and email personalization as they progress through specific Steps in each Workflow.

Navigation Across Steps

Automated Workflows are also capable of navigating Contacts across different Steps or completely different Workflows depending on engagement outcomes and updates to a Contact’s PHI. Better still, if a Step has already been visited, LuxSci Secure Marketing automatically prevents repetition and infinite loops.

Automate Your Healthcare Marketing and Engagement Efforts

LuxSci Secure Marketing is a HIPAA compliant healthcare marketing solution especially designed for the stringent security and regulatory requirements of the healthcare industry. Our solution enables healthcare organizations to confidently communicate with patients and customers at scale without risking compliance violations, driving increased engagement and boosting the ROI of their marketing campaigns in the process.

The latest version of LuxSci’s Secure Marketing solution with Automated Workflow functionality streamlines your company’s outreach efforts, saving considerable time, reducing human effort, and facilitating intelligent Contact management.

What’s more, LuxSci’s reporting capabilities empower you to carefully track the results of your healthcare engagement campaigns, gaining insights at every step, including:

Which Contacts received particular messages
Who engaged with email communication, and how
Precise points where drop-offs in engagement occur
The engagement achieved with each Step in the Workflow

To learn more about LuxSci’s Secure Marketing solution and how Automated Workflows boost engagement for your healthcare marketing and communications campaigns, contact us today.

Healthcare Email Threat Readiness Strategies

May 14, 2025
Pete Wermter

Are you up to date on the latest email security threats?

In this post, we share details from our just-released Email Cyber Threat Readiness Report, exploring the most effective ways to strengthen your healthcare organization’s email cyber threat readiness in 2025.

Let’s go!

Conduct Regular Risk Assessments

To strengthen your company’s email security posture, you must first identify vulnerabilities in your infrastructure that malicious actors could exploit. Frequent risk assessments will highlight the security gaps in your email infrastructure and allow you to implement the appropriate strategies to mitigate threats.

A comprehensive email risk assessment should include:

Assessment of email encryption practices.
Review of email authentication protocols, i.e., SPF, DKIM, DMARC.
Evaluation of access control policies and practices.
Assessment of malware detection capabilities.
Audit of third-party integrations.
Testing of employee email threat awareness through simulated attacks to determine threat readiness and training needs.
Review of incident response and business continuity plans, especially, in this case, in regard to email-based threats.

A risk assessment may also involve the use of vulnerability scanning tools, which scan your email infrastructure looking for conditions that match those stored in a database of known security flaws, or Common Vulnerabilities and Exposures (CVEs). Alternatively, healthcare companies often employ the services of ethical, or ‘white hat’, hackers who carry out penetration tests, in which they purposely attempt to breach your email security measures to pinpoint its flaws.

Implement Email Authentication Protocols

As touched on above, enabling and correctly configuring the right email authentication protocols is an essential mitigation measure against phishing and BEC attacks, domain spoofing and impersonation, and other increasingly common email threats. Just as importantly, it allows recipient email servers to verify that a message is authentic and originated from your servers, which reduces the risk of your domain being blacklisted and your emails being directed to spam folders instead of the intended recipient’s inbox.

The three main email authentication protocols are:

DomainKeys Identified Mail (DKIM): adds a cryptographic signature to outgoing emails, allowing the recipient’s server to verify that the email was not altered in transit.
Sender Policy Framework (SPF): allows domain owners to specify which servers are authorized to send emails on their behalf, mitigating domain spoofing and other forms of impersonation.
Domain-based Message Authentication, Reporting & Conformance (DMARC): builds on SPF and DKIM by establishing policies for handling unauthorized emails. It instructs the recipient email server to monitor, quarantine, or reject emails that fail authentication checks.

Establish Robust Access Control Policies

Implementing comprehensive access control policies reduces the chances of ePHI exposure by restricting its access to individuals authorized to handle it. Additionally, access privileges shouldn’t be equal and should be granted based on the employee’s job requirements, i.e., role-based access control (RBAC).

Zero Trust Architecture (ZTA), in contrast, is a rapidly emerging, and more secure, alternative to RBAC. ZTA’s core principles are “least privilege”, i.e., only granting the minimum necessary access rights, and “never trust, always verify”, i.e., continually asking for the user to confirm their identity as the conditions of their session change, e.g., their location, the resources they request access to, etc.

Enable User Authentication Measures

Because a user’s login credentials can be compromised, through a phishing attack or session hijacking, for instance, access control, though vital, only protects ePHI to an extent. Subsequently, you must require a user to prove their identity, through a variety of authentication measures – with a common method being multi-factor authentication (MFA).

Recommended by HIPAA, MFA requires users to verify their identity in two or more ways, which could include:

Something they know (e.g., one-time password (OTP), security questions)
Something they have (e.g., a keycard or security token)
Something they are (i.e., biometrics: retinal scans, fingerprints, etc.).

What’s more, it’s important to note that the need to enable MFA will be emphasized to a greater degree when the proposed changes to the HIPAA Security Rule go into effect in late 2025.

Identify and Manage Supply Chain Risk

While on the subject of access control, one of the most significant security concerns faced by healthcare organizations is that several third-party organizations, such as vendors and supply chain partners, have access to the patient data under their care to various degrees. As a result, cybercriminals don’t have to breach your email security measures to access ePHI – they could get their hands on your patients’ data through your vendors.

Consequently, third-party risk management must be a fundamental part of every healthcare organization‘s email threat mitigation strategy. This requires you to ensure that each vendor you work with has strong email security measures in place. In light of this, a HIPAA requirement is to have a business associate agreement (BAA) in place with each third party, or business associate, so you both formally establish your responsibilities in securing ePHI.

Set Up Encryption for Data In Transit and At Rest

Encrypting the patient data contained in email communication is a HIPAA regulation, as it prevents its exposure in the event of its interception by a cybercriminal. You should encrypt ePHI both in transit, i.e., when being included in emails, and at rest, i.e., when stored in a database.

Encryption standards sufficient for HIPAA compliance include:

TLS (1.2 +): a commonly-used encryption protocol that secures email in transit; popular due to being ‘invisible’, i.e., simple to use.
AES-256: a powerful encryption standard primarily used to safeguard stored data, e.g., emails stored in databases or archives.
PGP: uses public and private key pairs to encrypt and digitally sign emails for end-to-end security.
S/MIME: encrypts and signs emails using digital certificates issued by trusted authorities.

Develop a Patch Management Strategy

One of the most common means of infiltrating company networks, or attack vectors, is exploiting known security vulnerabilities in applications and hardware. Vendors release updates and patches to fix these vulnerabilities, so it’s crucial to establish a routine for regularly updating and patching email delivery platforms and the systems and infrastructure that underpin them.

Additionally, vendors periodically stop supporting particular versions of their applications or hardware, leaving them more susceptible to security breaches. With this in mind, you must track which elements of your IT ecosystem are nearing their end-of-support (EOS) date and replace them with suitable, HIPAA-compliant alternatives.

Implement Continuous Monitoring Protocols

Continuously monitoring your IT infrastructure is crucial for remaining aware of suspicious activity in your email traffic and potential security breaches. Without continuous monitoring, cybercriminals have a prime opportunity to infiltrate your network between periodic risk assessments.

Worse, they can remain undetected for longer periods, allowing them to move laterally within your network and access your most critical data and systems. Conversely, continuous monitoring solutions employ anomaly detection to identify suspicious behavior, unusual login locations, etc.

Develop Business Continuity and Disaster Recovery Plans

The unfortunate combination of organizations being so reliant upon email communication, email threats being so prevalent, and the healthcare sector being a consistent target for cyber attacks makes a data breach a near inevitability rather than a mere possibility.

Consequently, it’s imperative to develop business continuity and disaster recovery protocols so you can resume normal operations as soon as possible in the event of a cyber attack. An essential part of a disaster recovery plan is making regular data backups, minimizing the impact on the service provided to patients and customers.

Implement Email Threat Awareness Training for Employees

Healthcare organizations must invest in email threat awareness training for their employees, so they can recognize the variety of email-based cyber attacks they’re likely to face and can play a role in their mitigation.

Email threat awareness training should include:

The different email-based cyber threats (e.g., phishing), how they work, and how to avoid them, including AI-powered threats.
Who to inform of suspicious activity, i.e., incident response procedures.
Your disaster recovery protocols.
Cyber attack simulations, e.g., a phishing attack or malware download.

While educating your employees will increase their email threat readiness, failing to equip them with the knowledge and skills to recognize email-based attacks could undermine your other mitigation efforts.

Download LuxSci’s Email Cyber Threat Readiness Report

To gain further insight into the most effective email threat readiness strategies and how to better defend your healthcare organization from the ever-evolving threat landscape, download your copy of LuxSci’s Email Cyber Threat Readiness Report for 2025.

You’ll also learn about the top email threats facing healthcare organizations in 2025, as well as how the upcoming changes to the HIPAA Security Rule may further impact your company’s cybersecurity and compliance strategies.

Grab your copy of the report here and reach out to us today if you want to learn more.

Is WhatsApp HIPAA Compliant?

September 23, 2024
Erik Kangas

WhatsApp is not HIPAA compliant for healthcare communications containing protected health information. Despite offering end-to-end encryption, WhatsApp lacks several required elements for HIPAA compliance, including Business Associate Agreements, adequate access controls, and audit logging. Healthcare organizations cannot legally use standard WhatsApp to communicate patient information without risking regulatory violations and potential penalties under HIPAA compliant enforcement rules.

WhatsApp Encryption and Security Features

WhatsApp provides end-to-end encryption that protects message content during transmission between users. This encryption prevents even WhatsApp itself from accessing message contents, creating a basic level of confidentiality. Two-factor authentication adds protection against unauthorized account access. Message deletion capabilities allow removing content after sending. Screenshot blocking in disappearing messages mode prevents certain forms of message capture. Device linking requires biometric or PIN verification when connecting new devices to accounts. While these security features offer protection for personal communications, they fall short of the structured safeguards required for HIPAA compliant healthcare messaging.

Missing Business Associate Agreement

Meta (WhatsApp’s parent company) does not offer Business Associate Agreements for standard WhatsApp accounts. This absence creates an insurmountable barrier to becoming HIPAA compliant, regardless of any security features or usage policies implemented. Without a BAA establishing WhatsApp as a business associate under HIPAA compliant regulations, healthcare organizations cannot legally use the platform for communications containing protected health information. The WhatsApp terms of service make no provisions for healthcare regulatory compliance or protected health information handling. Healthcare organizations seeking compliant messaging must select platforms from providers willing to enter into appropriate contractual relationships governing healthcare data.

Access Control and Authentication Limitations

WhatsApp lacks the granular access controls needed for healthcare communications. The platform offers limited ability to manage which users can access specific conversations beyond simple group membership. Administrative oversight tools for organizational accounts fall short of healthcare requirements for managing user permissions. Account access remains tied primarily to phone numbers rather than organizational identity systems. The platform lacks integration with enterprise authentication systems used in healthcare settings. Message visibility cannot be restricted based on staff roles or need-to-know principles within healthcare teams. Organizations cannot implement the access management hierarchies typically needed for proper information governance in clinical environments.

Audit and Compliance Documentation Challenges

HIPAA compliance requires detailed records of who accessed information and when this access occurred. WhatsApp provides limited message delivery and reading confirmations but lacks comprehensive audit logs needed for regulatory compliance. The platform offers no administrative portal for reviewing user activities across an organization. Message history may be lost during device changes or app reinstallation. Organizations cannot generate compliance reports showing message handling patterns. Data retention controls do not align with healthcare recordkeeping requirements. Without proper audit capabilities, healthcare organizations cannot demonstrate compliance with HIPAA access monitoring requirements or investigate potential security incidents involving patient information.

Data Management and Retention Issues

WhatsApp creates several data management challenges that conflict with HIPAA requirements. The platform automatically saves received media to users’ personal devices, potentially exposing protected health information. Backup settings may send message history to personal cloud storage accounts outside organizational control. Message deletion features allow recipients to remove content without administrator knowledge. Data retention periods cannot be centrally managed to align with healthcare recordkeeping policies. The platform lacks classification tools for identifying which conversations contain protected health information. Organizations cannot implement consistent data lifecycle management across all communications containing patient information.

Compliant Alternatives to WhatsApp

Healthcare organizations requiring HIPAA compliant messaging should implement appropriate alternatives to WhatsApp. Platforms like TigerConnect, Spok, and Halo Health provide secure messaging designed specifically for healthcare environments. Many electronic health record systems include compliant messaging components within their patient care applications. Telehealth platforms offer secure communication channels as part of virtual visit workflows. Enterprise communication platforms like Microsoft Teams can support HIPAA compliant messaging when properly configured and covered by appropriate agreements. These alternatives provide the necessary security features, administrative controls, and compliance documentation needed for healthcare communications containing protected health information.

Limited Acceptable Use Cases

WhatsApp may have limited acceptable use cases within healthcare environments when properly restricted. Administrative communications that never include patient information can utilize the platform with clear policies prohibiting any protected health information. Public health outreach and general wellness information that contains no individually identifiable health data may be appropriate for WhatsApp distribution. Patient communications through WhatsApp should occur only when patients have been clearly informed of privacy limitations and have explicitly chosen this communication method despite its risks.

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.

How to Secure SMTP Email Delivery with TLS

August 29, 2023
LuxSci

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:

Computer A connects to Computer B (no security)
Computer B says “Hello” (no security)
Computer A says, “Let’s talk securely over TLS” (no security)
Computers A and B agree on how to do this (secure)
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:

purchase SSL certificates
configure the email servers to use them (and keep these configurations updated)
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:

No TLS: never use it.
Opportunistic TLS: use it if available; if not, send it insecurely.
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:

The recipient’s servers support TLS for outbound email (there is no way to test this externally).
The mail servers (where the “From” or “Reply” email address is hosted) support TLS for inbound email.
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:

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.
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:

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.
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.
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.
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.
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).
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.
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.
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.