Email is a primary method of communication within the healthcare industry, allowing patients to make inquiries, schedule appointments, and seek medical advice conveniently. It also allows healthcare professionals to message each other rapidly. At the same time, email is a vulnerable threat to the healthcare industry. Microsoft’s Jack Mott emphasizes that “email remains one of the largest vectors for delivering malware and phishing attacks for ransomware attacks.”
Healthcare organizations are susceptible to cyber threats that compromise systems and patient data, especially through email communication. Healthcare organizations must take proper precautions by writing and following strong email policies to better protect email systems and ultimately, themselves and their patients.
Email-related policies outline how healthcare providers use and protect email communication, including when and how to share protected health information (PHI) through email channels. Maintaining such policies is crucial to organizations remaining HIPAA compliant.
Related: HIPAA compliant email: The definitive guide
The Health Insurance Portability and Accountability Act (HIPAA) was designed to protect the privacy of patients and their sensitive information. HIPAA neither prohibits sending PHI in an email nor provides specific guidelines for email protection. Ultimately, the act enforces security requirements for PHI in an email through the Privacy and Security Rules.
HIPAA’s regulations address various aspects of healthcare communication and how to safeguard patient information. The Privacy Rule establishes guidelines for the appropriate use and disclosure of PHI, including in electronic communication. It allows covered entities to communicate with patients through email while enforcing safeguards to prevent unintentional disclosures.
The Security Rule, then, complements the Privacy Rule by imposing comprehensive requirements for the security of electronic PHI (ePHI). This rule mandates that covered entities and their business associates implement technical, administrative, and physical safeguards to protect the confidentiality, integrity, and availability of patient data.
The Security Rule puts the Privacy Rule into practice by addressing the how of use and disclosure, helping healthcare organizations be HIPAA compliant. Together, they provide the means to ensure that email is HIPAA compliant for practitioners to use in day-to-day communication.
HIPAA compliance in email communications refers to organizations adhering to HIPAA’s regulations when sending, receiving, or storing email. Email is a convenient and effective method for healthcare organizations to directly engage with their patients and other healthcare professionals. Yet, with increasing cybersecurity risks today, guaranteeing and maintaining HIPAA compliant communication is critical for proper and effective patient care.
Therefore, to use email communication properly and securely, every email communication must be HIPAA compliant. Not using HIPAA compliant email increases an organization's attack surface, creating more room for cyberattackers to get into any system.
According to the U.S. Health and Human Services, "Given that the health care marketplace is diverse, the Security Rule is designed to be flexible and scalable so a covered entity can implement policies, procedures, and technologies that are appropriate for the entity's particular size, organizational structure, and risks to consumers' ePHI." The most effective method to substantiate this compliance is by writing, enacting, and updating email policies.
Email policies set guidelines on how employees should use an organization’s email system. These policies should show employees how to communicate with and about patients. HIPAA compliant email policies ensure that email communication that involves PHI is secure and accessible only to authorized individuals.
Rather than being a single policy, it is best to think of email security in terms of separate policies that work together to protect email communication. Besides a policy on the proper use of email, other email policies include email:
Healthcare email policies should clearly define who has access to email systems and how that access is granted. For example, strong passwords and multifactor authentication should be required for all email users. These policies should also establish procedures for creating, modifying, and terminating email access when employees join, change roles, or leave an organization.
Furthermore, they should specify when and how encryption should be used for email communication. Emails containing PHI must be encrypted in transit and at rest. Finally, email policies should define which email security solutions, like Paubox Email Suite, will be used to maintain HIPAA compliance.
See also: A guide to creating HIPAA compliant email policies
Read more: Why should ePHI be encrypted at rest and in transit?
HIPAA compliance demonstrates an organization's dedication to safeguarding patient privacy and adhering to healthcare regulations. The absence of clear guidelines can lead to confusion and uncertainty about what constitutes appropriate communication. It can also result in inconsistent practices among healthcare providers, leading to misunderstandings and breaches of confidentiality. Without clear policies, staff may inadvertently expose patient data.
Common violations include:
Unknowledgeable staff or staff who don’t understand or access email policies can result in misdiagnoses and other medical errors that lead to avoidable health complications, adverse incidents for patients, and HIPAA violations. HIPAA violations can also lead to reputational damage, legal consequences, and financial penalties. Healthcare organizations can reduce such issues and risks and demonstrate HIPAA compliance by implementing and maintaining secure email policies.
The success of email policies in healthcare depends on how an organization maintains and updates them. Success requires a combination of clear communication, regular training, consistent enforcement, and leadership support. Organizations must make their policies easily accessible, conduct periodic compliance checks, and use automated tools where possible to enforce security requirements.
Email policies should also be updated regularly. In fact, organizations should periodically review and update them to ensure they remain relevant and compliant with current laws and organizational practices. Furthermore, healthcare organizations must stay on top of changes in the industry’s standards and new cyber threats.
An organization’s email policies and any changes to them should be well-documented and easily accessible to employees. Any gaps or misunderstandings should be taken care of right away. Unfortunately, experts say that 37% of healthcare organizations don’t have a cyberattack contingency plan in place in case of an issue with an email. Strong email policies cover a wide range of internal matters specific to an organization and can help demonstrate that organization's commitment to HIPAA compliance.
Paubox helps patients send HIPAA compliant emails by providing a secure email platform that encrypts messages and attachments to ensure the confidentiality of sensitive health information. Patients can easily sign up for a Paubox account, compose emails as they normally would, and attach any necessary files containing PHI.
Paubox takes care of automatically encrypting both the email and attachments before sending them to the intended recipient. Recipients can access these encrypted emails securely without needing their own Paubox account, ensuring compliance with HIPAA regulations for both senders and recipients alike. Moreover, Paubox provides optional features such as email archiving and API integration, catering to organizations requiring more comprehensive compliance solutions.
More about: How can my patients send me a secure HIPAA compliant email first?
HIPAA requires encryption of PHI, access controls, audit trails, employee training, and incident response procedures. The policy must address each of these elements and specify how they'll be implemented and monitored.
An example of a HIPAA violation email is an unencrypted email containing PHI sent to the wrong recipient.
Without a policy, organizations risk inconsistent security practices, increased vulnerability to attacks, potential data breaches, regulatory violations, and financial penalties. For healthcare organizations, this could mean HIPAA violations and compromised patient information.
Using personal email accounts for sending HIPAA compliant inquiries is not recommended, as personal email platforms may lack the necessary security measures to protect sensitive health information. It's advisable to use secure email platforms provided by healthcare organizations or encrypted email services specifically designed for HIPAA compliance.
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