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What types of email need patient authorization?

What types of email need patient authorization?


Patient authorization under HIPAA is written consent allowing healthcare providers to use or disclose protected health information (PHI) beyond routine activities. Emails discussing diagnoses, treatments, medications, non-standard PHI sharing, communication with unauthorized recipients, and those potentially inferring health information require patient authorization. Exceptions include routine communications like appointment reminders and confirmation emails, which don't need patient consent.


Email communication under HIPAA

Email communication within the healthcare sector is allowed under HIPAA for routine activities, aligning with the Privacy Rule. This framework permits covered entities to use electronic communication methods for treatment, payment, and healthcare operations. It requires HIPAA compliant email communication practices to uphold patient privacy. This flexibility enhances the overall efficiency of healthcare delivery. According to the HHS, "patients may initiate communications with a provider using email. If this situation occurs, the healthcare provider can assume (unless the patient has explicitly stated otherwise) that email communications are acceptable to the individual."


Types of emails requiring patient authorization

  1. Sensitive health information: Certain healthcare details demand heightened protection, such as emails discussing specific diagnoses, treatment plans, or prescribed medications. Patient authorization is necessary for sharing intricate health-related content that could potentially reveal an individual's identity and health status, ensuring patients retain control over their most private PHI. 
  2. Non-standard purposes: When healthcare providers need to share PHI for legal or financial purposes unrelated to treatment, payment, or healthcare operations, patient permission is required. This ensures individuals have a voice in determining how their health information is used outside standard healthcare processes.
  3. Unauthorized recipients: Patient authorization is essential when healthcare providers send emails containing PHI to external recipients not authorized to access such information. This step guarantees patient data remains within the authorized healthcare network, minimizing the risk of unauthorized access.
  4. Potential inferences: Even seemingly innocuous emails may contain information that, when pieced together, could infer an individual's health status. In such cases, patient authorization may be necessary to proactively protect privacy. This approach aligns with broader principles of patient consent and control over their health information.


Emails that do not require patient authorization

  • Routine communication: Certain email communications, including appointment reminders and general health information, are considered routine and exempt from patient authorization. These facilitate effective communication between healthcare providers and patients without delving into specific PHI.
  • Confirmation emails: Simple confirmation emails acknowledging the receipt of information or payment fall within permissible boundaries. These communications offer transparency to patients without disclosing specific PHI.

Related: What are the opt-in exceptions?


Exceptions and special cases

  • Public interest and benefit activities: HIPAA acknowledges specific scenarios allowing PHI disclosure without patient authorization for the greater public good. This encompasses public health reporting, disease prevention, research with proper oversight, and assisting law enforcement during emergencies.
  • Limited data sets and incidental uses: Covered entities can use limited data sets (with identifiers removed) for research, public health initiatives, and healthcare operations without requiring patient authorization. Moreover, the Privacy Rule recognizes incidental uses and disclosures during permitted activities, provided there are reasonable safeguards in place.



If a patient revokes their authorization, can healthcare providers continue using previously disclosed PHI?

No, once a patient revokes authorization, healthcare providers must cease any further use or disclosure of the patient's PHI for the specified purposes, even if it was disclosed before the revocation.


Can patient authorization be obtained verbally, or must it be in writing?

HIPAA generally requires written patient authorization. While some verbal agreements may be acceptable in specific situations, obtaining written consent is a more secure and preferred practice to document the patient's approval.

Read more: Does HIPAA allow verbal consent? 


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