The American Hospital Association Annual Survey, published in the 2025 Fast Facts report, states that there are 6,093 hospitals across the United States, including 5,112 community hospitals that collectively have over 781,000 staffed beds. These hospitals manage more than 34 million admissions annually, demonstrating the massive scale of patient care.
Research published by Cochrane Library further shows that nearly two-thirds of US physicians use email for clinical communication, enabling timely coordination of care, delivery of lab results, diagnostic reports, and automated alerts. This digital transformation supports improved care coordination and faster response times in critical patient situations across the vast and complex hospital ecosystem.
The 2025 Healthcare Email Security Report by Paubox highlights that email remains the number one attack vector for healthcare data breaches. In 2024 alone, 180 healthcare organizations reported email-related breaches, exposing millions of patient records with significant financial and reputational harm. Key factors driving this crisis include lax email security settings, weak authentication protocols, and human error. For example, only 5% of phishing attacks are reported by employees, making early detection nearly impossible.
Email integration in healthcare has evolved far beyond simple messaging to become the backbone of complex clinical processes. Understanding these workflows allows organizations to implement appropriate security measures that protect patient data without disrupting care delivery.
Electronic consultations (e-consults) and secure clinical email communications improve response times in healthcare. A 2025 patient survey involving over 13,000 users found that most expected answers to e-consults within 24 hours, with many responses delivered much faster than traditional in-person appointments or phone calls. The findings also show median specialist response times to e-consults can be less than a day, with some specialties responding within minutes. This streamlines care coordination, reduces wait times, and enhances patient access to timely clinical advice, supporting greater efficiency across healthcare systems.
Patient care coordination emails facilitate complex multi-provider care scenarios. Case managers send treatment plan updates to entire care teams, social workers coordinate discharge planning with external agencies, and quality assurance teams distribute patient safety alerts across departments. These workflows often involve multiple healthcare organizations, creating complex chains of protected health information (PHI) transmission that require careful security oversight.
Modern AI-powered email security solutions can protect these time-sensitive clinical communications by analyzing sender behavior and message context to detect threats without introducing delays that could compromise patient care. Advanced behavioral detection capabilities understand healthcare communication patterns, enabling rapid identification of spoofing attempts or business email compromise attacks targeting clinical workflows.
"We encountered a significant case where an outdated email system directly impacted patient care due to a cybersecurity breach," said Matt Murren, CEO of True North ITG. "This incident illustrates how outdated email infrastructure isn't just an IT issue—it's a patient safety issue. The inability to quickly detect and contain the phishing attempt ultimately disrupted critical services, highlighting the essential role secure, modern communication systems play in healthcare operations."
The integration of email into clinical processes creates unique attack surfaces that cybercriminals actively exploit. These vulnerabilities can disrupt patient care, compromise PHI, and undermine the trust relationships required for healthcare delivery, as evidenced in a study about the implications of healthcare data breaches.
The Healthcare and Public Health Sector Coordinating Council's 2025 report "On the Edge: Cybersecurity Health of America's Resource-Constrained Health Providers" documents how the healthcare industry is now targeted by more cyber adversaries seeking monetary gain than any other industry sector in the United States. The report, based on interviews with 40 executives across 30 states, reveals that resource-constrained providers "skate on the razor's edge between maintaining clinical care or going out of business from a cyber attack."
Critical alert spoofing and workflow interruption attacks represent one of the most dangerous threats to email-based clinical systems. Attackers can spoof emergency alerts, laboratory critical values, or medication interaction warnings to manipulate clinical decision-making. Advanced AI behavior detection can counter these threats by understanding what constitutes "normal" communication patterns for healthcare organizations, analyzing tone, sender behavior, and message intent to flag deviations that could indicate spoofed emergency alerts or fraudulent clinical communications.
The Matt Murren case study demonstrates this threat's real-world impact. The attacked medical group experienced system inaccessibility for nearly two weeks, during which the clinic operated at a fraction of capacity. Scheduling systems failed, electronic health records became inaccessible, and staff communication was severely hindered. Routine appointments required cancellation or delay, test results couldn't be reviewed timeously, and urgent care cases needed diversion to other facilities. Patient trust eroded as ongoing treatment plans faced disruption, illustrating how email security failures cascade into comprehensive care delivery breakdowns.
Integration point vulnerabilities emerge where clinical email systems connect with electronic health records (EHRs), laboratory systems, imaging platforms, and external healthcare networks. These integration points often lack authentication mechanisms, creating opportunities for lateral movement within healthcare networks. Attackers can compromise email credentials and use legitimate clinical integration pathways to access broader systems, exfiltrate patient databases, or deploy ransomware across interconnected healthcare infrastructure.
Healthcare organizations face an evolving regulatory landscape that demands sophisticated email security measures for clinical workflows. These requirements intersect multiple jurisdictions and standards, creating complex compliance obligations that extend far beyond basic HIPAA requirements.
HIPAA Security Rule mandates require healthcare organizations to implement administrative, physical, and technical safeguards when PHI is transmitted through email networks. The Security Rule's recent updates emphasize risk-based approaches to protecting clinical communications, requiring organizations to conduct comprehensive risk assessments of their email workflows. "The requirements would be costly, but likely manageable, for larger, more resource-rich organizations. However, similar to the proposed revamp of HIPAA's Security Rule, the administrative, assessment/audit, and testing requirements could pose significant challenges, especially for smaller health care entities," explains Brent Hoard, partner in the Privacy + Cyber practice group at Troutman Pepper Locke.
The proposed Health Infrastructure Security and Accountability Act (HISAA) would fundamentally transform email security requirements for healthcare organizations. The legislation proposes replacing HIPAA's voluntary safeguards with prescriptive technology requirements, annual independent audits, and enhanced penalties that could include criminal charges. Healthcare organizations can address these evolving requirements by implementing HITRUST-certified email security platforms that provide built-in compliance frameworks and automatically adapt to regulatory changes.
Go deeper: How proposed HISAA rules could change healthcare data protection
Healthcare organizations must implement comprehensive security frameworks that address the unique challenges of clinical email workflows while maintaining operational efficiency and regulatory compliance.
Authentication and access controls form the foundation of secure clinical communication. Multi-factor authentication is required when clinical staff access email systems containing PHI from various locations and devices. Advanced email security platforms can integrate seamlessly with existing healthcare IT infrastructure, providing automatic user authentication and role-based access controls that align with clinical workflow requirements.
Encryption and data protection strategies must address both data at rest and in transit within clinical email systems. Modern solutions provide automatic encryption for all clinical emails containing PHI, removing the burden of encryption decisions from busy clinical staff while ensuring comprehensive protection. Real-time threat detection capabilities can identify and quarantine suspicious emails before they reach clinical staff, preventing phishing attacks and business email compromise attempts.
"Healthcare organizations must move to modern, cloud-hosted email systems as a baseline for security," says David Chou, Founder of Chou Group Healthcare Technology Advisory Services. "Equally important is ongoing education to protect staff from phishing and social engineering, which continue to be the most effective tactics used by attackers."
Staff training programs should include realistic healthcare-specific phishing simulations and clear guidance on identifying suspicious clinical emails. However, traditional training methods often fail because staff can't understand why certain emails were flagged as threats. Transparent outcomes and insights solve this challenge by tying blocked threats to evidence-based outcomes determined by generative analysis. Administrators can review detection rationale, explore historical events, and investigate patterns in mail logs, then use these real-world examples to help clinical staff understand specific threats targeting their healthcare environment.
"Choosing technology partners and platforms that prioritize HIPAA compliance and hold a HITRUST certification is vital in healthcare," says Leonard Hamer, MBA, CMPE, CEO of Physician Select Management. "HITRUST certification provides our customers assurance that we have implemented robust security controls and procedures that comply with healthcare regulations and industry standards."
Business email compromise is a cyberattack where criminals impersonate executives or trusted business partners to trick employees into transferring money, sharing sensitive data, or changing payment instructions.
Lateral movement refers to techniques attackers use to move from one compromised system to another within the same network after gaining initial access.
HITRUST (Health Information Trust Alliance) certification is a comprehensive cybersecurity framework specifically designed for healthcare organizations. It combines requirements from multiple regulations including HIPAA, NIST, and ISO standards into a single certification process that demonstrates an organization has implemented security controls for protecting healthcare data.
AI behavior detection analyzes patterns in email communication to establish what's "normal" for an organization, then identifies deviations that could indicate threats. This technology examines factors like sender behavior, message tone, and communication timing to detect sophisticated attacks that traditional security filters might miss.