The HIPAA Security Rule includes specific technical safeguards that affect the way healthcare organizations approach email usage. These include user authentication procedures to verify that the person accessing ePHI is authorized, encryption to protect data during electronic transmission, and audit controls to record and examine email activity involving PHI.
The use of the logs that stem from these audit controls is noted in a Nature Portfolio study, “The audit logs can be used to implement stricter access and verification controls on users and also allow greater supervision from patients and communities into how their data are stored and used.”
The verification requirement ensures that email systems restrict access only to authorized users through mechanisms like unique user identifiers, strong passwords, and multifactor authentication. This prevents unauthorized persons from viewing or altering email messages containing PHI.
According to a Cochrane Library study on the use of email for clinical communication, “The main quality and safety issues around email communication include: confidentiality, potential for errors and ensuing liability.”
Verification is a way to make sure that the intended recipient is indeed the legitimate party authorized to receive the information, thereby preventing unintended disclosure. This involves mechanisms like unique user IDs and digital signatures that confirm the identities of communicating parties.
It acts as a way to ensure data integrity, ensuring messages have not been altered, and that PHI in transit remains secure from interception or tampering. Beyond its legal and ethical considerations, verification in email communication reduces administrative burdens and errors that can arise from misdirected emails or misinformation.
45 C.F.R. § 164.514(h) of the HIPAA Privacy Rule specifically addresses the matter of the verification requirement. According to a policy brief published in the Council of State and Territorial Epidemiologists, “HIPAA’s identity and authority verification requirements for those requesting data are found at 45 C.F.R. §164.514(h). A HIPAA covered entity is required to verify the identity and authority of a person requesting access to PHI” This section falls under the broader category of "Other requirements relating to uses and disclosures of protected health information."
The verification requirement in 45 CFR 164.514(h) requires that covered entities must take reasonable steps to verify the identity of any person or entity who requests access to PHI and the authority of that person to have access before releasing such information. The rule does not prescribe a specific verification method, such as requiring a driver's license or particular identification.
The provision complements other HIPAA safeguards, such as the Security Rule requirements for technical and administrative controls, by adding a practical operational requirement on verifying the requester’s legitimacy before PHI release.
The Security Rule standards that complement the verification requirement influence email communications. Email messages containing PHI should be transmitted through secure channels using encryption protocols such as transport layer security (TLS) or secure sockets layer (SSL). A PLoS One study notes, “As a widely used encryption protocol, TLS protocol is fundamental to encrypted communication. Due to various versions of TLS protocol, different vulnerabilities are introduced by different implementations.”
Integrity controls such as digital signatures or message authentication codes provide further verification. Patient consent interrelates with verification because HIPAA requires that patients be informed of risks associated with unencrypted email communication.
Patients must explicitly consent to receive PHI through unencrypted email after being apprised of security risks. This consent process itself serves as a form of verification, verifying that the patient understands and accepts the potential vulnerabilities associated with electronic communication.
The use of HIPAA compliant email software greatly assists healthcare organizations in meeting the HIPAA verification requirements by ensuring that email communications containing PHI are secure. The digital signature feature in Paubox further strengthens verification by authenticating the sender of the email. A digital signature is a cryptographic value that is unique to the sender and the message content.
This allows the recipient to verify the sender’s identity and ensures the integrity of the email content, confirming that the message has not been altered during transmission. This capability aligns with HIPAA’s requirements for integrity controls (45 CFR 164.312(c)) and person or entity authentication (45 CFR 164.312(d)), which are designed to verify the identity of users accessing ePHI and to ensure that the information remains accurate and unmodified.
Paubox also simplifies compliance with HIPAA by providing seamless integration with popular email platforms like Google Workspace and Microsoft 365 while ensuring that emails remain HIPAA compliant without requiring recipients to navigate complex portals or encryption keys. This user-friendly approach increases adoption and reduces errors or non-compliance risks caused by user mistakes, such as sending unencrypted emails. By automating complex security and verification processes in the background.
See also: HIPAA Compliant Email: The Definitive Guide (2025 Update)
HIPAA verification is also required for any disclosures of PHI including treatment, payment, or healthcare operations.
Protected health information refers to any health related information that can identify a patient like medical records.
An encrypted, electronic form used to verify the identity of the signer.