How do I know that my email is HIPAA compliant?

The secure handling of healthcare information is an important part of any organization that works with protected health information (PHI), as it must adhere to the Health Insurance Portability and Accountability Act (HIPAA) regulations.

Achieving and maintaining HIPAA compliance in email communication is a multifaceted process that requires continuous effort and attention to detail.

The importance of HIPAA compliant email

Email remains one of the most widely used communication tools in healthcare. “In primary care, email is routinely used by healthcare professionals to communicate within and between institutions about a range of issues, from diagnoses to logistical issues. Messages can convey multiple topics and can be sent to several recipients,” writes Clare Goyder, et al. in the study Email for clinical communication between healthcare professionals. Additionally, the study notes that email can also be used “to request prescriptions from pharmacists.” However, standard email platforms were not built to safeguard PHI, which leaves sensitive data vulnerable unless proper safeguards are in place. HIPAA compliant email ensures:

• Patient privacy protection: By ensuring that email communications adhere to HIPAA standards, healthcare organizations can prevent unauthorized access, disclosure, or breaches of sensitive patient information.
• Legal compliance: Compliance with HIPAA regulations is a legal requirement for healthcare organizations. Failure to adhere to these standards can result in severe penalties, fines, and legal consequences. Using HIPAA compliant email helps healthcare entities avoid legal liabilities and demonstrates a commitment to regulatory compliance.
• Prevention of data breaches: 94% of cyberattacks begin with a malicious email, and healthcare organizations are particularly vulnerable due to the valuable nature of PHI. HIPAA compliant email practices can help prevent data breaches, thus protecting patients from identity theft and other malicious activities.
• Avoiding penalties and sanctions: Non-compliance with HIPAA regulations can result in significant financial penalties and sanctions. Using HIPAA compliant email is a proactive measure to avoid these penalties.
• Secure communication among healthcare professionals: Secure email communication ensures that sensitive information is shared only with authorized individuals, supporting effective collaboration without compromising patient privacy.
• Mitigating risks associated with technology: As technology evolves, so do the risks associated with email communication. HIPAA compliant practices adapt to emerging threats, helping healthcare organizations stay ahead of cybersecurity challenges and mitigate the risks posed by evolving technologies.
• Improved patient care coordination: By ensuring the confidentiality and integrity of PHI, HIPAA compliant email practices contribute to seamless and secure patient care coordination.

Related: Understanding and implementing HIPAA rules

How do I know that my email is HIPAA compliant?

Ensuring that your email communication is HIPAA compliant protects sensitive healthcare information. Here are some general guidelines to help you determine if your email is HIPAA compliant:

Encryption protocols

To safeguard PHI during transmission, organizations must implement encryption protocols such as TLS or SSL. These cryptographic measures protect the data as it travels between the sender and recipient, minimizing the risk of unauthorized access.

Access controls and authentication

Maintain strict access controls by employing strong authentication methods. Implementing robust passwords, two-factor authentication (2FA), and limiting access on a need-to-know basis are critical steps to ensure that only authorized individuals can access PHI.

Audit trails for accountability

Keep detailed audit trails that track user activities related to PHI. This includes monitoring who accessed information, when they accessed it, and any modifications made. Audit trails enhance accountability and help identify and address potential security breaches.

Securing email servers

Regularly update and secure your email servers with the latest patches and security measures. Firewalls and other protective mechanisms should be in place to safeguard against unauthorized access and potential vulnerabilities.

Business associate agreements (BAAs)

If you use email service providers, ensure they sign business associate agreements (BAAs). These legal documents establish the responsibilities of service providers in safeguarding PHI, providing an added layer of assurance. The absence of a BAA means the provider is not HIPAA compliant, regardless of the security features they claim to offer. As the HHS states, “The HIPAA Rules generally require that covered entities and business associates enter into contracts with their business associates to ensure that the business associates will appropriately safeguard protected health information.” Using a provider that refuses or fails to do so exposes the organization to compliance violations, potential OCR enforcement actions, and significant financial penalties.

User training on HIPAA compliance

Educate your staff on HIPAA compliance and train them to recognize and handle PHI appropriately. Promote awareness about secure communication practices and the risks associated with mishandling sensitive information.

Securing email attachments

Extend security measures to email attachments containing PHI. Encrypt files or use password protection to ensure that only authorized recipients can access the sensitive information.

Secure storage of email messages

If your email system stores messages, implement secure storage practices. This includes encryption and access controls to protect stored PHI from unauthorized access.

Comprehensive HIPAA compliance policies

Develop and enforce comprehensive HIPAA compliance policies and procedures within your organization. Clearly outline guidelines for email communication, PHI handling, and security measures to maintain compliance.

Regular audits and assessments

Conduct regular audits and assessments of your email system to identify and address any potential vulnerabilities. This proactive approach ensures ongoing compliance and helps organizations stay ahead of evolving security threats.

How do I send HIPAA compliant emails?

Sending HIPAA compliant emails involves implementing specific measures to ensure the secure transmission of PHI. Here's a guide on how to send HIPAA compliant emails:

• Use a secure email service: Choose a secure and HIPAA compliant email service provider, such as Paubox. Make sure the service adheres to HIPAA regulations, signs a BAA, and uses encryption for data in transit.
• Enable encryption: Ensure that your email system supports encryption at rest and in transit.
• Implement access controls: Limit access to PHI by implementing access controls to authorized personnel.
• Use secure attachments: When sending attachments containing PHI, encrypt the files or use password protection. This adds an extra layer of security to ensure that only intended recipients with the decryption key or password can access the sensitive information.
• Avoid including PHI in subject lines: Refrain from including PHI in email subject lines. Keep subject lines generic and avoid any content that directly identifies the nature of the information being transmitted.
• Use disclaimers: Include a disclaimer in your email footer indicating that the information in the email is confidential and protected by HIPAA. This disclaimer reminds recipients about the sensitive nature of the content.
• Set message expiry and recall options: Some email systems allow you to set message expiry or recall options. This can be useful if you need to restrict access to the information after a certain period or if a message needs to be recalled due to an error.
• Regularly update software and security measures: Keep your email software and security measures up-to-date. Regularly apply patches and updates to address any vulnerabilities that could be exploited by malicious actors seeking unauthorized access to PHI.
• Provide training for staff: Train staff on HIPAA compliance policies and the proper handling of PHI in emails. Ensure that employees are aware of the risks associated with mishandling sensitive information and understand the organization's protocols for secure communication.
• Use secure networks: Send HIPAA compliant emails from secure networks to minimize the risk of interception. Avoid public Wi-Fi networks or unsecured connections when transmitting PHI.
• Monitor and audit email activity: Implement monitoring and auditing mechanisms to track email activities. Regularly review logs and audit trails to identify any unauthorized access or potential security breaches promptly.
• Obtain patient consent: Obtain patient consent before communicating sensitive information via email. Clearly explain the nature of the information to be shared and obtain explicit permission.
• Regularly review and update policies: Conduct regular reviews of your organization's policies regarding email communication and HIPAA compliance. Update policies as needed to align with changes in regulations or improvements in security practices.
• Secure email archiving: If your organization archives emails, ensure that the archiving system is also secure and compliant with HIPAA regulations. This helps in maintaining the security of PHI over the long term.

Go deeper:

• How to send HIPAA compliant emails
• HIPAA email: What you need to know

FAQS

What makes an email HIPAA compliant?

An email is HIPAA compliant when it includes appropriate administrative, technical, and physical safeguards to protect PHI. This typically includes encryption, access controls, audit logging, secure storage, employee training, and a signed BAA with any email service provider handling PHI.

Is regular email, like Gmail or Outlook, HIPAA compliant?

Standard email platforms are not inherently HIPAA compliant. They can only be used for HIPAA-regulated communication if they are properly configured with encryption, access controls, audit logging, and if the provider signs a BAA. Without these safeguards, regular email poses a high risk to PHI.

Are internal emails between staff subject to HIPAA rules?

Yes. HIPAA applies to both internal and external email communications if PHI is involved. Internal emails must still be secured, monitored, and accessible only to authorized personnel.