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What is a Secure Email Gateway?

secure email sending button on keyboard

As threats to email security are increasing, organizations are looking for ways to enhance their security and reduce risk. One option is a secure email gateway. In this article, we review what secure email gateways are and how they can be used to secure sensitive data as it flows into and out of your accounts.

secure email sending button on keyboard

Protect Your Accounts With A Secure Email Gateway

Secure email gateways are an excellent way to strengthen the security of your email accounts without a costly switch to a new email provider. They layer on top of your existing email accounts to encrypt messages, scan for threats, and even capture messages for archival or backup purposes. They can also hide the sender’s IP address because messages are routed through another email infrastructure before delivery to the recipient. If you are concerned about increasing risks to sensitive data, secure email gateways offer a simple and effective way to enhance your email security.

How Do Secure Email Gateways Work?

When using a secure email gateway, your messages are routed to a separate server before being sent or received. When sending an outbound message with LuxSci’s Secure Connector, it is routed through our SecureLine encryption before being securely delivered to the recipient. A copy of the message may also be sent to an independent email archive to help meet compliance requirements for message retention.

 

LuxSci Secure Connector

 

For incoming messages, the gateway can employ email filtering technology to quarantine suspicious messages. These technologies can scan incoming messages and prevent spammers and scammers from reaching employee inboxes and wreaking havoc. Just like with outbound email sending, the gateway can also capture a copy of inbound messages and retain them in an independent message archive.

The exact features of a secure email gateway will vary from vendor to vendor, but these represent some of the core functions that these tools provide. Simply put, a secure email gateway protects both incoming and outgoing messages to ensure that sensitive data is guarded from threats.

Why Choose a Secure Gateway?

There are two main reasons to implement a secure email gateway: the security and compliance benefits and their ease of use. Let’s look at each.

Compliance and Security Benefits

Many companies, like healthcare organizations, must comply with regulations for protecting patient or customer data. Many organizations grapple with the best way to secure potentially sensitive communications without interfering with or slowing down critical business workflows. Because secure email gateways layer on top of existing email accounts, they offer a speedy way to bring your organization into compliance with data security and retention guidelines.

As email continues to be an important channel for essential business communications, all organizations can benefit from protecting their employee accounts and reducing their risk and liability.

Easy to Administer and Use

Another benefit of using a secure email gateway is that your organization does not need to switch your primary email provider to enhance its security. Changing to a more secure email provider can be extremely challenging, especially if you have a lot of users with a lot of data that needs to be migrated to a new system. Add on the training time, and some organizations will find that switching email providers is a significant burden on the organization.

Installing a secure email gateway is very easy for account administrators and often does not require additional training or implementation for email users. Employees can continue to use their regular Microsoft or Google email accounts and do not need to take additional steps to learn an entirely new email program. With 73% of breaches in the healthcare industry caused by human factors, implementing tools that don’t rely on employee decision-making is essential.

Learn More About LuxSci’s Secure Connector

LuxSci’s Secure Connector is unlike other secure email gateways in that it encrypts every email automatically to reduce the risk of breaches caused by human errors. LuxSci provides the flexibility to opt-in to more secure methods of encryption for highly sensitive messages. Email filtering and archival tools are also available to reduce risk and improve resilience in the case of a cyber incident. Contact our sales team to learn more about our email security tools.

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HIPAA Compliant Email

Rethinking HIPAA Compliant Email – Not Just a Checkbox

The compliance-only mentality is outdated.

Let’s be honest—when most healthcare organizations think about HIPAA compliant email, it’s usually in the context of avoiding fines or satisfying checklists. And while yes, compliance is critical, viewing it only through the lens of risk management is a missed opportunity.

In reality, HIPAA compliant email, when implemented properly, is one of the most powerful tools for patient and customer engagement. Why? Because it unlocks the ability to leverage protected health information (PHI) safely, enabling personalized, timely, and high-impact email communication that drives better engagement, satisfaction, and outcomes.

What Makes Email Truly HIPAA Compliant?

As a reminder, HIPAA compliant email requires that protected health information (PHI) is safeguarded both in transit and at rest. That means your email provider must:

  • Use encryption at all times
  • Be access-controlled
  • Include audit logs
  • Be stored and transmitted in a secure manner
  • Provide a Business Associate Agreement

Regular email services just don’t cut it. In fact, most consumer or marketing email platforms like Sendgrid or Constant Contact, while great at sending email, are not HIPAA compliant or have limitations when it comes to using PHI in your messages. Even when bolted-on encryption solutions are used, they often lack the flexibility, scalability, and automation needed for safe and effective healthcare email engagement.

LuxSci goes beyond the basics with policy-based encryption, secure TLS, PKI encryption and escrow/secure portal options. LuxSci’s SecureLine™ encryption technology dynamically selects the appropriate encryption method based on recipient capabilities and messaging context and can be configured to enforce secure delivery automatically according to organizational policies. LuxSci also provides the ability to enforce advanced multi-factor authentication. Every message is tracked with full audit trails—no guesswork, no loose ends.

The Real Opportunity – Secure, Personalized Email with PHI

Using PHI to Drive Personalized Messaging
Imagine sending a personalized reminder to a diabetic patient about an upcoming check-up. Or reaching out to new mothers with postnatal care resources tailored to their needs. Or sending automated email workflows to all your members to accelerate and increase new plan enrollments. Or email customer and prospects about a new product upgrade or new service offering. The list goes on. That’s the power of PHI-personalized email—when done securely.

Targeted Segmentation with Sensitive Data
With HIPAA compliant email solutions like LuxSci, you can segment your audience based on real health data with high levels of precision, such as chronic conditions, appointment history, insurance status, health risks, and more, without compromising patient trust or security.

Breaking the One-Size-Fits-All Approach in Healthcare Email
Generic email blasts are over. Modern patients expect personalization. With LuxSci, you can deliver highly targeted, highly secure emails with encrypted content, while staying HIPAA compliant.

Real Business Results from Secure Email

Here’s how secure, personalized email can drive improved results across a range of healthcare communications, including:

  • Increased Patient Appointments and Follow-ups – Sending encrypted, personalized appointment reminders and follow-up notices can reduce no-shows and boost overall appointment volume.
  • Boosting Preventative Care with Outreach Campaigns – Preventative campaigns (think flu shots or cancer screenings) sent securely to the right segments can lead to higher response rates, better health outcomes, and a lower cost of care.
  • Improving Health Plan Enrollments – Targeted email outreach during open enrollment, tailored by eligibility or plan type, and powered by automated workflows leads to higher enrollments and lower call center costs.
  • Driving Awareness and Sales of New Services or Products – Have a product upgrade offer, new wellness program or telehealth service? Send secure, PHI-informed HIPAA compliant email to the right audience for increased sales and faster adoption.
  • Optimize Explanation of Benefits NoticesReplace snail mail with email that’s fast, reliable and trackable, ensuring customers are informed and compliance is met.

The Healthcare Marketer’s Secret Weapon: Using PHI Responsibly

In a world moving away from third-party cookies, first-party data is more valuable than ever, and PHI is the most powerful form of it in healthcare. With secure HIPAA compliant email, PHI doesn’t have to be locked away. Marketers can safely use it to understand patient needs and send relevant, timely messages. PHI-driven segmentation lets you build hyper-targeted campaigns that speak to relevant conditions, unique needs and timely topics, increasing open rates, clicks throughs, and campaign conversions.

Meeting the Personalization Demands of Today’s Patients and Customers

HIPAA-compliant email is no longer just about checking a box. It’s about unlocking the full potential of your patient and customer data to drive better engagement, healthier outcomes, and measurable business results.

In closing, below are some final thoughts on how secure, HIPAA compliant email delivers long-term value for your organization and better connections with your patients and customers, including:

    • Future-Proofing Healthcare Engagement – Patients expect Amazon-level personalization. HIPAA-compliant tools let you meet those expectations securely.

    • Adapting to Data Privacy Regulations Beyond HIPAA – From GDPR to state-level privacy laws, secure communication is no longer optional, it’s foundational.

    • Building Trust Through Secure Communication – Each secure, personalized message sent is a trust-building moment with your patients and customers.

Why LuxSci? The Infrastructure Behind the Performance

With LuxSci’s secure email infrastructure and email marketing solutions, healthcare organizations can confidently personalize communication, reach patients more effectively, and fuel growth with PHI-safe segmentation, messaging, and email automation.

LuxSci takes data security and email performance to the next level by offering dedicated cloud infrastructure for each customer, which means your email campaigns aren’t slowed down by other vendors on shared cloud services and your attack footprint is much smaller. In short, you get higher delivery rates and throughput with proven HIPAA compliance and data security.

The future of healthcare engagement is personal, secure, and performance-driven—and it starts with HIPAA compliant email done right.

Reach out today with any questions or to learn more about LuxSci.


FAQs

1. Is HIPAA-compliant email necessary for marketing communications?
Yes—if your emails include or are based on PHI (like appointment reminders, condition-based messaging, or insurance info), you need HIPAA-compliant email and recipient consent to avoid legal risk and preserve patient trust.

2. Can PHI be used in marketing emails under HIPAA?
Yes, with proper consent and secure, HIPAA compliant infrastructure like LuxSci’s, PHI can be safely used in emails for personalized, segmented campaigns.

3. How does LuxSci ensure high email deliverability for healthcare messages?
LuxSci uses dedicated cloud servers for each customer, active email reputation monitoring, and best-practice configurations to ensure high deliverability rates for sensitive emails.

4. Is LuxSci only for marketing teams?
No—LuxSci supports marketing, clinical, operations, and IT teams by enabling secure, compliant email communication across the entire organization.

5. What types of PHI can I use to segment campaigns using LuxSci?
You can segment based on chronic conditions, visit history, insurance status, provider details, age, gender, location, and more—all while staying fully compliant.

HIPAA compliant email

Most Popular LuxSci Blog Posts of 2025

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

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

1. Improve Email Engagement and Marketing Results with Automated Workflows

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

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

2. Healthcare Email Threat Readiness Strategies

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

Read the full post: Healthcare Email Threat Readiness Strategies

3. HIPAA Compliant Email — 20 Tips in 20 Minutes

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

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

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

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

Read the full post: Is SendGrid HIPAA-Compliant?

5. LuxSci Shines in G2 Winter 2026 Reports

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

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

Looking Ahead to 2026

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

Follow LuxSci on LinkedIn

HIPAA compliant email

LuxSci Welcomes Angel Mazariegos as Head of Finance

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

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

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

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

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

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

HIPAA Compliant Email

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

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

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

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

Why G2 Matters

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

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

What We Earned in Winter 2026

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

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

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

Awards Reflect Our Commitment to Customer Success

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

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

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

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

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

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HIPAA compliant email services

How To Implement HIPAA Compliant Email Marketing?

HIPAA compliant email marketing requires healthcare organizations to obtain written patient authorization before using protected health information in promotional communications, implement end-to-end encryption for all marketing messages, execute business associate agreements with email service providers, and maintain detailed audit trails of all promotional activities. Medical practices must distinguish between permissible treatment communications and restricted marketing activities, ensuring that any promotional campaigns involving patient data receive explicit consent through properly executed authorization forms while utilizing secure email platforms that meet HIPAA requirements.

Healthcare organizations may feel pressure to attract new patients through digital marketing channels while navigating privacy regulations. Email marketing campaigns that appear straightforward in other industries are legally complicated when patient information enters the equation, demanding careful planning and compliance oversight.

Patient Authorization for HIPAA Compliant Email Marketing

Written patient consent precedes any use of protected health information in promotional email campaigns, including patient testimonials, demographic targeting, or treatment outcome sharing. Authorization forms require sixteen specific elements including detailed descriptions of information usage, recipient identification, expiration dates, and clear explanations of revocation rights. Healthcare organizations cannot condition treatment or payment on patients providing marketing authorization. HIPAA compliant email marketing authorization forms use plain language that patients understand without legal expertise. Organizations cannot combine marketing authorization with treatment consent documents or bundle multiple promotional purposes into single authorization requests. Each marketing campaign requiring PHI usage needs separate, specific authorization that clearly explains how patient information will be used.

Patients retain the right to revoke marketing authorization at any time, forcing organizations to immediately remove those individuals from all promotional campaigns. Revocation requests receive prompt attention, with most organizations processing these within 48 hours of receipt. Organizations maintain systems to quickly identify and remove revoked patients from active marketing lists across all platforms and campaigns.

Email Platform Selection Ensures HIPAA Compliant Email Marketing

Email service providers handling patient information for marketing purposes sign business associate agreements that outline HIPAA compliance responsibilities, data protection requirements, and breach notification procedures. These agreements cannot be generic vendor contracts but specifically cover healthcare privacy obligations and liability allocations for potential violations. Marketing platforms provide end-to-end encryption for all messages, secure data storage with access controls, and comprehensive audit logging capabilities. Email systems encrypt data both in transit and at rest, utilize strong authentication protocols, and maintain detailed records of message creation, transmission, delivery, and recipient interactions.= Cloud-based email marketing platforms present compliance challenges because patient data may be stored on servers in multiple geographic locations. Organizations ensure their chosen platforms maintain appropriate data residency controls and can demonstrate compliance with HIPAA safeguards through independent security assessments and certifications.

Platform configuration requires careful attention to default settings that may not meet HIPAA requirements. Marketing teams disable automatic data sharing features, configure appropriate access controls based on staff roles, and establish secure backup and disaster recovery procedures that protect patient information throughout the email marketing infrastructure.

Content Creation Within Privacy Protection Guidelines

Marketing email content avoids using patient information without proper authorization, even for seemingly innocuous purposes like demographic statistics or general treatment outcome claims. Any reference to patient experiences, treatment results, or practice statistics derived from patient data requires explicit authorization from affected individuals or proper de-identification according to HIPAA standards. HIPAA compliant email marketing content creation involves careful review processes to ensure no protected health information appears in marketing messages without appropriate consent. Stock photography replaces actual patient images, and testimonials include proper authorization documentation. Even appointment scheduling or service reminder emails can become marketing communications if they promote extra services or third-party products. De-identification offers an alternative to patient authorization but requires removing all identifying elements that could reveal patient identity when combined with other available information. Safe harbor de-identification requires removing eighteen specific identifier categories, while expert determination methods need statistical analysis to ensure re-identification risks stay appropriately low.

Content review workflows include legal oversight for any marketing emails that reference patient data, treatment outcomes, or practice statistics. Organizations benefit from establishing clear guidelines about what constitutes marketing versus treatment communications to prevent inadvertent violations when staff create promotional content.

Segmentation and Targeting

Patient list segmentation for marketing purposes requires careful evaluation of whether targeting criteria constitute protected health information usage. Segmenting patients based on age, gender, or geographic location may be permissible, while targeting based on medical conditions, treatment history, or appointment patterns requires specific authorization for marketing purposes. Email marketing platforms provide sophisticated targeting capabilities that can inadvertently use protected health information without proper authorization. Healthcare organizations configure these systems to prevent automatic segmentation based on medical data while still enabling effective marketing communication with appropriate patient segments. External marketing vendors and consultants need clear guidelines about permissible data usage when creating targeted email campaigns. Business associate agreements specifically prohibit vendors from using patient information for purposes beyond the agreed-upon marketing activities, and organizations monitor vendor compliance through audits and oversight procedures.

Marketing automation workflows present particular challenges because they may trigger different messages based on patient behavior or characteristics that constitute protected health information. Organizations carefully design these automated systems to ensure all triggered communications comply with authorization requirements and privacy protection standards.

Security Measures and System Protection

HIPAA compliant email marketing systems implement appropriate safeguards including access controls, audit logs, integrity protection, and transmission security measures. User authentication requires strong passwords, multi-factor authentication for administrative access, and access reviews to ensure only authorized personnel can access patient information used for marketing purposes. Email transmission security requires encryption protocols that protect messages during delivery to patient email accounts. Transport Layer Security protocols need proper configuration, and organizations verify that recipient email systems can receive encrypted messages appropriately. Some patients may need alternative secure communication methods if their email providers cannot handle encrypted messages. Backup and disaster recovery procedures for marketing email systems maintain the same privacy protections as primary systems. Marketing data backups containing patient information require encryption, access controls, and secure disposal procedures when retention periods expire. Organizations test recovery procedures to ensure patient data stays protected during system restoration activities.

Network security measures isolate marketing email systems from other practice management systems when possible, reducing potential exposure if security breaches occur. Firewalls, intrusion detection systems, and security monitoring help protect patient information used in marketing campaigns from unauthorized access or cyberattacks.

Performance Monitoring and Compliance Auditing

HIPAA compliant email marketing requires monitoring of campaign performance, patient engagement metrics, and compliance adherence across all promotional activities. Organizations track authorization status for all marketing recipients, monitor revocation requests, and maintain detailed records of patient consent for regulatory auditing purposes. Email marketing analytics avoid collecting protected health information without authorization. Standard metrics like open rates, click-through rates, and unsubscribe rates don’t require extra authorization, but behavioral tracking that reveals health-related interests or conditions may trigger privacy protection requirements. Compliance audits examine marketing authorization documentation, vendor compliance with business associate agreements, and safeguard implementation across all email marketing systems. These audits help identify potential violations before they result in regulatory enforcement actions or patient complaints.

Staff training on HIPAA compliant email marketing occurs annually and whenever marketing procedures change significantly. Training covers authorization requirements, content creation guidelines, and system usage to ensure all team members understand their compliance responsibilities when handling patient information for marketing purposes.

Enforcement Trends and Violation Prevention

Recent Office for Civil Rights enforcement actions have targeted healthcare organizations for using patient information in email marketing without proper authorization, sharing marketing data with vendors without business associate agreements, and failing to honor patient requests to opt out of marketing communications. These cases show increasing regulatory scrutiny of healthcare marketing practices. Common violations include using patient email accounts obtained for treatment purposes in marketing campaigns without separate authorization, incorporating patient testimonials or photos in promotional emails without consent, and failing to properly segment marketing lists to exclude patients who have revoked authorization. Organizations establish clear procedures to prevent these compliance failures.

Settlement agreements require organizations to implement HIPAA compliant email marketing programs, conduct staff training, and submit to monitoring for extended periods. Compliance programs that consider these enforcement priorities can minimize violation risks and avoid costly regulatory investigations that disrupt practice operations and damage professional reputations.

HIPAA Compliant Email Encryption

What Is HIPAA Compliant Email Encryption?

HIPAA compliant email encryption protects protected health information (PHI) during electronic transmission by converting readable data into coded format that only authorized recipients can decode. This encryption method meets HIPAA Security Rule requirements for protecting electronic PHI in transit and helps healthcare organizations maintain compliance when communicating patient information via email. Healthcare organizations accumulate pressure to secure patient communications while maintaining operational efficiency. Email is the backbone of healthcare communication, yet standard email transmission leaves PHI vulnerable to interception and unauthorized access.

How HIPAA Compliant Email Encryption Functions

HIPAA Email encryption transforms plain text messages containing PHI into unreadable code during transmission. The process uses mathematical algorithms to scramble data, making it accessible only to recipients who possess the correct decryption key. When healthcare providers send encrypted emails, the message travels through internet infrastructure in protected form, preventing unauthorized parties from reading PHI even if they intercept the communication. Most HIPAA compliant email encryption uses two main methods: Transport Layer Security (TLS) and end-to-end encryption. TLS creates a secure tunnel between email servers, protecting messages during transit. End-to-end encryption goes further by encrypting messages on the sender’s device and decrypting them only on the recipient’s device, ensuring even email service providers cannot access the content.

The encryption process happens automatically in most healthcare-grade email systems. Users compose messages normally, but the system applies encryption protocols before transmission. Recipients receive encrypted messages through secure portals or their own encrypted email clients, where proper authentication allows access to the original content.

Legal Requirements Under HIPAA Security Rule

The HIPAA Security Rule mandates protections for electronic PHI, including email communications. Organizations must implement addressable transmission security standards that protect PHI from unauthorized access during electronic transmission. While HIPAA does not explicitly require encryption, the regulation demands “reasonable and appropriate” safeguards for ePHI transmission.Healthcare entities must conduct risk assessments to determine appropriate security measures for their email communications. When risk analysis reveals vulnerabilities in email transmission, encryption helps meet HIPAA compliance standards. Organizations that choose not to implement encryption must document alternative safeguards that provide equivalent protection for PHI.

Business associate agreements play an important role in HIPAA compliant email encryption requirements. When healthcare organizations use third-party email services, these vendors must sign business associate agreements and implement appropriate security measures. The agreements must outline how the vendor will protect PHI and maintain HIPAA compliance standards.

Authentication Methods for Secure Access

HIPAA compliant email encryption relies on strong authentication mechanisms to verify recipient identity before granting access to encrypted messages. Multi-factor authentication has become the gold standard, requiring users to provide multiple verification forms such as passwords, SMS codes, or biometric data before accessing encrypted communications.Digital certificates provide another layer of authentication in encrypted email systems. These certificates verify the sender’s identity and ensure message integrity during transmission. Recipients can confirm that messages originated from legitimate healthcare providers and have not been tampered with during delivery.

Some encrypted email systems use secure web portals for message access. Recipients receive notification emails directing them to protected portals where they must authenticate their identity before viewing encrypted content. This method allows healthcare organizations to maintain control over PHI access even when communicating with external parties who may not have encrypted email capabilities.

Integration with Existing Healthcare Systems

Healthcare organizations require HIPAA compliant email encryption solutions that integrate seamlessly with their current technology infrastructure. Modern encryption platforms connect with electronic health record systems, practice management software, and other healthcare applications to streamline encrypted communication workflows.API integrations allow healthcare applications to send encrypted notifications and reports automatically. For example, laboratory systems can generate encrypted emails containing test results and send them directly to ordering physicians without manual intervention. This automation reduces the risk of human error while maintaining HIPAA compliance throughout the communication process.

Mobile device compatibility has grown in importance as healthcare professionals rely on smartphones and tablets for patient care. HIPAA compliant email encryption must function across various devices and operating systems while maintaining security standards. Mobile encryption apps often include features like remote wipe capabilities to protect PHI if devices are lost or stolen.

Cost Considerations for Healthcare Organizations

Implementing HIPAA compliant email encryption involves various cost factors that healthcare organizations must evaluate. Setup costs include software licensing, system integration, and staff training expenses. Ongoing costs encompass monthly or annual subscription fees, maintenance, and support services from encryption vendors. The financial impact of HIPAA violations often exceeds encryption implementation costs by large margins. Recent HIPAA enforcement actions have resulted in monetary penalties ranging from thousands to millions of dollars, depending on violation severity and organizational size. These potential fines make encryption implementation a cost-effective investment in long-term compliance protection.

Return on investment calculations should include improved operational efficiency from streamlined secure communications. Encrypted email systems often reduce time spent on manual PHI handling processes and eliminate the need for alternative communication methods like fax machines or physical mail for sensitive information transmission.

Tracking and Audit Trail Requirements

HIPAA regulations require healthcare organizations to maintain detailed audit trails for all PHI access and transmission activities. HIPAA compliant email encryption systems must provide logging capabilities that track message creation, transmission, receipt, and access events. These logs help during compliance audits and breach investigations.Automated tracking tools can identify unusual patterns in encrypted email usage that might indicate security threats or compliance violations. For example, systems can flag instances where users attempt to send large volumes of PHI or access encrypted messages from unusual locations.

Regular audit reviews help ensure that HIPAA compliant email encryption systems continue meeting regulatory requirements as organizations grow and technology changes. Healthcare entities should establish periodic assessment schedules to evaluate encryption effectiveness, user compliance, and system performance. These reviews help identify areas for improvement and ensure continued HIPAA compliance.

HIPAA Marketing Compliance

What Are the HIPAA Marketing Compliance Requirements?

HIPAA marketing compliance requires healthcare organizations to obtain written patient authorization before using protected health information for promotional communications, with strict exceptions for treatment communications, appointment reminders, and health-related benefits descriptions. Organizations must distinguish between permissible healthcare operations communications and restricted promotional activities, ensuring that any PHI used for advertising purposes receives explicit patient consent through properly executed authorization forms that detail the intended use, recipients, and patient rights.

Healthcare organizations tend to struggle with the boundary between acceptable patient communications and prohibited promotional activities. Marketing materials that reference patient experiences, treatment outcomes, or demographic information without proper authorization create immediate HIPAA marketing compliance violations.

Authorization Requirements & Marketing Boundaries

Written patient authorization must precede any use of PHI for promotional purposes, including testimonials, case studies, or targeted advertising campaigns. These authorization forms must specify the exact information to be used, identify recipients of the promotional materials, and explain the patient’s right to revoke consent at any time. Healthcare organizations cannot condition treatment or payment on patients providing authorization for promotional activities.

Authorization forms require language elements including expiration dates, patient signature requirements, and clear descriptions of how PHI will be used in promotional contexts. Organizations must maintain signed authorization documents and respect revocation requests immediately upon receipt, stopping all ongoing promotional activities involving that patient’s information.

Treatment Communications Receive Different Standards

Healthcare organizations can communicate directly with patients about treatment alternatives, appointment scheduling, and health-related services without obtaining separate authorization. These communications fall under treatment or healthcare operations rather than promotional activities, allowing providers to send appointment reminders, medication adherence information, and preventive care notifications without additional consent.

Communications that promote third-party products, include financial incentives for referrals, or advertise non-medical services require authorization even when sent to existing patients. Organizations must evaluate each communication to determine whether it serves legitimate healthcare purposes or constitutes promotional activity requiring consent.

Third-Party Vendor Relationships Create Additional Obligations

BAAs with promotional vendors must address PHI handling requirements and specify permitted uses of patient information. Vendors creating promotional materials, managing patient communications, or analyzing treatment data for promotional purposes need appropriate legal frameworks governing their access to protected information.

Healthcare organizations are liable for vendor compliance failures, making careful selection and monitoring of promotional partners essential. Contracts must include breach notification procedures, data destruction requirements, and audit rights to ensure HIPAA marketing compliance with patient information protection standards.

Challenges of Digital Advertising Platforms

Social media advertising, email campaigns, and online promotional activities often involve sharing patient data with technology platforms that may not meet HIPAA requirements. Healthcare organizations must avoid uploading patient contact lists, demographic information, or treatment details to advertising platforms without proper authorization and business associate agreements.

Retargeting campaigns that track patient website visits or online behavior require careful evaluation to ensure no PHI is shared with advertising networks. Organizations should implement protections to prevent accidental transmission of patient information through website analytics, social media pixels, or advertising platform integration.

Patient Testimonials and Case Studies

Using patient stories, photographs, or treatment outcomes in promotional materials requires detailed authorization forms that specify exactly how patient information will be used. These authorizations must address potential future uses, distribution channels, and the duration of consent to prevent compliance violations when promotional materials are repurposed or distributed broadly.

De-identification of patient information offers an alternative to authorization but requires removing all identifying elements according to HIPAA standards. Organizations must ensure that demographic information, treatment dates, and outcome details cannot be combined to identify patients when creating promotional case studies or success stories.

Staff Training & HIPAA Marketing Compliance Violations

Employees involved in promotional activities need training on distinguishing between permissible healthcare communications and restricted promotional activities. Staff must understand authorization requirements, recognize when business associate agreements are necessary, and identify situations requiring legal review before implementing promotional campaigns.

Training updates address new promotional channels, new technology platforms, and changing regulatory interpretations of HIPAA requirements. Organizations should establish clear approval processes for promotional materials and designate compliance personnel to review campaigns before launch.

Common Violations

Recent OCR enforcement cases display the penalties incurred for using patient information in promotional materials without authorization, sharing PHI with advertising vendors without business associate agreements, and failing to honor patient requests to opt out of promotional communications. These violations result in significant financial penalties and corrective action requirements.

Healthcare organizations face scrutiny of their promotional activities, particularly digital advertising campaigns and patient outreach programs. Compliance programs must include audits of promotional materials, vendor relationships, and patient authorization procedures to identify and address potential violations before they result in enforcement actions.

hands on a keyboard sending secure email

How to Secure SMTP Email Delivery with TLS

Secure email sending is a priority for organizations that communicate sensitive data externally. One of the most common ways to send secure emails is with SMTP TLS. TLS stands for Transport Layer Security and is the successor of SSL (Secure Socket Layer). TLS is one of the standard ways that computers on the internet transmit information over an encrypted channel. In general, when one computer connects to another computer and uses TLS, the following happens:

  1. Computer A connects to Computer B (no security)
  2. Computer B says “Hello” (no security)
  3. Computer A says, “Let’s talk securely over TLS” (no security)
  4. Computers A and B agree on how to do this (secure)
  5. The rest of the conversation is encrypted (secure)

In particular:

  • The conversation is encrypted
  • Computer A can verify the identity of Computer B (by examining its SSL certificate, which is required for this dialog)
  • The conversation cannot be eavesdropped upon (without Computer A knowing)
  • A third party cannot modify the conversation
  • Third parties cannot inject other information into the conversation.

TLS and SSL help make the internet a more secure place. One popular way to use TLS is to secure SMTP to protect the transmission of email messages between servers.

Secure SMTP Email Delivery with TLS 

The mechanism and language by which one email server transmits email messages to another email server is called Simple Mail Transport Protocol, or SMTP. For a long time, email servers have had the option of using TLS to transparently encrypt the message transmission from one server to another.

When available, using TLS with SMTP ensures the message contents are secured during transmission between the servers. Unfortunately, not all servers support TLS! Many email providers, especially free or public ones, have historically not supported TLS. Thankfully, the trend is shifting. LuxSci found that most providers now support TLS- approximately 85% of domains tested as of July 2022.

Using TLS requires that the server administrators:

  1. purchase SSL certificates
  2. configure the email servers to use them (and keep these configurations updated)
  3. allocate additional computational resources on the email servers involved.

For TLS transmission to be used, the destination email server must offer support for TLS, and the sending computer or server must be configured to use TLS connections when possible.

The sending computer or server could be configured for:

  1. No TLS: never use it.
  2. Opportunistic TLS: use it if available; if not, send it insecurely.
  3. Forced TLS: use TLS or do not deliver the email at all.

How Secure is Email Delivery over SMTP TLS?

TLS protects the transmission of the email message contents. It does nothing to protect the security of the message before it is sent or after it arrives at its destination. For that, other encryption mechanisms may be used, such as PGP, S/MIME, or storage in a secure portal.

For sending sensitive information to customers, transmission security is the minimum standard for compliance with healthcare and financial regulations. TLS is appropriate to meet most compliance requirements and offers an excellent alternative to more robust and less user-friendly encryption methods (like PGP and S/MIME).

There are different versions of TLS- 1.0 and 1.1 use older ciphers and are not as secure, while TLS 1.2 and 1.3 use newer ciphers and are more secure. When an email is sent, the level of TLS used is as secure as can be negotiated between the sending and receiving servers. If they both support strong encryption (like AES 256), then that will be used. If not, a weaker grade of encryption may be used. The sending and receiving servers can choose the types of encryption they will support. If there is no overlap in what they support, then TLS will fail (this is rare).

What About Replies to Secure Messages?

Let’s say you send a message to someone that is securely delivered to their inbox over TLS. Then, that person replies to you. Will that reply be secure? This may be important if you are communicating sensitive information. The reply will use TLS only if:

  1. The recipient’s servers support TLS for outbound email (there is no way to test this externally).
  2. The mail servers (where the “From” or “Reply” email address is hosted) support TLS for inbound email.
  3. Both servers support overlapping TLS ciphers and protocols and can agree on a mutually acceptable means of encryption.

Unless familiar with the providers in question, it cannot be assumed that replies will use TLS. So, what should you do? Ultimately, it depends on what compliance standards you must meet, the level of risk you are willing to accept, and the types of communications you send. There are two general approaches to this question:

  1. Conservative. If replies must be secure in all cases, assuming TLS will be used is unreasonable. In this case, a more secure method should be used to encrypt the messages in transit and store them upon arrival. The recipient must log in to a secure portal to view the message and reply securely. Alternatively, PGP or S/MIME could be used for additional security.
  2. Aggressive. In some compliance situations like HIPAA, healthcare providers must ensure that ePHI is sent securely to patients. However, patients are not beholden to HIPAA and can send their information insecurely to anyone they want. If the patient’s reply is insecure, that could be okay. For these reasons, and because using TLS for email security is so easy, many do not worry about the security of email replies. However, this should be a risk factor you consider in an internal security audit. Consider nuanced policies that allow you to send less sensitive messages with TLS while sending more sensitive messages with higher security.

What are the Weaknesses of SMTP TLS?

As discussed, SMTP TLS has been around for a long time and has recently seen a great deal of adoption. However, it has some deficiencies compared to other types of email security:

  • There is no mandatory support for TLS in the email system.
  • A receiver’s support of the SMTP TLS option can be trivially removed by an active man-in-the-middle because TLS certificates are not actively verified.
  • Encryption is not used if any aspect of the TLS negotiation is undecipherable/garbled. It is very easy for a man-in-the-middle to inject garbage into the TLS handshake (which is done in clear text) and have the connection downgraded to plain text (opportunistic TLS) or have the connection fail (forced TLS).
  • Even when SMTP TLS is offered and accepted, the certificate presented during the TLS handshake is usually not checked to see if it is for the expected domain and unexpired. Most MTAs offer self-signed certificates as a pro forma. Thus, in many cases, one has an encrypted channel to an unauthenticated MTA, which can only prevent passive eavesdropping.

The Latest Updates to Secure SMTP TLS

Some solutions help remedy these issues—for example, SMTP Strict Transport Security. SMTP STS enables recipient servers to publish information about their SMTP TLS support in their DNS. This prevents man-in-the-middle downgrades to plain text delivery, ensures more robust TLS protocols are used, and can enable certificate validation.

In addition, users can adopt TLS 1.3. NIST recommends that government agencies develop migration plans to support TLS 1.3 by January 1, 2024. LuxSci supports both SMTP MTA-STS and TLS 1.3.

How Secure SMTP TLS Email Works with LuxSci

Inbound TLS

LuxSci’s inbound email servers support TLS for encrypted inbound email delivery from any sending email provider that also supports that. For selected organizations, LuxSci also locks down its servers to only accept email from them if delivered over TLS.

Outbound Opportunistic TLS

LuxSci’s outbound email servers will always use TLS with any server that claims to support it and with whom we can talk TLS v1.0+ using a strong cipher. The message will not be sent securely if the TLS connection to such a server fails (due to misconfiguration or no security protocols in common). Outbound opportunistic TLS encryption is automatic for all LuxSci customers, even those without SecureLine.

Forced TLS

When Forced TLS is enabled, the message is either dropped or sent with an alternate form of encryption if the recipient’s server does not support TLS. This ensures that messages will never be sent insecurely. Forced TLS is also in place for all LuxSci customers sending to banks and organizations that have requested that we globally enforce TLS to their servers.

Support for strong encryption

LuxSci’s servers will use the strongest encryption supported by the recipient’s email server. LuxSci servers will never employ an encryption cipher that uses less than 128 bits (they will fail to deliver rather than deliver via an excessively weak encryption cipher), and they will never use SSL v2 or SSL v3.

Does LuxSci Have Any Other Special TLS Features?

When using LuxSci SecureLine for outbound email encryption:

  1. SMTP MTA STS: LuxSci’s domains support SMTP MTA STS, and LuxSci’s SecureLine encryption system leverages STS information about recipient domains to improve connection security.
  2. Try TLS: Account administrators can have secure messages “try TLS first” and deliver that way. If TLS is unavailable, the messages would fall back and use more secure options like PGP, S/MIME, or Escrow. Email security is easy, seamless, and automatic when communicating internally or with others who support TLS.
  3. TLS Exclusive: This is a special LuxSci-exclusive TLS sending feature. TLS Exclusive is just like Forced TLS, except that messages that can’t connect over TLS are just dropped. This is ideal for low-importance emails that must still be compliant, like email marketing messages in healthcare. In such cases, the ease of use of TLS is more important than receiving the message.
  4. TLS Only Forwarding: Account administrators can restrict any server-side email forwarding settings in their accounts from allowing forwarding to any email addresses that do not support TLS for email delivery.
  5. Encryption Escalation: Often, TLS is suitable for most messages, but some messages need to be encrypted using something stronger. LuxSci allows users to escalate the encryption from TLS to Escrow with a click (in WebMail) or by entering particular text in the subject line (for messages sent from email programs like Outlook).
  6. Domain Monitoring: When TLS delivery is enabled for SecureLine accounts, messages will never be insecurely sent to domains that purport to be TLS-enabled, i.e., TLS delivery is enforced and no longer “opportunistic.” The system monitors these domains and updates their TLS-compliance status daily.
  7. Double Encryption: Messages sent using SecureLine and PGP or S/MIME will still use Opportunistic TLS whenever possible for message delivery. In these cases, messages are often “double encrypted.” First, they are encrypted with PGP or S/MIME and may be encrypted again during transport using TLS.
  8. No Weak TLS: Unlike many organizations, LuxSci’s TLS support for SMTP and other servers only supports those protocol levels (e.g., TLS v1.0+) and ciphers recommended by NIST for government communications and which are required for HIPAA. So, all communications with LuxSci servers will be over a compliant implementation of TLS.

For customers who can use TLS to meet security or compliance requirements, it enables seamless security and “use of email as usual.” SecureLine with Forced TLS enables clients to take advantage of this level of security whenever possible while automatically falling back to other methods when TLS is unavailable.

Of course, using Forced TLS as the sole method of encryption is optional; if your compliance needs are more substantial, you can turn off TLS-Only delivery or restrict it so that it is used only with specific recipients.

If your email use cases are complicated, LuxSci’s flexibility enables the secure sending of emails to any recipient, regardless of their email service provider’s support for TLS. Contact the LuxSci sales team to learn more about our secure SMTP TLS email sending.