Email encryption is essentially a compliance requirement in U.S. healthcare.
Yes, it's possible to have patients sign a waiver to receive sensitive information via unencrypted email, but it's hard to track when dealing with large numbers of patients. In addition, covered entities still need to encrypt email when sending protected health information (PHI) to other covered entities and business associates. In fact, encryption is a central component of HIPAA compliant email.
When it comes to email attachments, there's some confusion as to what encryption methods will encrypt them and which ones won't. For example, not all encryption methods encrypt email headers. Is the same true for attachments?
As such, this post will answer the question: What types of encryption methods encrypt email attachments?
Transport Layer Security, or TLS, is an encryption protocol that's used to secure the communication channel between both email clients and email servers.
When an email attachment is sent over a modern TLS connection, the data is encrypted in transit, making it impossible for bad actors to decipher the content.
There's a couple caveats with TLS when it comes to encrypting email attachments:
See related: Paubox eliminates obsolete TLS protocols, follows NSA guidance
PGP, or Pretty Good Privacy, uses public key cryptography to encrypt email messages and attachments. The sender uses the recipient's public key to encrypt the email and the recipient uses their private key to decrypt it. In theory, this method ensures that only the recipient can read the email and that the content remains secure even if the email is intercepted by a third party. As we’ll see, PGP can no longer make this case.
However, there are considerable caveats to using PGP for encrypting email attachments:
Learn more: PGP and S/MIME aren’t as secure as you think
See also: What does seamless encryption mean? Hint: It’s not PGP
S/MIME (Secure/Multipurpose Internet Mail Extensions) is a standard for public key encryption and signing of MIME data, which includes email attachments.
S/MIME requires both the sender and the recipient to have a digital certificate, which is used to encrypt and sign the message.
As with PGP, S/MIME has legitimate caveats when it comes to encrypting email attachments:
We've saved the least effective method of encrypting email attachments for last: password-protected zip files.
This method involves compressing an attachment into a ZIP file and setting a password. The password must then be shared with the recipient, who can use it to extract the attachment(s) from the ZIP file. This method is simple and widely used, but it does not provide nearly the same level of security as other methods.
Here are the downsides to using password-protected zip files to encrypt email attachments:
In our opinion, relying on password-protected zip attachments to achieve HIPAA compliance is an unnecessary risk.
When choosing an encryption method for email attachments, it's important to balance security with ease of use. In our opinion, that balance is met with TLS encryption, provided you can ensure TLS encryption is always supported. That's precisely what we've done with Paubox and its patented approach to HIPAA compliant email.