Using Onebox (onebox.com) for emailing, it allows me to send a "secure email" to a patient... it actually just sends them an email with a link to my email message, which is kept on the Onebox server. I believe since it never leaves there, it is "secure"... plus I can set a password for the message (like last 4 digits of their SS#)... and have it send me a "read receipt" so I know when they've accessed the message.
It's not able, as far as I can tell, to be set as the default email program (like Outlook or Thunderbird)... so the email address needs to be cut/paste to the address line.
There is a monthly fee for a Onebox account, but it has a lot of other features that make it worth it