Why therapists are moving away from MailHippo and portal-based solutions

While patient portals offer some communication benefits, research has identified disadvantages and limitations that challenge their effective integration in healthcare practices. Consequently, therapists and other healthcare professionals might decide to avoid using portal-based communication tools such as MailHippo. The study Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey identifies numerous key limitations of portal-based healthcare solutions. These include:

• Limited access and low uptake among many patients: The study found that less than 50% of patients were offered portal access, and only about one-third reported ever using one. Access was strongly associated with having a regular doctor, higher education levels, English proficiency, and health insurance. This suggests that portals often unintentionally exclude vulnerable groups rather than expanding access.
• Usability and digital-literacy barriers: Many patients experience difficulties navigating portals, interpreting medical information, and troubleshooting technical issues. Patients with limited health literacy or English proficiency encounter even greater challenges, making portals functionally inaccessible for large portions of the population.
• Privacy, security, and trust concerns: Some individuals are reluctant to access sensitive health information through digital portals due to concerns about data security. This mistrust is particularly prevalent among people with less stable healthcare access or poorer health conditions.
• Inconsistent benefits and unclear impact on health outcomes: Even when patients gain access, many do not use the portal beyond an initial login. Access alone does not ensure meaningful engagement. Without proper guidance, patients can feel confused or anxious when viewing medical results or clinical notes, reducing the intended benefits. Evidence also shows limited consistent improvement in measurable health outcomes.
• Risk of worsening health disparities: Because portal usage is tied to socioeconomic factors, such as education, income, and internet access, these systems often amplify the digital divide. As a result, portals may deepen existing inequities in healthcare access and information availability.

Go deeper: The disadvantages of patient portals

Healthcare alternatives to MailHippo and other portal-based solutions

As described in the above study, patient portals are not always the most accessible or effective way for patients and providers to communicate. Furthermore, the study proves that many patients struggle with portal logins, navigation, or limited mobile usability, and clinicians often need more flexible tools for timely communication. Consequently, healthcare organizations, including therapy practices, are increasingly seeking alternative solutions that provide easier access, enhance engagement, and better align with real-world workflows. Alternative solutions include: 

Telehealth and virtual care platforms

Telehealth platforms, like Zoom, include secure chat, video calls, and document sharing built into the visit workflow. These platforms can be used as an alternative to portal-based communication platforms because patients can receive links that authenticate them directly into their virtual session or secure chat.

According to an article published by Harvard Health, the advantages of telemedicine in patient-provider communication include: 

• Cost savings and convenience: Telehealth reduces travel time, transportation costs, and time away from work or other responsibilities, making care more accessible and convenient for patients. 
• Improved access for people with mobility limitations or in remote/rural areas: People who live far from clinics, have limited mobility, or lack local access to healthcare providers can receive care remotely. Telehealth can help bridge this gap by providing remote healthcare.
• Flexibility and ease of use: Telehealth enables virtual visits via computer or smartphone, which can be more flexible and easier to fit into people’s schedules compared with in-person visits. 
• Remote monitoring and data sharing: Patients can send health data, like blood pressure, blood sugar, weight, or other readings, manually or via wearable devices, to providers, enabling ongoing monitoring without clinic visits. 
• Coordinated care and improved communication among providers: Telehealth can facilitate the sharing of test results, diagnoses, medications, and medical history among all providers a patient sees, improving continuity of care.

Secure messaging apps

Secure messaging apps are specialized applications or services designed, like TigerConnect, to encrypt messages, maintain audit logs, and manage access. In healthcare, they support the “delivery of messages containing clinical documents and/or other information between healthcare organizations, sent either directly or through one or more secure messaging providers,” says the Australian Digital Health Agency.

The article notes that healthcare providers benefit by:

• Faster delivery and receipt of referrals and clinical documents
• Better clinical decision-making because accurate information is available when needed
• Ability to connect with a wider network of referring clinicians
• Reduced administrative burden by moving away from paper-based tasks
• Enhanced care coordination through smoother communication between providers
• Greater assurance that patient data is transmitted securely and remains private
• Improved ability to track and audit information movement due to clearer traceability

Secure email

According to Statista, “E-mail is one of the most widely used tools for communication, organization, and marketing. Every minute, over 251 million e-mails are exchanged among global users, approximately five times more than the number of instant messages exchanged during the same time at the end of 2024. In August 2025, the United States was the market with the highest volume of e-mails exchanged, with 9.8 billion daily e-mails sent on average.” Moreover, Stephen Ginn from Cambridge University notes that “email is a major means of communication in healthcare and it facilitates the fast delivery of messages and information.” Given the ubiquity of email, HIPAA compliant email platforms, such as Paubox, allow healthcare providers to leverage this widely adopted communication channel while ensuring that protected health information (PHI) remains encrypted and secure.

According to Ginn, the benefits of email for both provider and client/patient include the following:

• Emails can be sent almost instantly and at little to no cost for both the sender and recipient.
• Email can remove the need for more time-consuming interactions, such as phone calls or face-to-face meetings.
• Digital images and documents can be transferred with ease.
• Messages can be sent and read at a convenient time, even outside of typical office hours.
• Emails act as reference tools for recipients, helping to recall and offer proof of the exchange.
• Email facilitates communication with large groups.

See also: HIPAA Compliant Email: The Definitive Guide (2025 Update)

How secure messaging apps differ from secure email

While secure messaging apps and secure email may support HIPAA compliance, they serve different communication needs. Secure messaging apps typically operate within a closed system. Messages are exchanged inside the app rather than through traditional email inboxes, which allows for features like presence indicators, read receipts, role-based access, and structured clinical workflows

Secure email, on the other hand, is designed for broader, more flexible communication, including messaging patients, caregivers, and external partners who may not use the same platform. HIPAA compliant secure email solutions integrate with standard email clients and prioritize ease of access for recipients, often without requiring app downloads or account creation.

Why choose Paubox over MailHippo

Paubox is often preferred over MailHippo in healthcare settings because it offers automatic, default encryption for all outgoing emails, reducing the risk of human error and ensuring HIPAA compliance without extra steps. Unlike MailHippo’s portal-based system, Paubox delivers encrypted emails directly to recipients’ regular inboxes, creating a seamless experience for both senders and recipients. Additionally, Paubox integrates smoothly with existing email platforms like Google Workspace and Microsoft 365, making it easier for organizations to maintain their workflows while enhancing security and compliance.

Go deeper: Paubox vs. Hushmail: HIPAA compliant email software review

FAQS

Are portal-based solutions still HIPAA compliant?

Yes. Portal-based systems are HIPAA compliant when configured properly and used with a signed business associate agreement (BAA). However, compliance isn’t the issue; user experience is. Therapists are increasingly prioritizing tools that reduce barriers while maintaining HIPAA-level security.

Is it still safe to send PHI without a portal?

If the therapist uses a HIPAA compliant, encrypted email, like Paubox, that supports secure, direct-to-inbox delivery. Some modern solutions encrypt messages at the server level, so neither the therapist nor the client needs to use a portal to stay compliant.

Do portal-based systems support two-way communication easily?

Not always. Some systems make it difficult for clients to reply without logging in, navigating through menus, or verifying their identity again. This leads to lower response rates.

Do clients need technical skills to use portal-based systems?

Some level of digital literacy is required. Clients who struggle with technology, older adults, or those with mental health challenges often find multiple logins and portal navigation frustrating.