[MaxfordAndSons]

>To contract this out would be a terrible breach of protocol.

That's false. HIPPA covered entities are allowed to engage contractors, who are allowed to handle protected health information (they also must comply with HIPPA, of course).

Source: have worked for an HIO (health information organization, a type of HIPPA compliant contractor), and https://www.hhs.gov/hipaa/for-professionals/faq/547/to-what-...

[jacquesm]

You are 100% correct, I messed that up. What came to mind was the likes of Sendgrid or Mailchimp. Apologies and thank you for the correction.