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One of the largest nonprofit health systems in the United States, Providence has more than 50 hospitals across seven states, mostly in the Pacific Northwest. The health system cares for millions of patients each year. The Institute for Systems Biology (ISB) is a Seattle, Washington-based nonprofit research institute that is affiliated with Providence. ISB’s role is to collaborate with Providence on clinical studies and research.



Company snapshot

  • Founded in 1856
  • Number of locations: 52 hospitals in 7 states
  • Paubox client since 2020



Use case

Sending secure automated email notifications containing PHI


  • Eliminate the need for in-person clinical trial recruitment
  • Send automated e-consent forms and other communications at scale
  • Make the clinical trial experience convenient for patients
  • Maintain HIPAA compliance by encrypting automated emails

Used solution

Favorite features

  • Easy integration
  • Seamless, set it and forget it HIPAA compliant email
  • Robust security


When the coronavirus pandemic began, Providence and ISB engaged in several clinical trials focused on COVID-19 patients. Patients must be recruited to participate in trials, and they must also sign consent forms.

The team sought to enroll hundreds of COVID-19 patients in the Seattle area in order to study how the virus affects the immune system and organs. The study protocol included three blood draws: one at baseline, one a week later, and one six to eight weeks after that. “The idea was to capture the trajectory of the acute phase of the disease while minimizing the burden on patients and potential exposure to hospital staff,” said Andrew Magis, Ph.D., director of data science for ISB.

Typically, patient recruitment necessitates having a  research coordinator explain the trial and get patients to sign paper consent forms. Although everyone knew how antiquated the system was, before COVID-19, there was no compelling reason to move to an electronic approach for clinical research study recruitment.

“The process of joining a research study is most often paper-based,” Dr. Magis explained. “We wanted to streamline the process while reducing the risk to our healthcare providers by not having them need to meet the patients in person for clinical trial enrollment. We believe that clinical studies should become more decentralized, and the COVID-19 pandemic was a major impetus to do that.”

ISB rapidly created a cloud infrastructure that made it easier for the team to recruit patients who were hospitalized with COVID-19 or who were recovering at home. Part of the new system was an e-consent form. To succeed in this endeavor, patient email communications needed to be HIPAA compliant.



“We needed an email provider that would enable us to send [protected health information] PHI over email securely to patients connected to the study,” Dr. Magis noted.  “When we landed on Paubox, it seemed like it was an ideal solution for our needs.”

Providence and ISB evaluated several solutions, but the other options were cumbersome or had restrictions. “Some solutions are confined to emails within an enterprise system. That didn’t work for us, because we wanted to communicate with outside email addresses,” Dr. Magis said. “Other solutions require you to log into a portal, creating an account with a third-party system in order to read your email. It works fine, but it’s not a great user experience.”

Paubox Email API enables Providence to send transactional emails at scale, including e-consent forms, confirmation of an individual’s enrollment in the study, and other automated communications. It uses TLS 1.3 security protocol to deliver secure, encrypted email directly into users’ inboxes. No extra steps, no portals, and no keywords necessary to trigger encryption. Senders just click “send,” and recipients just click “open.” And because Paubox Email API is HITRUST CSF® certified, Providence can trust that Paubox meets the healthcare industry’s gold standard for HIPAA compliance.

“Paubox offers seamless, encrypted email, and to the end-user in particular, it’s invisible. That’s a core feature. Having the API allows us to send secure emails in an automated way, which saves significant time,” Dr. Magis explained.

ISB’s development team found Paubox Email API easy to use, and implementation was a breeze. The set-it-and-forget-it automation enabled ISB and Providence to manage patients with ease throughout the research study. “A key feature that I really like about Paubox is the seamless nature of it. It works flawlessly,” Dr. Magis added.



Providence and ISB garnered international attention with their groundbreaking COVID-19 study. The team published many high-profile papers in some of the top peer-reviewed journals in the world, including Nature BiotechnologyImmunity and Cell. Providence and ISB were also able to collaborate with people all over the world on the research and received significant media attention

“It’s a big research success story, providing a new model for future studies, and Paubox has been a critical part of that,” Dr. Magis concluded.

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