Shadow AI is creating unseen risk in healthcare email

Shadow AI is spreading faster than healthcare IT teams can keep up. The latest Paubox Research report, Shadow AI is outpacing healthcare email security, reveals a widening gap between innovation and oversight. As generative AI tools find their way into daily workflows, the systems meant to protect patient data are being left behind.

The problem isn’t limited to experimental tools or rogue users. When staff use AI tools that aren’t approved, monitored, or covered under a Business Associate Agreement (BAA), they introduce invisible risk into every layer of communication. Email, long the backbone of healthcare operations, is now one of the most exposed points.

Shadow AI is already widespread
Paubox surveyed healthcare IT and compliance leaders across the U.S. to understand how AI is being used in clinical and administrative communication. Nearly every organization said employees are experimenting with AI for tasks like summarizing patient updates, writing follow-ups, or drafting responses. But few have oversight in place to manage those interactions.

This is the essence of shadow AI: technology deployed or accessed without formal approval or governance. The report found that while leaders recognize the potential of AI, many organizations have not extended their security frameworks to cover it. That oversight gap is already showing up in risk profiles.

Healthcare email systems handle protected health information (PHI) daily. When AI tools process or generate messages containing that data—without encryption or audit trails—they can violate HIPAA requirements without any indication to the sender. The result is an unmonitored channel where PHI may be stored, transmitted, or reused in ways that violate compliance standards.

A growing threat to compliance
The research found that shadow AI incidents are already happening, often without the organization realizing it until after exposure occurs. Healthcare teams are adopting AI faster than compliance teams can respond, leaving a governance vacuum that attackers and human error are quick to exploit.

The report highlights that 25% of organizations still lack formal email AI governance policies. Even among those with policies in development, few have the technical infrastructure to monitor or restrict unauthorized AI use. This is a dangerous combination: widespread adoption with no clear boundaries or accountability.

Shadow AI risk increases with every new integration point. When clinicians or administrators use unsecured plugins or AI-powered assistants connected to their email platforms, those tools can capture sensitive patient data. Without encryption, audit logs, or contractual safeguards, the organization can be liable for violations even if the exposure happens outside its systems.

Why it matters for healthcare email
Email is already one of healthcare’s weakest security points. Adding uncontrolled AI use makes it exponentially harder to protect. The report shows that AI security incidents are increasingly tied to email workflows, where tools are used to compose, categorize, or analyze messages. In these cases, even a small oversight can turn a routine exchange into a breach.

Shadow AI undermines the principle of least privilege. Instead of access being controlled, it’s often extended to third-party systems that store or process information outside the organization’s control. That makes incident detection almost impossible. If PHI is copied into an AI model or prompt history, there’s no clear way to track where it went or how it’s used later.

For healthcare IT and compliance leaders, this creates a paradox. The tools that promise efficiency can quietly erode the safeguards built to maintain compliance. Without visibility into where and how AI is being used, even well-intentioned innovation can lead to violations, fines, and reputational damage.

Closing the visibility gap
The solution begins with visibility. The report calls for healthcare organizations to treat AI use like any other security surface, subject to audit, risk assessment, and enforcement. That means knowing what tools employees use, where data is sent, and whether encryption and logging are applied.

IT teams should also assume that shadow AI already exists within their environment. The question isn’t if, but where. Regular audits, user education, and policy enforcement can help bring this activity under control before it leads to a breach.

Every healthcare organization must balance innovation with protection. The takeaway is simple: unchecked AI use in email communication is a compliance risk waiting to happen.

Download the full Shadow AI is outpacing healthcare email security report to read the complete findings and guidance for IT and compliance leaders.