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How to ensure the standard of integrity is upheld in email

Written by Kirsten Peremore | September 14, 2023

According to a journal article on the topic of International Journal of Information Management, “Poor security measures and inadequate responses to data breaches, for example, give rise to privacy concerns among users. Consequently, this can impede the effective use of digital health systems.”

The standards of integrity, honesty, confidentiality, respect, accountability, transparency, and fairness apply to email by requiring careful, accurate, and respectful correspondence. In practice, the application of integrity standards in emails is achieved through clear institutional policies and informed consent protocols. 

Checklists for drafting emails, review of recipients, and data management practices can help avoid risks. Email integrity is about compliance and upholding the ethical foundation rooted in the preservation of trust, privacy, and the well-being of those served.

 

What is the standard of integrity? 

A study looking at the concepts of moral and ethical integrity in research titled ‘Research Integrity: Where We Are and Where We Are Heading’ notes, “Integrity in research is the incorporation of principles of honesty, transparency, and respect for ethical standards and norms throughout all stages of the research endeavor, encompassing study design, data collecting, analysis, reporting, and publishing.”

The source of integrity as a concept lies in these core moral standards. These values are not arbitrary but are rooted in moral philosophy and social ethics, often described as moral foundations that distinguish good conduct from unethical or self-serving behavior. Integrity implies making deliberate choices aligned with these standards, even in situations where no explicit rules exist or when there is no external monitoring, thus requiring self-initiated, principled behavior rather than mere compliance with orders or norms.  

It includes honesty in reporting results, transparency about methods and conflicts of interest, respect for human subjects and data confidentiality, and fairness in authorship and peer review. These standards are codified in institutional policies and international guidelines aimed at preventing misconduct such as falsification, fabrication, or plagiarism. 

See also: How physical safeguards can help in securing email communication

 

A look at its application in communication 

Integrity in communication creates transparency and accountability, allowing individuals and organizations to be held responsible for their words and actions. A Behavioral Science (Basel) study noted on the topic of the mechanisms through which integrity plays a role in leadership behavior, “Fostering a supportive organizational culture and providing resources for ethical decision making can further enhance the likelihood of ethical leadership behavior.” This responsibility is not merely procedural; it sustains professional relationships and patient-provider trust, which are cornerstones of quality care and ethical practice. Without committed adherence to these standards, the likelihood of misinformation, ethical violations, or exploitation increases substantially.

Research integrity can be seen as a specialized application of integrity standards in scientific communication. The timely and accurate exchange of information advances the public good by enabling reproducibility and validation of research findings, while also preventing scientific misconduct such as data falsification or plagiarism. The integrity in communication supports not only scientific progress but also public confidence in research outputs, reinforcing the social contract between the scientific community and society.

Standards of integrity in communication help establish a professional culture of respect and fairness. It involves the equal treatment of colleagues, patients, and other stakeholders, and so that communications do not exploit power imbalances or marginalize voices. Ethical communication guidelines encourage openness about limitations, potential conflicts, and intentions. Respectful communication also reduces the risk of workplace conflicts, harassment, and burnout by creating a psychologically safe environment where concerns can be raised and addressed constructively.

 

The standard of integrity in email 

The HIPAA compliance framework aligns tightly with this standard by codifying explicit requirements for securing electronic protected health information (ePHI) during electronic communication, including emails, and reflecting these integrity principles into enforceable rules. A research paper from The Institution of Engineering and Technology, “Violation of data integrity will compromise the fundamentals of infrastructure, national security, commerce, political systems and health.” Upholding these standards mitigates risks of data breaches, legal liabilities, and loss of patient trust. 

HIPAA imposes technical, administrative, and physical safeguards to ensure email communications are encrypted, access-controlled, and auditable, thereby minimizing risks of data breaches or unauthorized disclosure. For email to meet these integrity standards, healthcare organizations must ensure that robust authentication, encryption (both in transit and at rest), and audit trails are in place, along with organizational policies that require careful scrutiny of email content and recipients before sending.

See also: The role of administrative safeguards in email

 

How to integrate the standard into email policies

  • Require all emails to include only accurate and truthful information.
  • Prohibit the sharing of sensitive data without proper authorization.
  • Use encryption for emails containing personal or health information.
  • Set clear rules for who can send, receive, or forward confidential emails.
  • Include disclaimers reminding staff not to alter or misuse message content.
  • Enforce strong passwords and multi-factor authentication for email accounts.
  • Train staff to recognize and report phishing or suspicious messages.
  • Keep records of email communications for accountability and audits.
  • Prohibit deleting or tampering with email history related to patient care.
  • Review and update email policies regularly to meet legal and ethical standards.

See also: HIPAA Compliant Email: The Definitive Guide

 

FAQs

Is it safe to use email for healthcare communication?

Email can be used safely in healthcare if appropriate security measures are in place. This includes encryption, secure servers, and strong authentication protocols. Sending sensitive patient information without these protections can expose it to unauthorized access.

 

What are the risks of using regular email systems in healthcare?

Regular email is vulnerable to hacking, phishing, misdelivery, and unauthorized access, which can lead to breaches of patient confidentiality and legal penalties.

 

Is it legal to send patient information via email?

Yes, under HIPAA and similar regulations elsewhere, it’s legal to use email to transmit patient information, as long as organizations have safeguards to protect the privacy and security of health data. 

 

When is email appropriate for communicating with patients?

Email is best for non-urgent issues like information updates, prescription renewals, appointment reminders, routine questions, or follow-up communications. It should not be used for urgent or highly sensitive issues, unless a secure, compliant platform is used.

 

Should internal emails between healthcare staff be encrypted?

Yes, especially if they contain PHI. Encryption helps prevent unauthorized access during transmission.