Email Testing Checklist for Healthcare and Compliance

Define what PHI will appear in sandbox emails and what must be synthetic or de-identified. Document approved senders, mailboxes, and prohibited content to prevent inadvertent PHI exposure.

If any ePHI could be present in test traffic, ensure a BAA is executed and the testing vendor is covered. Record legal contacts and the exact services under the agreement.

Map the fields required to validate workflows, such as MRN and date of service, and remove nonessential identifiers. Use data masking for names and addresses where possible.

Choose cloud region or on-premise deployment aligned with organizational policies. Document encryption requirements and evidence needs for SOC 2 or HITRUST.

List email types like referrals, lab results, radiology reports, eRx confirmations, and payer notices. Link each scenario to controls for intake, parsing, routing, and audit.

Provision unique addresses per scenario and team, such as lab-results+teamA@sandbox.example.org. Prevent cross-mailbox delivery to reduce PHI mixing and simplify audits.

Require STARTTLS with strong ciphers and verify certificates. Configure inbound servers to hard fail non-TLS connections to protect sensitive test content.

Permit only expected content types like PDF, XML, and DICOM, with maximum sizes tailored to clinical documents. Quarantine or block items that violate policies.

Use a KMS or HSM to encrypt stored MIME and parsed JSON. Schedule key rotation and document key usage for audits and incident response.

Enable RBAC with least-privilege roles, enforced MFA, and IP allowlists for testing users. Review access for mailbox ownership and webhook management.

Test multipart/alternative and multipart/related with inline images from radiology portals. Ensure the JSON output preserves all parts, boundaries, and content IDs.

Send HL7 v2 segments in text/plain and PDFs as base64 attachments. Verify parsing prevents mojibake and produces correct Unicode in the final payload.

Scan for MRN patterns, ICD-10 codes, CPT codes, and payer IDs, then tag findings in metadata for downstream routing. Validate false positive and false negative rates.

Ensure that debug logs, dashboards, and error traces do not include raw identifiers. Substitute tokens or hashed values when operational visibility is needed.

Parse structured clinical documents to identify patient, encounter, and provider data. Validate XPath or parser logic without writing PHI into developer consoles.

Enable signed webhooks and validate signatures server side with rotating secrets. Enforce a timestamp window and nonce to prevent replay attacks.

Use the RFC Message-ID and provider envelope metadata to de-dupe retries. Record processing state so PHI is not written twice to downstream systems.

Create separate credentials for polling APIs and disable unused scopes. Audit token usage and rotate secrets when anomalies or staff changes occur.

Use exponential backoff for webhook failures and route exhausted events to a secure dead-letter queue. Ensure error bodies and traces exclude PHI.

Deliver attachments through presigned URLs with TLS, minimal expiry, and client side scanning. Avoid caching PHI in edge services or CDN layers.

Send PDFs and DICOM with realistic metadata and batch identifiers. Verify MIME parsing, attachment extraction, and routing to appropriate clinical queues.

Include winmail.dat, message/rfc822 wrappers, and mixed alternative parts. Confirm the parser surfaces final clinical content in a consistent JSON schema.

Use provider names and patient data with accented characters and non Latin scripts. Confirm normalized UTF-8 in headers and bodies to avoid EHR mismatches.

Simulate delivery failures to ensure non deliverable reports are not ingested as clinical mail. Record bounce events and link them to the original Message-ID.

Scan attachments for known threats and macro payloads, then neutralize or block suspicious items. Log evidence in a secure audit trail without exposing PHI to testers.

Record sender, recipient, Message-ID, timestamps, webhook status, and who viewed attachments. Use write once storage and produce evidence for OCR inquiries.

Detect unexpected domains, excessive attachments, or surges in identifiers like MRN patterns. Tie alerts to on call runbooks with containment steps.

Measure time from SMTP receipt to webhook delivery and set thresholds for clinical workflows. Investigate outliers to protect care coordination timelines.

Practice restoring from archives and reprocessing test messages end to end. Validate that screenshots and incident notes do not include raw PHI.

Audit mailbox ownership, remove stale API keys, and rotate webhook secrets on a schedule. Document changes and approvals for audit readiness.