How to communicate securely without making clients log into a portal

According to A randomized study comparing patient portal and email communications for trial recruitment, “An estimated 40% of US adults accessed their portal in 2020 and frequency of both offers of and access to is increasing over time, more than doubling in the US between 2014 and 2020.” While portal-based messaging in electronic health record (EHR) systems was designed to improve communication between healthcare providers and patients, it has unintentionally introduced barriers that reduce accessibility and personalization.However, healthcare providers can still securely communicate without a portal by using encrypted email or secure messaging services. Secure, HIPAA compliant email platforms that safeguard protected health information (PHI) can enable direct, convenient communication by delivering encrypted messages straight to patients’ regular inboxes, eliminating the need for separate logins while ensuring confidentiality, integrity, and compliance.

Why portals are not the best option

According to Boss Magazine, “Care providers use portals disproportionately. Because portals are secure, a great deal of clinic-patient communication has migrated there, including messages about scheduling, appointment reminders, information about post-vaccine or post-procedure care, and more. In these cases, there’s no need for the powerful protection and attendant friction of a portal, just for messages to go unseen.”

The article notes the following as “the reason people avoid portals”:

• Too much friction: Logging onto patient portals may take longer, thus frustrating patients. Furthermore, logging onto a patient portal requires more effort as the portal may require extra steps, such as resetting a password or inputting other security steps to authenticate the user (e.g., multi-factor authentication (MFA)). “It’s not surprising that most patients don’t want to navigate into a portal just to open an appointment reminder. They know that they could simply Google post-surgery care, read a text message with a reminder, or call the receptionist to reschedule their appointment — all activities which are far smoother than logging into a portal,” the article stated.
• Increasing security concerns: The article notes that patients may “worry that portals offer yet another path for criminals to steal their data.” This distrust is especially prevalent among older patients who lack confidence in digital technology.
• Sparking digital confusion: Faced with the anxiety of using an unfamiliar interface, patients may avoid portals. This may be because they “aren’t sure how to use them, or are nervous that they’ll make a mistake that breaks the portal or compromises their data security,” the authors write. Moreover, “a portal also forces patients to open another account that they need to keep track of and manage. It means they’re more likely to get flustered and forget which platform or logins” they need. Again, this is particularly common among older patients, who often receive the most communications from their healthcare providers.”
• Not always accessible: Poverty-stricken populations may not always have access to the internet, resulting in them missing important communication from their provider. This may be more prevalent in rural communities, which are more likely to experience poor internet connectivity. However, “Even in big cities, internet access can be patchy, especially in deprived areas.”

Go deeper: The disadvantages of patient portals

Secure alternatives

Telehealth

Telehealth is the use of electronic communication and information technologies, such as video calls and phone calls, to provide remote healthcare. It allows patients to consult with a healthcare provider from the comfort of their home, making it a convenient option when an in-person visit is not ideal or necessary or when getting to an appointment is difficult. 

According to the HHS, telehealth allows patients to:

• Keep themselves and others from getting sick by being close to them.
• See their healthcare provider anywhere. With telehealth, patients can meet with their healthcare provider from their home, work, or car.
• Save time by eliminating the need to travel to a care provider, take time off, or find someone to watch their loved ones.

Telehealth also allows patients to get appointments faster and exercise choice by meeting with a health care provider who may be far away.

Healthcare providers also benefit from telehealth by: 

• Preventing the spread of infectious diseases. According to an article published by Johns Hopkins University, “Doctors can use telehealth appointments to prescreen patients for possible infectious disease.”
• Because telemedicine allows the provider to connect with patients in the comfort of their own homes, it can facilitate a more accurate and comprehensive assessment. “Neurologists and physical and occupational therapists can observe you and assess your ability to navigate and take care of yourself in your home. Telemedicine is also a good way to get mental health assessment and counseling.”
• Having a family member present during medical consultations helps with information sharing and questions. If the family member lives far away, telemedicine allows you to include them in virtual visits with your permission.

Secure messaging apps

Secure messaging apps are dedicated apps or services that encrypt messages, provide audit logs, and control access. In healthcare, they support the “delivery of messages containing clinical documents and/or other information between healthcare organisations, sent either directly or through one or more secure messaging providers,” says the Australian Digital Health Agency.

Healthcare providers may benefit through: 

• Improved timeliness for the sending and receipt of referrals and clinical information
• Improved clinical decisions due to the right information being available at the point of care
• Access to a broader range of referring practitioners
• Streamlined administration due to reduction in paper-based processes
• Improved coordination of care as a result of improved communication between healthcare providers
• Confidence in privacy and security of transmitted patient data
• Improved traceability and tracking of information for audit purposes.

Additionally, “Patients may benefit through: 

• Patient data being appropriately and securely managed
• A reduced need to retell the same information
• Confidential patient correspondence only being seen by treating clinicians
• Improved clinical decisions due to the right information being available at the point of care
• A more streamlined patient experience overall.” 

See also: Developing secure messaging protocols

Email

Cambridge University’s Stephen Ginn notes that “email is a major means of communication in healthcare and it facilitates the fast delivery of messages and information.” With more than 251 million e-mails exchanged among global users every minute, email may be the best option for patient/client communication.

According to Ginn, the benefits of email for both provider and client/patient include the following:

• Emails can be sent almost instantly and usually at little to no cost for both the sender and recipient.
• Email can eliminate the necessity for more time-intensive interactions like phone calls or in-person meetings.
• Digital images and documents can be easily transferred.
• Unlike a telephone conversation, email is an asynchronous communication method because it doesn't require participants to coordinate timing.
• Messages can be sent and read at a convenient time, even outside of typical office hours.
• Emails serve as reference tools for recipients, helping with recall and providing evidence of the communication.
• Email enables communication with large groups.
• Correspondents may be located far apart geographically.

Read also: Why email is the best complement to conventional healthcare

Paubox email solution

Paubox is a leading secure email solution designed specifically for healthcare organizations seeking seamless HIPAA compliant communication. Unlike traditional secure messaging platforms that require patients to log into a separate portal, Paubox encrypts emails automatically and delivers them directly to the recipient’s regular inbox without extra steps or passwords. This frictionless approach enhances patient engagement by making secure communication simple and convenient while maintaining the highest levels of data protection. Paubox also provides robust features such as real-time threat detection, comprehensive audit logs, and a signed business associate agreement (BAA), ensuring full compliance with HIPAA regulations. By integrating easily with existing email systems, Paubox helps healthcare providers streamline their workflows, reduce administrative burdens, and safeguard PHI effectively.

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

FAQS

Are text messages (SMS) secure for healthcare communication?

Standard SMS is not inherently secure for transmitting PHI. It can be used for appointment reminders or brief notifications with patient consent, but sensitive information should be shared through encrypted platforms.

How can providers ensure compliance when communicating outside patient portals?

Providers must use HIPAA compliant tools, sign BAAs with vendors, encrypt PHI in transit and at rest, document patient consent and communication preferences, and maintain audit logs.

How do providers maintain audit trails when communicating outside portals?

HIPAA compliant platforms automatically log message delivery, access, and content. Providers should ensure their chosen methods provide these audit capabilities for compliance and record-keeping.

Can mobile phones be used securely for patient communication?

Yes, if using HIPAA compliant apps with encryption and access controls. Providers should enforce mobile device management policies and educate patients about privacy.