Microsoft Outlook is one of the most widely used email platforms, including in healthcare, but is it truly HIPAA-compliant? The answer isn’t straightforward. While Outlook, and the entire Microsoft 365 application suite, offer security features that can support HIPAA compliance, they are not inherently compliant out of the box. 

Healthcare organizations must actually take additional measures to ensure they meet HIPAA’s stringent requirements before they can transmit electronic protected health information (ePHI) in their email communications – without risking the consequences of non-compliance. 

With this in mind, this post examines Microsoft 365 and Microsoft Outlook’s security capabilities, where and how they fall short of compliance standards, and, subsequently, how to secure each application in accordance with HIPAA regulations. 

Understanding HIPAA Compliant Email Requirements

HIPAA compliant email requires healthcare organizations to implement a series of technical, administrative, and physical safeguards to protect the sensitive patient data that they’ve amassed during the course of their operations – and are legally obliged to secure it in transit and at rest. Taking a brief look at each category in turn, these safeguards include: 

Technical

• Encryption: converting ePHI into an unreadable format.
• Access controls: ensuring only authorized personnel can access patient data.
• Audit logs: tracking who has accessed ePHI and what they did with it.

Administrative

• Risk assessments: identifying and categorizing risks to ePHI and implementing mitigation measures.
• Workforce training: educating employees, especially those who handle ePHI, on how to identify cyber threats, e.g, phishing, and how to respond. 
• Business Associate Agreements (BAAs): a required document for HIPAA compliance that outlines each party’s responsibility and liability in protecting patient data.

Physical safeguards: 

• Securing servers: preventing access to the servers on which ePHI resides.
• Restricting device access: implementing measures to keep malicious actors from accessing employee devices, should one fall into their hands.
• Implementing screen locks: a simple, yet effective, form of device access control is setting them to lock after a few seconds of inactivity.

What Security Features Do Microsoft 365 and Microsoft Outlook Have?

Before detailing how Microsoft 365 and Microsoft Outlook do not meet HIPAA’s standards by default, let’s look at its security features:

1. Encryption and Data Protection

Microsoft 365 offers several encryption options, including:

• TLS: Transport Layer Security (TLS) secures email in transit but does not encrypt emails at rest; if a recipient’s email server does not support TLS, messages may be sent in plaintext.
• Office Message Encryption (OME): Office Message Encryption (OME) allows users to send encrypted messages, but it requires recipients to log in to a Microsoft account or use a one-time passcode. OME integrates with Microsoft 365’s Purview Message Encryption feature, which incorporates encryption, Do Not Forward, and rights management. 
• BitLocker Encryption: Encrypts data at rest within Microsoft’s cloud infrastructure.
• Azure Information Protection: a cloud-based solution that allows users to classify, label, and protect data based on its sensitivity.

While these encryption methods provide some security, they lack the flexibility and automation needed to ensure consistent HIPAA compliance, especially for high-volume email campaigns.

2. Access Controls & Authentication

Microsoft 365 and Microsoft Outlook include access controls, such as role-based permissions and device management policies, and user authentication measures such as Multi-Factor Authentication (MFA). However, organizations must actively manage and enforce these policies to prevent breaches.

3. Audit Logging & Compliance Reporting

Microsoft provides audit logging and reporting tools via the Microsoft Purview Compliance Portal. These logs help organizations track access to ePHI, but proper configuration is required to ensure that HIPAA-required retention policies are met.

4. Business Associate Agreement

One of the distinguishing features of using Microsoft 365 and Microsoft Outlook is that the company will sign a Business Associate Agreement (BAA) with healthcare organizations. However, the Microsoft BAA only applies to specific Microsoft 365 services that meet HIPAA requirements, such as Outlook, Exchange Online, and OneDrive – while apps like Skype may not be covered. 

This means healthcare organizations must carefully configure Microsoft 365 to use only HIPAA-covered services and apply security controls like encryption, access restrictions, and audit logging. 

How Microsoft Outlook and Microsoft 365 Fall Short of HIPAA Regulations

Despite Microsoft 365 and Outlook’s comprehensive security features, out of the box, they still lack a series of capabilities and configurations that prevent them from being fully HIPAA-compliant. 

1. No End-to-End Encryption: TLS protects emails in transit, but messages may be readable on recipient servers if they don’t support TLS, exposing ePHI.
2. Lack of Automatic Encryption: Microsoft 365 requires users to manually apply encryption settings for emails containing sensitive data, increasing the risk of human error and falling victim to data breaches.
3. Key management issues: healthcare organizations must rely on Microsoft’s encryption key management, rather than maintaining full control over their own keys.
4. Lack of recipient flexibility: OME requires recipients to authenticate via Microsoft accounts, which can be cumbersome for patients and other third-parties.
5. Limited DLP Enforcement: Outlook’s default settings don’t prevent ePHI from being sent unencrypted without proper data loss prevention (DLP) rules.
6. Audit Logging Gaps: while Microsoft 365 logs activity, they must be reviewed and retained properly to meet HIPAA guidelines.

To bridge these security gaps, healthcare organizations need an additional layer of protection.

In short, Microsoft 365 and Microsoft Outlook are not HIPAA-compliant out of the box, and healthcare companies should fully understand the implications and steps needed before using them for HIPAA compliant email communications and campaigns. However, unlike other leading email platforms, such as Mailchimp and SendGrid, they can be made HIPAA-compliant.

How LuxSci Makes Microsoft 365 and Microsoft Outlook Email HIPAA-Compliant

If your organization relies on Microsoft 365 or Microsoft Outlook for its email communications, LuxSci can streamline the process of making the platform HIPAA compliant – better-securing ePHI in the process and helping you avoid the consequences of a compliance shortfalls and a data breach.. 

LuxSci’s HIPAA compliant email features were specially designed with the security needs of healthcare organizations in mind, and include:

1. Automatic, End-to-End Email Encryption

LuxSci’s SecureLine™ encryption dynamically applies the strongest available encryption, including TLS, PGP and S/MIME,  based on the recipient’s server’s security posture and capabilities, ensuring that every email remains secure without manual intervention, and reducing human error.

2. Seamless Integration with Microsoft 365

With LuxSci’s Secure Email Gateway, organizations can continue using Microsoft 365 and Microsoft Outlook for email, while benefiting from automated encryption, outbound email filtering, and advanced compliance logging, where logs are retained per HIPAA’s strict requirements.

3. Dedicated, HIPAA-Compliant Infrastructure

LuxSci offers dedicated email servers with full control over encryption keys, ensuring compliance with HIPAA and other data privacy regulations, such as GDPR and HITRUST. This is particularly important for organizations needing high-volume email security without performance bottlenecks.

4. Secure Patient Communication & Forms

Beyond email encryption, LuxSci provides Secure Forms and Secure Text, allowing healthcare providers, payers and suppliers to safely collect sensitive patient data and improve patient engagement and workflows. 

Talk to Our Experts Today

If your organization relies on Microsoft 365 or Microsoft Outlook for email and wants to ensure full HIPAA compliance, schedule an intro call or demo with LuxSci today. Our experts will answer all your questions and help you implement a secure, high-performance email solution tailored to your needs.

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

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

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

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

LuxSci vs. Zix: Evaluation Criteria

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

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

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

LuxSci vs. Zix: How Do They Compare?

Data Security and Compliance

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

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

Performance and Scalability

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

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

Infrastructure

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

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

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

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

Marketing Capabilities

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

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

Ease of Use

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

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

Other HIPAA-compliant Products

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

Get Your Copy of LuxSci’s Vendor Comparison Guide

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