According to a Paubox survey of healthcare IT leaders, email caused accidental protected health information (PHI) disclosures at 60% of responding organizations. With effective training, staff can connect established guidelines to routine decisions, including verifying recipients, limiting the scope of disclosed information, handling unexpected attachments, and promptly reporting errors. HIPAA compliant email gives staff an approved channel to apply those lessons when sending a message that contains PHI.

 

What HIPAA requires healthcare organizations to teach

The HIPAA Privacy Rule and Security Rule define related, but separate training requirements. 45 CFR § 164.530(b) requires a covered entity train its workforce on its policies and procedures as necessary and appropriate for each member’s job functions. “Implement a security awareness and training program for all members of its workforce (including management).” is a separate statement in the Security Rule.

When HIPAA refers to the ‘workforce,’ it's actually a wider group than simply the permanent staff at a practice. Workforce members include any person who performs work for a covered entity or business associate. The rule applies to all individuals performing work under a covered entity or business associate's direction, irrespective of compensation, such as employees, volunteers, and trainees. A practice should therefore identify anyone who can access PHI or use its email systems. Training should be customized to align with an individual's role. Requiring completion of relevant privacy and security training before a new employee independently uses organizational email is one method to prevent early mistakes.

Documentation should also reflect required Privacy Rule training was completed. 45 CFR § 164.530(j) requires covered entities to “Retain required documentation…” for six years from the date of its creation or the date when it last applied, whichever is later. Useful training documentation identifies the learner, date of completion, course or policy version, topics covered, and whether the learner passed or was exempted.

 

What effective HIPAA training should cover

Recognizing PHI in routine communication

Any email that includes information capable of identifying an individual, or that could be used for that purpose, and is handled by a covered entity or business associate is considered to contain PHI. Most patients can be reasonably identified using their name, diagnosis, appointment, medical record number, bill, prescription, image, or test result when the provider is their healthcare organization.

The minimum necessary standard obligates covered entities to limit PHI disclosures to the minimum necessary to accomplish the intended purpose, but there are exceptions to this rule, including treatment-related disclosures by a provider to another provider. Employees should learn to redact unnecessary details and attachments before sending email through a HIPAA compliant email provider.

 

Sending email through an approved workflow

The Security Rule’s transmission security standard, requires technical safeguards that protect electronic PHI (ePHI) when it is transferred over an electronic communications network. Under the rule, covered entities have the discretion to implement encryption as an addressable specification. However, the Security Rule 164.306 also requires a risk assessment of whether implementing encryption is reasonable and appropriate.

If the practice determines encryption is not reasonable and appropriate, it must document its decision and implement an equivalent alternative if it is reasonable and appropriate to do so. Training can then teach workers which organizational accounts are approved, how encryption protects information in transit, and remind them to double-check recipients, review autofill email addresses and attachment details, and not forward PHI to personal email.

 

Recognizing phishing and impersonation

According to a review published in BMJ Health & Care Informatics, “Phishing is a method of exploitation for malicious purposes using targeted communications (email/ messaging).”. Training can help staff recognize when messages impersonate executives, colleagues, vendors, password-reset emails, shared documents, and billing instructions. Workers can confirm the validity of an unusual request using a previously known phone number, text message, or other channel before clicking a link, approving an authentication prompt, changing account settings, or sending PHI.

According to a multicenter study published in JAMA Network Open that reviewed nearly 3 million simulated phishing emails sent at six US healthcare organizations, employees clicked 14.2% of them. The study further reported IT themed messages had the highest median click rate across institutions at 18.6%. Healthcare organizations can learn what messages their staff are likely to click using simulated phishing messages, while inbound email security can help prevent many malicious messages from ever reaching a staff inbox.

 

Reporting mistakes and suspicious activity

Training should also cover internal mistakes and reporting. According to the same Paubox survey, employees only reported 5% of known phishing attacks and 4% of known HIPAA-violating email sent within their organizations. Training should provide staff with a single reporting method and instruct them to report a misaddressed message, suspicious login notification, unexpected authentication prompt, opened attachment, or disclosed password as soon as possible. A dedicated address hosted inside the organization’s secured email environment allows employees to alert the response team without risking a malicious message being forwarded or PHI being sent to unintended recipients.

 

How often should HIPAA training occur?

HIPAA’s Privacy Rule does not specify annual training for all workforce members. Instead, it requires that new employees receive training not long after they begin, and that any staff affected by a policy or procedure update be trained within a reasonable timeframe. The Security Rule requires a security awareness and training program, and lists periodic security updates as an addressable implementation specification. Healthcare organizations can satisfy both of these requirements by providing onboarding training, targeted updates when policies or systems change, and periodic reminders between full training sessions.

Many healthcare organizations leave long gaps between training. In a 2026 Paubox survey, 57% of healthcare organizations provided email security training once per year, while another Paubox data brief revealed only 16% trained quarterly or more frequently. HIPAA compliant email providers can send brief security updates to the entire organization whenever they use email. Simulations, policy updates, or reminders about common sending errors can be automated to reach staff immediately after the topic becomes relevant rather than waiting for the annual training session.

 

Use practice and technology together

Behavioral improvements from phishing simulations are more likely when employers provide immediate training and a private, supportive reporting process. Researchers at JAMA Network Open observed, “Repeated phishing campaigns were associated with decreased odds of clicking on a subsequent phishing email.” The study was observational rather than experimental, so the results do not prove simulations cause behavior change. However, healthcare organizations can review metrics like click rates, reporting rates, time to report, training records, and repeat offenses to discover where additional training or technical safeguards can most improve security.

HIPAA training should not hold the weight of an organization’s security program by itself. Paubox’s 2026 Healthcare Email Security Report found 41% of those breached organizations had high-risk email configurations; 74% of breached domains lacked effective DMARC enforcement. Integrate training with built-in safeguards such as encryption, multifactor authentication, access controls, authenticated senders, inbound threat detection, logging, and a regularly practiced incident response plan.

A HIPAA compliant email provider reduces how often employees must remember each security step. Paubox automatically encrypts users’ outbound email and scans inbound email for threats, allowing healthcare organizations to protect messages between training sessions. Users can continue to work in the Google Workspace or Microsoft 365 inboxes they are familiar with while Paubox supports their HIPAA compliance efforts.

Paubox however cannot maintain compliance for the organization. The organization itself is still responsible for appropriate policies, risk analysis, workforce training, access controls, and response to incidents.

 

FAQs

Would an online HIPAA course be enough for a small practice?

Provided that general course allows you to add your own policies, reporting instructions, and email usage guidelines, then yes. The Privacy Rule requires training be necessary and appropriate for each worker’s job functions.

 

If providers change email service providers, do they have to retrain staff?

Staff who are affected by the change should receive additional training if the change alters the policies or procedures they follow to use email or handle PHI.

 

Who is responsible for training a provider that works for multiple healthcare organizations?

Each organization is responsible for training their staff on that organization’s policies and procedures.