How to get started with Email Marketing: Choose an ESP

Here is the follow-up to last week’s article about the pros and cons of email vs social media marketing.

If you recall, email is not better than social media (and vice versa). Both have their place in marketing and should be part of marketing your practice.

  • Social media helps practice owners build their brand and drive traffic to the practice website, which helps build up the practice email list.
  • Email marketing is effective in building trust and establishing authority. It lets you stay in touch with the people on your list, educating them about health and keeping them informed about your practice.

Today, many NPs use social media marketing to help grow their practice. However, only a few use email in their marketing.

One reason for this is the big elephant in the room… HIPAA, even though we’re talking about marketing emails that don’t contain personal health information (PHI) per se.

Digital Marketing and HIPAA

Privacy laws have changed and will continue to develop as technology does.
I think it’s safe to assume we will see increasingly tighter privacy laws, which will impact how you can market your practice across all channels.

The challenge is to keep up with changes, maintain compliance, and protect yourself and patients’ personal data.
Last year, the Office for Civil Rights (OCR) and the Federal Trade Commission (FTC) released a bulletin concerning the use of online tracking technologies by HIPAA-covered entities and Business Associates.

At issue is software like Google Analytics and the Facebook Pixel, used on websites and mobile apps that may collect and send information to third parties who may continue to track users.

While the initial warning was directed at Hospital Systems and Telehealth Providers, anyone using analytics and pixels on their sites is affected.

If you’re using a Facebook/Meta pixel or Google Analytics on your website, be sure to read the bulletin to assess if you need to make any changes to your website.

Which brings me to email marketing…

The question is, do you need to have a HIPAA-compliant ESP today? The answer is yes, and it’s in your best interest that you do.

If you don’t have a HIPAA-compliant ESP, you can’t personalize your emails, use even the most generic testimonials, or send emails to a segment of your list.

With HIPAA increasingly tightening and enforcing all regulations, you could be facing a potential breach of patient privacy and looking at stiff penalties. Not worth it…

Privacy concerns at all levels, including federal and state, will only be increasing, and it’s best to stay ahead of the curve as much as possible.

Getting Started With Email

So, what does it take to get started with email marketing?

There are two things you need:

  • An email list to send emails to (no surprise here)
  • A HIPAA-compliant email Service Provider (ESP)

The email list is something you will build over time. However, you will need an email service provider to collect email addresses and add people to your list of subscribers.

How does it work? How does your name get on an email list? You’ve probably been through the process many times without realizing you were added to a list.

Here’s what happens behind the scenes...

  • There is a sign-up box on the website for people to enter their name and email address in exchange for getting a report or receiving updates.
  • The owner of the website has an account with an ESP, which provides access to the email address collected via the sign-up box.
  • Once someone enters their information, it is sent automatically to the email service provider, the ESP, where the name gets added to a database (a list) of other email addresses.
  • The ESP handles all the technical things behind the scenes… the hosting, maintaining, and storing of the records that make up the email list.
  • Each record in the list consists of individual fields of information such as name, address, phone number, and other information collected by the list owner.
  • Whenever the list owner wants to communicate with the list, all it takes is logging into the account, creating an email, clicking on the send button, and the email is delivered to the list.
  • Powerful! The list owner knows the emails will be delivered to subscribers’ inboxes and have a chance of being opened and read.
  • That’s it in a nutshell!

So, the first step in email marketing is to set up an account with an ESP or Autoresponder, which provides the infrastructure to collect email addresses.

You have the option to send one-off, aka broadcast emails, or to send pre-written and pre-scheduled email sequences. The ESP also makes it possible to send emails to all or a select group of your subscribers, referred to as list segmentation.

The Bottom Line…

Using an autoresponder makes it easier to stay in touch with your subscribers and engage with them regularly, compared to reaching all of them via social media.

Could you use your personal email to get started with email marketing? Technically, you could. However, using a personal email is never a good idea, is not recommended, is unprofessional… and violates HIPAA.

It’s best to start with a reputable HIPAA-compliant ESP from the beginning.

Which brings me to the next topic…

How do you choose the best Email Service Provider for your practice? What’s important, and what can take a back seat?

As you can imagine, the ESP field is crowded, with many choices. Here is a list of what I consider most important when shopping for an ESP.

List of Features


Choosing a HIPAA-compliant provider is a top priority; most everything else is a second-level consideration. Verify that the encryption used by the ESP meets HHS requirements.

Ease of Use:

The platform should be user-friendly and easy to use, especially for those with little technical background or expertise. Using the platform to accomplish your objectives (sending emails) should be relatively easy. At the same time, expect a learning curve to get up to speed.

Type of Support:

Timely access to support is critical… Most ESPs will offer email and chat support, with phone support available only to the highest-level accounts. I find email support too cumbersome and time-consuming. However, support via chat is a viable option, provided the support hours will work for you.


Pricing should be in line with your marketing budget and the size of your practice. Many ESPs offer free trials that include a certain number of subscribers and monthly emails you can send. Be sure to understand precisely the monthly/yearly cost once you leave the free plan and transition to paid.
Ask questions so you know what’s included with the paid plan:

  • number of subscribers (what constitutes a subscriber: active users, bounces, etc.?)
  • number of monthly emails you can send
  • unlimited support or metered

Training & Resources:

Most ESPs provide training videos, articles, FAQs, and other resources to help new users get started and to provide ongoing help and support. The quality of the available training and resources is essential because you will utilize them to get started and when you get stuck trying to do XYZ. Is there an onboarding process to help you get started?


Ideally, the ESP should integrate with existing practice management software and other tools you may use. Make a list of all the integrations important to you.

Templates and Customization:

Most ESPs offer a variety of email templates and customization options for newsletters, alerts, and educational content for you to send to your list. The editing capabilities amongst different ESPs are something to consider, as you will spend a lot of time setting up emails in the editor, which resembles editing a document.


Do you have the ability to segment your list of subscribers easily? Can you send emails to specific groups of your contacts?

Analytics and Reporting:

What tools are included to help you track the effectiveness of email campaigns, such as open rates, click-through rates, and conversions?

Exporting your List:

How easy is it to move your list if you want to move to a different ESP? While you can move a list, it can be a pain; typically, you will use some of your subscribers. So, exploring which ESP is the best fit for you is worth the time and effort.

And finally, check or ask to see who the customers are and read their reviews. Do your due diligence, then make your decision.

HIPAA Compliant ESPs:

I don’t want to end this article without giving you a few ESPs you can start investigating.

A quick Google search brings up these nine HIPAA-compliant ESPs. Keep in mind though, since we are not a covered entity under HIPAA, I have not used any of them and have no experience using their platform. The list below is simply to help you get started.

Here is a shortcut: a site comparing all nine ESPs.

  • Paubox
  • Zivver
  • Hushmail
  • Virtru
  • ProtonMail
  • Egress
  • Identillect
  • MailHippo
  • NeoCertified

Let us know how your search and evaluation go. We would love to hear about it; please leave your feedback below…

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