Despite emails widespread use, ‘Email Use Reconsidered in Health Professions Education: Viewpoint’ notes it “does not ensure that…health professionals are skillful in its use,” which means shortcomings in deliverability and communication practices can quickly create bottlenecks. When messages fail to reach recipients, clinicians are forced to resend information, make additional phone calls, or manage unnecessary patient follow-ups to address missed communications. These disruptions slow workflows and increase administrative strain.
When email systems function reliably, communication is more direct and efficient. Providers can prioritize patient care rather than troubleshooting delivery failures, and patients benefit from timely instructions, updates, and responses. Given that “more than 200 billion emails” are exchanged globally each day, and that healthcare environments increasingly depend on electronic coordination.
Delivery analytics and logging provide visibility into bounce rates, engagement, and message flow, allowing teams to detect and address issues proactively. Real-time monitoring and bounce management also help protect sender reputation, a determining factor in whether future communications are accepted or filtered. Maintaining accurate delivery records additionally supports compliance and audit readiness by creating a defensible communication trail.
Email deliverability simply refers to whether messages actually make it to the recipient’s inbox rather than being filtered, blocked, or lost along the way. It matters more in this sector than most because email is a core communication tool for coordinating care, engaging patients, and sharing clinical information among providers.
A 2024 article indexed in the Cambridge Journal states, “As the healthcare literature notes, “over the past 20 years it has become a major means of communication between healthcare professionals,” and it is now “a primary method of correspondence” across clinical settings.
Because emails in healthcare often contain protected health information (PHI), failed delivery raises privacy and compliance risks under HIPAA. Providers routinely send care plans, test results, medication guidance, and appointment details via email. If those messages end up in spam folders or never arrive, patients may miss time-sensitive instructions, which can lead to confusion, delayed treatment, or poor adherence. Research on patient-provider email use has found that patients are often unsure whether their messages are seen or responded to, highlighting the need for systems that deliver reliably.
Care coordination among clinicians also depends on messages reaching the right people at the right time. When lab results, referrals, or treatment updates are delayed or undelivered, it can disrupt workflows and lead to avoidable errors. Strong deliverability helps protect against these gaps by ensuring updates move efficiently between providers. On the legal side, communication failures can create documentation and accountability problems, especially when decisions or instructions sent by email aren’t received. In that sense, maintaining consistent deliverability supports not only better care but also the professional and legal standards the industry is required to meet.
One of the biggest technical problems is when basic email authentication tools, SPF, DKIM, and DMARC, aren’t set up correctly or aren’t used at all. These protections confirm that a message is coming from a legitimate sender and help stop spoofing and phishing, which are common in healthcare because patient data is so valuable.
If those tools are missing or misconfigured, messages get flagged, bounced, or dumped into spam folders by the receiving system. That slows down communication and harms the sender’s reputation over time. A Journal of the American Medical Informatics Association study, which analyzed 3,007 patient–physician messages, revealed that “82.8% of messages addressed a single issue” and “very few (5.1%) included sensitive content,” which contradicts fears that email causes chaos. In reality, it’s system mismanagement, not patient behavior, that often causes breakdowns.
Spam filters and inbox sorting create another layer of trouble. Internet Service Providers use complicated filtering systems that look at sender history, email content, user behavior, and complaint levels. If a healthcare organization sends a lot of messages that bounce or get marked as spam, its domain reputation takes a hit.
The problem gets worse when outdated mailing lists are used or everyone gets the same bulk message without targeting. On the patient side, email expectations are high, “as long ago as 1993, 90% of patients surveyed responded positively to the use of e-mail for communication”, so missed or delayed messages undermine trust quickly.
That leads to more filtering and possible blocking. Problems get worse when outdated mailing lists are used or everyone gets the same bulk message without any targeting. Patients and providers also deal with serious inbox overload, so even relevant messages can get buried, ignored, or automatically filtered out.
High bounce rates from outdated or invalid addresses, spam complaints, or low engagement all chip away at reputation. Once that happens, spam filters tighten up, more emails get blocked or flagged, and the cycle gets worse. The stakes are higher in healthcare than in most industries. As one BMC Health Services Research publication puts it, healthcare providers rely on “the delivery of messages via mail, the Internet, and similar routes directly to consumers” to reach patients efficiently. Sudden spikes in email volume, irregular sending habits, or poorly maintained lists can signal risk to spam filters, especially when outreach resembles “spam in email inboxes,” a form of direct marketing that “clearly ha[s] the potential to irritate consumers.”
Mailbox providers pay close attention to things like how often messages are sent, whether content seems trustworthy, and whether authentication protocols are in place. Sudden spikes in email volume, irregular sending habits, or poorly maintained lists can signal risk to spam filters.
Even small details, like wording, formatting, or attachment types, can lead to deliverability issues. While healthcare messages like reminders, results, and updates usually get more engagement than marketing emails, inactive or unresponsive recipients can still drag performance down if list hygiene isn’t maintained.
One practical way healthcare groups protect their reputation is by platforms built specifically for the industry, like Paubox. Paubox is designed for HIPAA compliant email and manages a lot of the behind-the-scenes work that keeps messages from getting blocked.
It uses encryption by default, supports SPF, DKIM, and DMARC, and enforces secure transmission standards so PHI stays protected. By handling those technical requirements automatically, it lowers the risk of emails being rejected or mislabeled as spam and helps preserve a strong sender reputation over time.
Email deliverability tracking refers to monitoring whether messages actually reach recipients’ inboxes, not just whether they’re sent. It helps organizations catch issues like spam filtering, blocks, or bounces before they affect communication with patients, staff, or partners.
In healthcare, undelivered emails can delay appointment reminders, test results, care coordination, referrals, or compliance notices. Tracking helps ensure critical communication isn’t silently lost to spam folders or blocked servers.
Hard bounce is a permanent failure, an invalid address, a closed domain, fake user. A soft bounce is a temporary issue, mailbox full, server unavailable, message too large
High bounce rates hurt sender's reputation and should be fixed quickly.