Shared email inboxes lack individualized access controls. With multiple staff members sharing a single account, it becomes nearly impossible to determine who sent or received specific communications. A Perspectives in Health Information Management study published in 2022 notes, “The mean number of records affected by a breach due to unintentional insider threats is more than twice that of breaches caused by malicious intent such as external cyberattacks and theft.”
The anonymity increases the chance of this threat as staff can access data and transmit information without stringent access logs. Inadequate security also exposes organizations, especially larger ones with overlapping departments, to the possibility of PHI being sent to incorrect recipients. These are avoidable risks through the division and efficient management of email accounts.
HIPAA Security Rule Section 164.312 (a)(2)(i) addresses Unique User identification, an implementation requiring that covered entities, “Assign a unique name and/or number for identifying and tracking user identity.” Each user with access to electronic PHI (ePHI) must have a unique identifier to track and monitor their actions with systems. Shared email accounts, by nature, do not provide this level of individual accountability.
With staff members accessing the data in shared accounts and sharing passwords, PHI can easily be accessed by former employees long after their departure. This risk is one of many that lead to a potential data breach.
A study on the impact of email on physician-patient communication published in Cureus noted, “Physicians’ are primarily concerned about: 1) the lack of security measures in sending/receiving emails, 2) increased time commitment and effort required by doctors to read and respond to emails, 3) risk and liability stemming from a miscommunication or misunderstanding of vital information, 4) likelihood of patients consulting via email for trivial issues, and 5) increased possibility of crucial information being lost within the volume of emails that flood a physician’s inbox.”
Aligning with these concerns, shared inboxes often lack appropriate encryption and access controls. Emails containing sensitive patient data may be transmitted or stored without encryption, exposing them to interception or unauthorized reading. In healthcare environments where the confidentiality of patient records is necessary, it poses a serious risk of unintentional or malicious exposure of PHI. With multiple users having access, it becomes difficult to monitor or control who views or retrieves sensitive emails, widening the attack surface and increasing susceptibility to phishing attacks and other social engineering exploits targeting less security-savvy users.
Phishing risks are especially prevalent in these scenarios. Malicious actors exploit the ambiguity and multiple user presence by sending spoofed emails that appear to originate from internal sources or trusted partners. Users managing shared inboxes may fail to recognize phishing attempts due to inconsistent training or unclear responsibilities, leading to the potential compromise of credentials or the inadvertent disclosure of PHI. The complexity of tracking suspicious or unusual access patterns is heightened because the shared nature obscures individual user behavior, making early detection of breaches or phishing campaigns more difficult.
Unlike traditional email systems or shared inbox setups where encryption is optional or manually applied, Paubox’s encryption works transparently "in the background." This means that all emails are encrypted by default during transit and at rest, eliminating the risk of data interception or unauthorized exposure typical in shared inbox environments where sensitive messages might otherwise be accessible to anyone with shared credentials or during transmission over insecure networks. This automatic encryption eliminates the human error factor.
Paubox’s integration with major email platforms like Google Workspace and Microsoft 365 allows healthcare organizations to maintain user-friendly workflows without forcing recipients to access external portals or enter additional passwords. Patients and healthcare providers receive and open emails directly in their regular inbox, while Paubox handles the necessary encryption and compliance requirements behind the scenes. This user experience helps organizations avoid the common pitfalls of shared inboxes, where clunky security measures may lead to workarounds that increase risk.
Paubox incorporates advanced phishing and malware defenses to protect inboxes from external cyber threats, a risk factor in shared email contexts where multiple users might inadvertently open malicious emails. The software includes specialized filters and features such as DomainAge and ExecProtect that reduce risks posed by spoofed emails and phishing campaigns. These features are beneficial in environments with shared inboxes because the presence of many users increases the attack surface and complicates threat detection using standard security products.
Shared inboxes are practical for general inquiries and administrative workflows where transparency in message handling is necessary, and where it is necessary to give several people visibility to the same correspondence. This is supported by an editorial published in the Journal of General Internal Medicine, which looked at the risk of physicians using shared inboxes, “Clinical workflows that deploy the physician as the inbox triage agent result in physicians responding to clerical and lower-level clinical inquiries, such as requests for appointment scheduling or dates of last immunization.”
They can help avoid duplicated efforts and ensure messages are not missed, particularly where a single point of communication must be maintained. As discussed in this article, it presents central risks, including unauthorized access, loss of individual accountability, challenges with tracing user actions, and potential breaches of protected information.
When individual email accounts are used, every user maintains their own secure, unique access. Individual messaging is preferred in circumstances where the privacy and integrity of communication are necessary, like in clinically sensitive conversations involving individual patient care or decision-making. It reduces the risk of inadvertent data sharing or breaches inherent in shared credentials. However, individual emails may fragment communication if collaboration tools or clear processes are not in place.
While shared email inboxes are useful for specific collaborative tasks, the inherent risks to security, privacy, and accountability make them inappropriate for sensitive communications in healthcare and other regulated environments. Individual email accounts paired with secure, compliant group messaging platforms provide a more secure, auditable, and efficient communication framework suitable for modern collaborative needs while safeguarding protected information.
Related: HIPAA Compliant Email: The Definitive Guide
The option is not inherently compliant. For Outlook to be HIPAA compliant, a subscription to the appropriate Microsoft 365 or Office 365 plan to gain access to a business associate agreement. Even once accessed, the feature bears the risk mentioned above.
These safeguards protect ePHI and control access to it through the implementation of appropriate technology and policies.
Yes, staff members can bear individual liability for data breaches if their actions contribute to unauthorized access or disclosure.