What does a 'low risk' email security posture mean in healthcare?

From phishing campaigns and ransomware delivery to business email compromise (BEC), attackers consistently exploit email because it combines technology vulnerabilities with human behavior. However, with the right combination of technical safeguards, workforce training, continuous monitoring, and executive oversight, your email system can be “low risk.”

A low-risk email posture does not mean your organization is immune to cyberattacks. It means your systems, staff, and policies are structured to significantly reduce the likelihood of a breach and to minimize damage if one occurs.

Email as an attack vector

Email is useful for both clinical and administrative communication. It is used for:

• Referral coordination
• Lab result discussions
• Billing
• Vendor communication
• Executive approvals
• Patient engagement

Its ubiquity makes it attractive to attackers. According to the Paubox 2025 Healthcare Email Security Report, “Email remains the number one attack vector for healthcare breaches.” In fact, the report also notes that Paubox’s research found that “in 2024 alone, 180 healthcare organizations reported email-related breaches, exposing millions of patient records.” Additionally, “Only 1.1% of healthcare organizations had a low-risk email security posture, exposing widespread vulnerabilities.” These statistics represent operational disruption, regulatory exposure, reputational damage, and compromised patient trust.

Unlike other attack surfaces that require technical exploitation, email attacks often rely on a combination of technical exploitation and deception.

Why target healthcare data?

According to the American Hospital Association (AHA) Center for Health Innovation, “Health care organizations are particularly vulnerable and targeted by cyberattacks because they possess so much information of high monetary and intelligence value to cyber thieves and nation-state actors.” Protected health information (PHI); financial data, such as bank account and credit card details; personally identifiable information (PII), such as Social Security numbers; and intellectual property pertaining to medical research and innovation are among the targeted data.

The AHA further notes, “Stolen health records may sell up to 10 times or more than stolen credit card numbers on the dark web. Unfortunately, the bad news does not stop there for health care organizations — the cost to remediate a breach in health care is almost three times that of other industries — averaging $408 per stolen health care record versus $148 per stolen non-health record.”

What is a low risk email security posture?

A low risk email security posture describes a state in which an organization's email system is designed and managed to reduce vulnerability to common threats such as phishing, malware, data leaks, or impersonation attacks. The approach involves adhering to best practices concerning security protocols, compliance standards, and user behavior guidelines. Although no system can be free of risk, it ensures that risks are minimized effectively within acceptable limits.

Creating a low risk email security posture

Achieving a low risk email security posture requires a structured, layered approach that integrates technical controls, governance, employee awareness, and continuous oversight. The Canadian Centre for Cyber Security’s Email Security Best Practices outlines core areas healthcare organizations should address to reduce the likelihood and impact of email‑based attacks:

Implement strong email authentication and encryption

The guidance states that “organizations should use authentication standards such as SPF, DKIM, and DMARC to help prevent email spoofing and impersonation attacks.” These protocols verify the sender's identity and ensure that messages come from trusted sources, thereby decreasing the chances of phishing or BEC emails reaching inboxes.

For sensitive communications, such as PHI, the report notes, "Emails containing sensitive or confidential information should be encrypted to protect the information both in transit and at rest.” Encryption solutions like S/MIME or PGP help ensure that even if messages are intercepted, unauthorized parties cannot access the content.

Secure the email gateway and filter threats

The guidance advises that “email gateways should be configured to detect and block malware, spam, and other malicious content before it reaches users.” Healthcare businesses can lessen their reliance on user vigilance by implementing sophisticated, secure email gateways, which are frequently enhanced with machine learning, to prevent threats like ransomware and phishing attacks at the perimeter.

Read more: Safeguarding emails with secure email gateways

Validate user and server identities

The guidance stresses that verifying identities through “digital signatures and certificates should be used where possible to confirm the sender and ensure message integrity.” This prevents attackers from impersonating legitimate senders or tampering with messages, a common technique in business email compromise attacks.

Continuous monitoring and analytics

According to the report, “Organizations should monitor email traffic for unusual patterns and anomalies, and respond promptly to potential threats.” Through the integration of security information and event management (SIEM) systems, IT teams can detect suspicious changes in activity or unauthorized access attempts, thus improving early detection and limiting potential damage.

Employee awareness, policies, and training

Technical controls alone are insufficient. The Canadian Centre for Cyber Security recommends that “users should be trained on email security best practices, including how to recognize phishing attempts and the proper procedures for reporting suspicious emails.” Clear policies that include policies restricting personal use of work email and verifying unexpected requests for sensitive information empower employees to act as the first line of defense.

Related: What does cybersecurity training look like in 2025?

How Paubox creates a low-risk posture

Paubox helps healthcare organizations achieve a low risk email posture by combining pre‑inbox filtering, AI detection, authentication, encryption, and centralized management.

• Proactive filtering: Paubox analyzes emails before delivery, blocking phishing, malware, and business email compromise (BEC) attempts.
• AI-powered threat detection: Machine learning detects unusual sender behavior, tone, and intent, catching sophisticated attacks that traditional filters miss.
• Authentication and spoofing protection: Features like ExecProtect prevent domain spoofing and impersonation attacks, protecting users from fraudulent emails.
• Automatic encryption: Outbound emails are encrypted seamlessly, safeguarding sensitive data without relying on manual user action.

The combination of these features allows Paubox to reduce exposure to email-based attacks, minimize human error, and help healthcare organizations maintain both security and regulatory compliance.

See also: HIPAA Compliant Email: The Definitive Guide (2026 Update)

FAQS

Does a low risk posture guarantee HIPAA compliance?

While it significantly reduces risk, compliance also requires policies, workforce training, and incident response plans. A low-risk posture makes compliance easier to achieve and maintain.

What is the impact of having a low-risk email posture?

Organizations with a low-risk posture experience fewer successful attacks, reduced operational disruption, lower regulatory exposure, and higher patient trust.