Email Parsing API Checklist for Healthcare and Compliance

Document where PHI enters, is parsed, stored, and forwarded so minimum-necessary access can be enforced at every step. Include bodies, headers, and attachments in your data inventory.

Execute a Business Associate Agreement with your vendor, or use an on-premise deployment approved by compliance. Ensure subcontractors handling email or storage are covered.

Set rules for what is stored, redacted, tokenized, or dropped to maintain minimum necessary. Include header fields that may carry PHI such as Subject or custom X-headers.

Use separate inbound addresses for referrals, prior auth, results, and patient communications to scope parsing rules and access controls. Avoid mixing high-sensitivity data with general intake.

Whitelist clinical formats and define max sizes to prevent abuse and ensure timely processing. Reject or quarantine unknown or oversized attachments to reduce risk.

Decide between hosted, private cloud, or on-prem with dedicated subnets and private connectivity to EHR systems. Restrict egress to only required webhook destinations.

Record how patient emails are authorized (e.g., treatment, payment, operations, or explicit consent) and reflect this in retention and access policies. Ensure notices align with practice privacy policies.

Create intake addresses that reveal no patient identifiers (e.g., referrals@ or imaging-intake@). Prohibit MRNs, names, or DOBs in email addresses and subdomains.

Require modern ciphers and enable MTA-STS and TLS reporting to ensure message transit encryption. Reject or quarantine cleartext connections for PHI-bearing mailboxes.

Configure SPF and DKIM for trusted senders and set DMARC to p=reject over time to reduce spoofed referrals. Monitor aggregate and forensic reports for anomalies.

Restrict clinical inboxes to known partners (e.g., hospital domains) and optionally validate SMTP TLS client certs. Log exceptions and require manual approval for new senders.

Set connection and message rate caps to protect parsing capacity and downstream webhooks. Use separate queues per department to prevent cross-impact during spikes.

Compare SMTP MAIL FROM against From and Sender headers to detect spoofing attempts. Quarantine or flag inconsistencies for compliance review.

Follow RFC 5322 and 2045 while handling malformed input safely to avoid truncation or injection. Normalize multi-part boundaries and reject ambiguous structures.

Decode quoted-printable, base64, and legacy charsets reliably so PHI detection works across diverse sources. Convert to UTF-8 and record original encodings for audit.

Remove script, form, and embedded objects and block remote images and tracking pixels. Preserve textual content only for safe downstream processing.

Identify PDFs, TIFFs, DICOM, HL7, CDA, and FHIR attachments using magic bytes, not extensions. Route each class to appropriate parsing or quarantine paths.

Apply OCR to TIFF and PDF scans so PHI detection and indexing work on fax-like sources. Include page rotation and low-quality image handling tuned for clinical documents.

Detect patient names, MRNs, DOBs, phone numbers, addresses, ICD-10/HCPCS codes, and insurance IDs. Combine regex, dictionaries, and checksums to reduce false positives.

Replace detected PHI with redaction markers or secure tokens when full data is not required downstream. Preserve reversible mappings in a secure vault with access controls.

Require mutual TLS with pinned CAs for all outbound webhook calls and inbound API access. Rotate certificates on a predictable schedule and monitor expiry.

Attach HMAC signatures using per-tenant secrets with short rotation windows. Verify signatures server-side and log mismatches for incident review.

Use KMS or HSM backed keys with envelope encryption for messages and attachments. Isolate key access by tenant and keep detailed key usage audit trails.

Include unique message IDs and expiration timestamps to prevent duplicate processing. Reject stale or reused signatures and record attempts.

Issue narrowly scoped tokens per integration and rotate them regularly. Disable unused endpoints and require IP allowlists for administrative APIs.

Queue undelivered webhooks and back off on failures to protect downstream systems. Route persistent failures to a dead-letter queue for manual triage.

Reject incorrect content-types and enforce strict schema checks for parsed email objects. Log schema drift and block unexpected fields to reduce injection risk.

Record message receipt, parsing outcomes, redaction actions, and delivery events with synchronized clocks. Use tamper-evident storage and prevent retroactive edits.

Apply jurisdiction-specific retention for PHI and automatically purge expired data. Differentiate between transient parsing artifacts and records that must be retained longer.

Log every read and export with user identity and reason codes, and require just-in-time approvals for elevated access. Notify compliance when sensitive views occur.

Use multiple AV engines and sandboxing for Office macros, scripts, and PDFs. Quarantine suspicious files and record hash evidence in audit trails.

Enable case-based preservation of emails and logs without breaking retention policies. Provide export packages with verifiable checksums and chain-of-custody metadata.

Propagate a correlation ID from SMTP receipt through webhook delivery for every message. Store traces to accelerate RCA for delayed or missing clinical documents.

Include nested multiparts, malformed boundaries, large attachments, and internationalized headers. Verify redaction, tokenization, and detection accuracy against known ground truth.

Create integration tests that transform parsed JSON into expected clinical resources or ADT messages. Confirm field-level mappings for patient identifiers and encounter context.

Set SLOs for time-to-deliver and maximum failure rates. Alert when budgets are breached and annotate incidents with release and infrastructure changes.

Detect spikes in authentication failures, alias abuse, or unrecognized partner domains. Route alerts to security operations and temporarily quarantine affected messages.

Practice containment, notification, and remediation steps for emails delivered to the wrong mailbox or partner. Validate timelines and evidence collection for regulatory reporting.

Regularly restore from backups to validate RTO and RPO for parsing metadata and encryption keys. Keep restores isolated in a secure environment with audit logging.

Track dependencies with an SBOM and apply security updates promptly. Re-run regression suites on upgrade to catch parsing changes that impact PHI detection.