Email to JSON Checklist for Healthcare and Compliance

Document how email enters your environment, where JSON is produced, and which systems consume it, including EHR, CRM, and data lake. This supports HIPAA risk analysis and ensures PHI is only exposed to authorized systems.

Execute a BAA with all vendors handling PHI and set a RACI for email ingestion, parsing, storage, and delivery. Clear accountability reduces breach risk and audit gaps.

Choose on-premise, VPC isolated, or dedicated region based on sensitivity, volume, and residency needs. Validate that all components of the Email to JSON pipeline can be isolated within your chosen boundary.

Create a whitelist of fields to include in JSON, such as sender, timestamps, and clinical identifiers, excluding unnecessary content. Enforce this list in parsing and delivery to honor HIPAA's minimum necessary standard.

Specify where email and JSON can reside and how long they persist, with automated deletion policies. Align with state laws and organizational record retention schedules.

Enumerate threats covering SMTP ingress, attachment malware, webhook exposure, and insider misuse. Address controls like anti-malware, rate limits, and strict authentication for each vector.

Enforce STARTTLS or direct TLS for inbound mail and HTTPS with strong ciphers for webhooks. Verify certificates and disable legacy protocols to protect PHI in transit.

Set MX, SPF, DKIM, and DMARC with reject or quarantine policies for dedicated inbound domains. This reduces spoofing risk and improves provenance for downstream JSON consumers.

Use mTLS to authenticate both ends or sign payloads with rotating HMAC secrets. Add nonce and timestamp checks to prevent replay and man-in-the-middle attacks.

Ensure raw MIME, parsed JSON, and transient queues are encrypted using FIPS 140-2 validated libraries. Manage keys in an HSM or cloud KMS with strict separation of duties.

Support decryption of protected messages and attachments using managed private keys stored in an HSM. Log all key access for audit and ensure decrypted content never leaves the secure boundary.

Apply per-sender rate limits, blocklists, and spam filtering before parsing. Prevent floods that could bypass DLP or saturate downstream clinical integrations.

Normalize and validate From, To, CC, and Reply-To with RFC-compliant parsing and punycode handling. Preserve validated addresses in JSON to simplify access control decisions.

Capture Message-ID, Received headers, DKIM results, and parsing timestamps. Include a cryptographic digest of the raw MIME to anchor audits and idempotency.

Convert all parts to UTF-8, strip active content, and remove dangerous HTML attributes. Keep a sanitized HTML snapshot and a plain text version for downstream processing.

Detect MIME types using signature-based inspection, then scan with multiple engines. Quarantine and mark JSON with disposition if malware is suspected to protect clinical systems.

Run OCR on PDFs and TIFFs to extract text and apply regex or ML-based PHI classifiers. Tag JSON with PHI confidence and route for redaction if thresholds are exceeded.

Replace direct identifiers with tokens or hashed values where possible. Maintain a secure mapping service for authorized re-identification behind stricter access controls.

Validate HMAC or mTLS details on every request and reject reused nonces or timestamps outside a short window. Log verification outcomes for each event.

Generate a stable key from Message-ID and a content hash to prevent duplicate records in EHR or case systems. Store processing outcomes to support exactly-once semantics.

Use exponential backoff with jitter and route failed deliveries to a dead-letter queue. Include the raw MIME digest and JSON schema version for later replay.

Offer short-lived tokens and time-bounded cursors for periods when webhooks are disabled. Rate limit and audit each fetch to maintain compliance visibility.

Embed a schema version in every payload and validate in CI and at runtime. Backwards-compatibility guarantees reduce breaking changes in clinical workflows.

Deliver appointment emails to scheduling services, lab reports to a secure queue, and patient inquiries to support. Use PHI classification tags to restrict sensitive flows.

Create fixtures with synthetic names, MRNs, DOBs, and clinical terms across body, headers, and attachments. Use them to test detection, redaction, and minimum necessary enforcement.

Diff parsed JSON against ground truth for headers, encodings, and attachments under varied charsets. Catch edge cases like nested multiparts and malformed boundaries.

Apply rules for identifier counts, unexpected domains, and attachment leakage. Quarantine events that exceed thresholds and notify compliance for review.

Measure time from SMTP accept to webhook success and alert on SLO breaches. Segment by mailbox and attachment size to identify bottlenecks.

Write structured logs with event IDs, actor IDs, and cryptographic hashes to append-only storage. Periodically attest log integrity for auditors.

Exercise scenarios like compromised webhook secrets or malware-laden attachments. Validate notification timelines, containment steps, and evidence collection.