How MSPs manage shared email environments without compromising PHI

Shared email environments in healthcare refer to email systems or mailboxes accessed and used by multiple authorized individuals within an organization. The challenge is the lack of security presented by multiple employees having access to the information in a single inbox. 

A Journal of Medical Systems study on the topic security techniques for electronic health records notes what the primary security needs are for a protected email account, “The most frequently mentioned security measures and techniques are categorized into three themes: administrative, physical, and technical safeguards. The sensitive nature of the information contained within electronic health records has prompted the need for advanced security techniques.”

In healthcare organizations these environments are allowed when the technical, administrative, and physical safeguards are fulfilled. Managed service providers (MSPs) assist healthcare providers by deploying HIPAA compliant email in a convenient and effective way.

The risk of shared email environments 

Unlike individual email accounts, shared email environments inherently require authorized access by many healthcare professionals across roles and departments often with varying levels of technical proficiency and security awareness. This broad access increases the probability and complexity of maintaining effective access control, raising the risk of inadvertent or malicious protected health information (PHI) exposure. 

There is also the matter of phishing. A BMJ Health & Care Informatics study on phishing notes, “The findings from this small targeted study demonstrated that, on this occasion, no credentials were harvested through any of the phishing approaches but highlights that around 2%–3% of the large volume of emails and internet traffic to an NHS Healthcare Organisation are considered suspicious, emphasising the need for robust firewalls, cyber security infrastructure and IT policies and staff training.”

Shared inboxes are susceptible to external cyber threats such as phishing attacks and malware. Email remains one of the most common vectors for social engineering attacks targeting healthcare organizations, aiming to exploit shared email accounts that handle PHI. 

Phishing campaigns frequently attempt to compromise email credentials. Once attackers penetrate a shared mailbox, they can access a trove of PHI or impersonate authorized users to launch further attacks or exfiltrate sensitive data. The shared environment’s multiple user accounts and sometimes unclear ownership make detection of suspicious behavior more difficult and delay mitigation efforts, intensifying PHI risk.

How MSP operational frameworks are designed to protect PHI

One of the central pillars of MSP operational frameworks is the implementation of strong data protection controls focused on maintaining confidentiality, integrity, and availability of ePHI. MSPs employ encryption as a fundamental defense mechanism, so that PHI is encrypted both at rest and in transit, rendering data unreadable to unauthorized actors even if intercepted. This includes using industry-standard protocols such as Transport Layer Security (TLS) for secure transmission and solutions like Secure/Multipurpose Internet Mail Extensions (S/MIME) for message encryption.

A chapter from StatPearls notes on the importance of encryption, specifying, “Encryption is the equivalent of locking data in a vault and preventing anyone without the necessary digital key or certificate from accessing it…Encryption is more useful when attempting to protect data during transmission.”

This protection is enshrined in the legally binding Business Associate Agreement (BAA) between MSP and healthcare entity clients. This agreement legally commits MSPs to comply with HIPAA mandates concerning PHI protection, breach notification obligations, and data use limitations.

Avoiding common pitfalls like insecure shadow IT email alternatives

Shadow IT refers to the use of information technology systems, software, or devices that are deployed and used by healthcare workers or departments without the knowledge or oversight of the organization’s formal IT or security teams. These systems are often adopted by healthcare professionals seeking more efficient ways to communicate, share information, or manage work tasks. 

A study on the digital resources used by healthcare professionals titled ‘The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study’ sets forth that, “studies have revealed that health care institutions are grappling with the rise of shadow IT to complement shortcomings in hospital-provided IT resources, which can be beneficial, but also introduces vulnerabilities and potential access points for cyber threats”

Shadow IT is a risk because of the lack of oversight, which creates vulnerabilities for PHI exposure. While shadow IT tools may improve workflow and user convenience, they also increase the likelihood of data breaches, unauthorized access, and regulatory non-compliance. 

Examples include healthcare workers using personal email accounts or unsecured messaging apps to send patient information, or storing PHI on personal cloud storage services that are not subject to organizational security policies. Because IT security teams do not vet these tools, they often lack essential technical safeguards, such as encryption.

Are MSPs a solution to the risk of shared email accounts 

While MSPs provide tools and expertise to reduce risk in shared email environments, they cannot substitute for tailored, security strategies specific to each healthcare organization's needs. MSPs work best when they offer flexible, customizable solutions that respond to trust concerns and regulatory demands rather than a universal model. 

This is accompanied with the use of effective policies and procedures that align with HIPAAs Security Rule. Regarding shared email accounts, their best application is for administrative rather than clinical communication within healthcare organizations. Administrative shared email accounts are typically used for scheduling, referrals, general inquiries, and non-clinical correspondence. 

This uses the convenience of shared access, allowing multiple staff to manage these routine but necessary tasks, while minimizing the exposure of PHI. Since administrative emails often do not carry clinical decision-making information or detailed medical records, the risks of PHI breaches and legal liabilities are comparatively lower.

MSPs should also operate with healthcare organizations to adapt training content and monitoring policies continually. According to a Digital Health study assessing the impact of  a phishing simulation exercise on a large hospital, “Among healthcare organizations, hospitals are particularly vulnerable to phishing attacks as it is difficult for management to enforce a strict cybersecurity policy.”

Without specialized and frequent training to raise awareness and simulated phishing exercises, even the best technical defenses managed by MSPs may be circumvented. Automated alerts and behavioral analytics built into MSP monitoring solutions must be tuned to the institutional context to reduce false positives and prioritize genuine threats. 

See also: HIPAA Compliant Email: The Definitive Guide (2025 Update)

FAQs

What is an MSP?

An MSP, or Managed Service Provider, is a company that remotely manages a customer’s IT infrastructure, end-user systems, and day-to-day technical operations. Services often include network monitoring, data backups, cloud management, and IT support.

What is an MSSP?

An MSSP, or Managed Security Service Provider, is a specialized type of MSP that focuses on cybersecurity services. They provide proactive monitoring, threat detection, incident response, compliance management, and advanced security analytics.

How are MSPs and MSSPs different?

MSPs handle general IT management like system maintenance and helpdesk support, while MSSPs focus on security, offering services such as intrusion detection, managed firewalls, and continuous security monitoring.