The hidden costs of legacy email systems in healthcare

In healthcare, email remains the primary means of communication, connecting clinicians, administrative staff, patients, and external vendors. As the study “Patient Portals: Who uses them? What features do they use? And do they reduce hospital readmissions?” notes, “Although portal messaging systems were designed to replace email, many patients continue to prefer traditional email communication with their providers.”

However, beneath this familiar routine lies a growing problem: much of the industry still relies on legacy email infrastructure—systems designed decades ago, long before today’s cybersecurity threats, compliance mandates, and interoperability demands. These outdated platforms are often held together by patchwork fixes and workarounds, creating an illusion of reliability while quietly draining resources and exposing organizations to risk.

As Matt Murren, CEO of True North ITG, puts it, “I’ve seen firsthand how legacy email platforms can quietly—but critically—undermine operational stability and efficiency across healthcare organisations.” He further warns that “outdated systems often lack the security frameworks, integration capabilities, and scalability that modern healthcare environments demand. … This translates into a number of recurring issues, including frequent downtime, inefficient workflows, security vulnerabilities, and compliance risks.”

In an industry where every second counts and data protection is non-negotiable, the true cost of these legacy systems extends far beyond IT maintenance budgets. The hidden toll includes slower care coordination, compliance gaps, reduced staff productivity, and reputational harm when communication failures ripple outward to patients.

What are legacy email systems?

In the context of healthcare, a legacy email system may be characterized by one or more of the following:

• On-premises email servers or systems built many years ago, with minimal modern updates or patching.
• Limited or no built-in encryption for email, or encryption requiring manual workarounds.
• Poor integration with other systems (e.g., EHRs, secure messaging, portals), leading to siloed communication.
• User interfaces that are outdated, slow, not mobile-friendly, and cumbersome for modern workflows.
• Vendor support that is limited or discontinued, meaning patches, updates, or new features are scarce.

Essentially, this is a system designed for a different era, but it continues to serve core email workloads in a healthcare setting. And because email holds protected health information (PHI) and communications with patients, providers, and vendors, the stakes are much higher.

Cost of legacy systems in healthcare 

A recent article by RTInsights, Modernizing for Growth: Overcoming the Hidden Costs of Legacy Systems, offers a clear lens through which to view the often-overlooked burdens that legacy infrastructure places on organizations. While the piece is written with a broad enterprise audience in mind, its insights are highly transferable to healthcare settings, especially when applied to email systems that support PHI, care coordination, and compliance workflows. 

Here are the key themes from the report:

Maintenance over innovation

The report stresses that “nearly two-thirds of companies spend more than $2 million annually on maintaining legacy systems.” In a healthcare organization, this translates to large portions of the IT or communications budget being tied up in simply keeping an outdated email system running, leaving less room for innovation in patient-facing communications, secure messaging, or system integrations.

Operational inefficiencies and productivity drag

According to the article, “Legacy systems … can also create inefficiencies that hinder productivity. Many struggle to integrate with modern applications, forcing companies to rely on costly middleware or manual processes.” 

In the healthcare email context, this might look like staff manually copying emails into patient records, toggling between systems to send encrypted messages, or experiencing delays when attaching lab reports. Those extra minutes per user accumulate into a significant hidden cost.

Scalability, downtime, and competitive disadvantage

The article continues to state that “As businesses grow, legacy systems become a bottleneck … Frequent system crashes lead to costly downtime, disrupting daily operations.” 

For a hospital, clinic, or health system email platform, this means that growth (e.g., telehealth expansion, remote staff, vendor communications) may strain outdated systems, causing delays, outages, or degraded service. In healthcare, this isn’t just revenue lost; it could impact patient safety, referral timeliness, or regulatory reporting.

Security and regulatory risk

The report stresses this dual cost: “Security risks also increase, as older systems can lack modern threat protection, making them vulnerable to cyberattacks.” 

Given that emails in healthcare often contain PHI, vendor communications, lab results, and patient correspondence, the exposure rises dramatically if the underlying system is legacy. Encryption may be insufficient, audit logs may be weak or nonexistent, and patches may no longer be supported.

Opportunity cost and innovation blockade

The article observes that “Legacy systems represent a significant roadblock to digital transformation, creating inefficiencies, security risks, and financial burdens for businesses.” 

Transposed into healthcare: when your email system cannot scale, cannot integrate with EHRs/portals, or fails to support encryption workflows, you lose the opportunity to leverage secure onboarding emails, patient engagement via email, analytics on communication flows, or seamless vendor/patient interaction. Those lost opportunities are hidden costs.

The cumulative burden

Putting it all together: maintenance costs, productivity loss, downtime risk, security/compliance exposure, and missed innovation result in a far greater total cost than the “license fee” or “server cost” alone. The RTInsights article states: “The cost of maintaining outdated technology often outweighs the investment required to modernize.” 

Staying on a legacy email system may appear cheaper up front, but when you factor in slower workflows, compliance risk, potential breaches, later migration burdens, patient-care delays, and staff unhappiness, the hidden cost is high.

Read also: How legacy systems disrupt patient care

See also: HIPAA Compliant Email: The Definitive Guide (2025 Update)

FAQS

Why are legacy email systems risky for healthcare organizations?

Legacy systems pose significant cybersecurity and compliance risks. They often lack modern encryption, two-factor authentication (2FA), and secure data storage features, making them vulnerable to breaches. They also make it difficult to comply with HIPAA and other data protection regulations.

Can legacy email systems lead to HIPAA violations?

Yes. If an outdated email system fails to properly encrypt protected health information (PHI) or lacks access controls, it can result in unauthorized disclosures. Such incidents may trigger HIPAA violations, leading to hefty fines, audits, and reputational damage.

How can modern email platforms improve healthcare operations?

Modern cloud-based and HIPAA compliant email systems, like Paubox, offer robust encryption, seamless integration with EHRs and scheduling systems, and improved uptime reliability. They support automation, remote access, and enhanced threat protection, leading to safer, faster, and more compliant communication.

How does upgrading email infrastructure improve patient trust?

Secure and reliable communication builds patient confidence. When patients know their information is handled safely and communication is timely, it enhances trust and strengthens relationships with providers. Conversely, a single data breach can significantly erode that trust.