Violations carry significant penalties, and healthcare senders cannot use consumer email tools without a BAA.
The metrics that matter#
- Authentication pass rate: share of mail passing SPF, DKIM, and DMARC alignment. Healthy: 99% or higher.
- Spam complaint rate: Gmail enforces at 0.3%; stay under 0.1%.
- Hard bounce rate: under 2%; above 5% triggers platform reviews.
- Inbox placement: above 90% across major providers via seed tests.
- Engagement: click and reply rates by segment; opens are unreliable after Mail Privacy Protection.
Where to read them#
- Google Postmaster Tools for Gmail domain reputation, spam rate, and authentication.
- Microsoft SNDS and JMRP for Outlook.com IP reputation and complaints.
- Your ESP's delivery and bounce reports.
- DMARC aggregate reports for authentication by source.
Improving the numbers#
- Sign a BAA with your email provider and any AI or automation vendor touching mailbox content.
- Enforce TLS and use encryption for messages containing ePHI.
- Enable audit logging and retention appropriate to your policy.
- Train staff on what may and may not go in an email body or subject.
Frequently asked questions#
Is Gmail HIPAA compliant?
Google Workspace can be, with a signed BAA and proper configuration. Consumer Gmail is not.