SEG vs. ICES and which email security approach protects healthcare

Email continues to be the most common entry point for cyberattacks. In fact, according to the U.S. Cybersecurity and Infrastructure Security Agency, 90% of successful cybersecurity attacks start with email.

For healthcare organizations (or any regulated industry that handles sensitive data), adding email security defends against a growing volume of phishing, impersonation, and AI-driven attacks that slip past native filters in Google Workspace and Microsoft 365.

The advantage of SEG, demonstrated with a real workflow

Blocking threats before delivery is the safer, more reliable approach, especially when email is connected to other software, EHR systems, etc.

For instance, in one common workflow, an email arrives in Microsoft 365. Before any security tool can analyze it, the message is synced to a connected platform (CRM, EHR, automated workflow, etc.). An Integrated Cloud Email Security (ICES) tool flags the email as malicious and removes it from the user's inbox. However, that message still exists in the connected platform, creating a major risk and a potential for staff to engage with the malicious message.

With a Secure Email Gateway (like Paubox utilizes), this scenario would never occur. Malicious emails would be identified and quarantined prior to reaching the email platform and prior to any syncs to connected platforms.

What is a Secure Email Gateway (SEG)?

A Secure Email Gateway filters inbound messages before they reach user inboxes. SEGs sit at the SMTP level, scanning email content, metadata, attachments, URLs, and sender behavior.

The benefit of an SEG is that malicious mail will be filtered out and quarantined before it ever reaches an end user.

NIST and CISA recommend pre-delivery filtering because blocking threats before delivery greatly reduces the likelihood that users are exposed to dangerous messages.

What is Integrated Cloud Email Security (ICES)?

Integrated Cloud Email Security tools connect directly to cloud-based email providers using APIs. It monitors and analyzes emails for threats after they have entered the mailbox. When a threat is identified, the message is removed or quarantined.

Limitations of ICES

ICES tools offer powerful detection, but the architecture has inherent weaknesses.

• Threats are visible to users before they're filtered out: Because ICES tools filter after delivery, malicious emails are present in inboxes briefly before being removed or quarantined.
• Potential lag increases the likelihood of user engagement: A short delay before an ICES tool flags a malicious email can increase the possibility of a user responding to or engaging with a malicious email.
• Emails can sync into other systems before removal: Because ICES tools act after delivery, malicious emails may be synced with connected platforms (like CRMs, EHRs) before they're removed from the inbox.
• API-based access can increase risk: ICES tools connect to email platforms using APIs. Recent increases in OAuth attacks show that API access can expand potential exposure if compromised.

Paubox utilizes pre-delivery blocking with the power of AI analysis

Paubox utilizes a Secure Email Gateway to ensure malicious emails are filtered out before reaching users, eliminating the risk of a malicious email getting into the hands of a user.

In addition to the security benefits of email scanning and sender review, Paubox's Inbound Email Security also utilizes powerful AI analysis to detect anomalies in tone, sender behavior, and message intent, effectively detecting phishing, BEC, impersonation, and other attacks. AI analysis catches subtleties that may be missed by traditional filtering.

Paubox’s AI-powered inbound email security is the most effective method because it blocks dangerous messages before delivery and pairs AI detection to deliver comprehensive protection.