Last updated 1 March 2020. HIPAA compliance for email is often seen as a confusing topic. For starters, the Health Insurance Portability and Accountability Act (HIPAA) set the standard for protecting sensitive patient data.
In a nutshell, any organization dealing with protected health information (PHI) must ensure that all the required physical, network, and process security measures are in place and followed. HIPAA compliant email also falls into this scope.
This post will lay out the aspects involved in achieving compliance for email, as well the potential dangers involved for not doing so.
Organizations include Covered Entities (anyone who provides treatment, payment and operations in healthcare) and Business Associates (anyone with access to patient information and provides support in treatment, payment or operations). This also includes making sure you have HIPAA email baked in when it comes to your email service provider.
Even subcontractors, or business associates of business associates, must also be in compliance.
This is our definitive guide on HIPAA email.
What is HIPAA Compliant Email?
The HIPAA Privacy Rule created, for the first time, a set of national standards for the safeguard of certain health information. It allows Covered Entities to disclose PHI to a Business Associate if they receive assurances that the Business Associate will use the information only in the scope of which it was engaged by the Covered Entity.
The HIPAA Security Rule was added to set out what safeguards must be in place to protect electronic PHI (ePHI), which is health information that is held or transferred in electronic form.
In regards to email, this means that covered entities are required to take reasonable steps to protect PHI from their computer and as it’s transmitted electronically, all the way to the recipient’s inbox.
Once the email reaches the recipient, the obligation of the sender ends and it becomes the recipient’s job to secure any PHI they have in their inbox.
If you are using a third party to transmit or host PHI, they are required by law to sign a Business Associate Agreement (BAA) with you. The BAA establishes that certain administrative, physical and technical safeguards are in place.
While there’s no certification that makes an email provider achieve HIPAA compliant email status, meeting the requirements set by the HIPAA Privacy & Security Rules is the best place to start, along with strong technical security measures to make sure PHI is protected inbox to inbox.
Does HIPAA Require Email Encryption?
HIPAA encryption requirements are specified by two main terms — “required” and “addressable.”
Those labeled “required” must be put in place or it’s considered a failure to comply with HIPAA.
“Addressable” requirements only have to be implemented after a risk assessment has determined that encryption is needed for managing risks to PHI.
If your organization determines that encryption is not appropriate, then you must document your reasoning behind that decision and implement an equivalent solution to safeguard PHI.
As there’s not an appropriate alternative for protecting PHI other than encryption, it’s effectively required.
Not using encryption is risky for your patients’ information and your organization.
HIPAA Compliance Violations are Increasing
Over the past 10 years, the Office for Civil Rights (OCR) division within HHS has enforced violations at a blistering pace.
- Hackers are targeting healthcare.
- HIPAA violations tripled over 10 years. Confirmed HIPAA violations are skyrocketing. Their growth rate over the past 10 years outpaces almost any trend that comes to mind.
- Stolen laptops continue to result in huge fines. In several instances, a single stolen laptop led to fines in excess of $1,000,000 from HHS.
- A stolen thumb drive averages $925,000 in HIPAA fines. Since 2012, it costs an average of $925,000 in HIPAA fines for a single stolen thumb drive.
- Stolen office computers can be subject to fines too. Even a computer that never leaves your office can still be subject to a costly fine due to a HIPAA Privacy Act violation.
- Unpatched and unsupported software can also lead to fines.
- Accidental and non-malicious internal threats are increasing as well.
HIPAA Breaches: Email Leads the Way
Our research reveals there were a total of 418 HIPAA breaches reported to HHS in 2019.
Of those breaches, Email was by far the number one threat vector.
In fact, 39% of all HIPAA Breaches in 2019 were via Email.
How to Make Your Email HIPAA Compliant
In order to make sure your organization has HIPAA Compliant Email, you need to be sure you have processes and workflows in place to ensure your staff is properly trained on HIPAA compliance.
But you also need the right technology to be sure those procedures can be made as efficient as possible.
This is especially important to overcome human error, such as forgetting to press a button or type a password to encrypt an email. Human error accounts for the vast majority of email related HIPAA violations.
Popular consumer email providers are NOT compliant:
- Gmail. By far, one of the most popular email providers in the world, Gmail is not HIPAA compliant. But as we went through in a previous post, you can make Gmail HIPAA compliant with a few extra steps.
- Yahoo. Another popular email provider, Yahoo is not compliant.
- GoDaddy. A lot of people use GoDaddy’s hosting service and subsequently use GoDaddy’s Office 365 product, but not all Office 365 email is created equal.
- Host Gator. Another popular web hosting provider that offers email hosting and is not HIPAA compliant.
This is because normal email was created with the priority on delivering messages, not security. Even if your email provider does secure email with TLS encryption, that doesn’t mean your message will be delivered securely.
That’s because if the recipient’s email provider doesn’t support TLS, your message will be downgraded and delivered unencrypted in clear text.
Google’s own data shows that only 87% of email sent with Gmail is delivered encrypted.
For HIPAA, 87% isn’t good enough. Only 100% encryption is acceptable.
Further Reading: How to Make Your Email HIPAA Compliant