Accidental HIPAA breaches via email can have serious consequences for healthcare organizations and patients. In this very concise guide, we'll cover what constitutes a breach, who needs to report it, and the steps for managing such breaches effectively.
What constitutes a breach?
A breach occurs when unsecured protected health information (PHI) is accessed, used, disclosed, or acquired without proper authorization, potentially compromising the security or privacy of the PHI. Accidental email breaches often result from:
- Autofill errors
- Sending to the wrong recipient
- Inclusion of PHI in email threads
Who needs to report a breach?
- Covered Entities: Healthcare providers, health plans, and healthcare clearinghouses that transmit health information electronically must report breaches to the Office for Civil Rights (OCR).
- Business Associates: Organizations or individuals providing services to covered entities that involve access to PHI must also report breaches and collaborate with covered entities on notification and mitigation.
Risk assessment
Before reporting a breach, perform a risk assessment to determine if the breach meets the criteria for reporting. If there's a low probability of the PHI being compromised, the breach may not need to be reported.
Reporting timeline
Fewer than 500 Individuals: Notify the OCR within 60 days of the end of the calendar year in which the breach was discovered. b. 500 or More Individuals: Notify the OCR without unreasonable delay and no later than 60 days from the discovery of the breach.
Reporting method
Use the OCR's online breach report form on the HHS website to report breaches by both covered entities and business associates.
Notify affected individuals
Covered entities must notify affected individuals without unreasonable delay and no later than 60 days after discovering the breach. Notifications should be sent via first-class mail or email if the individual has agreed to receive electronic notifications.
Media notification (if applicable)
If a breach affects 500 or more individuals within a state or jurisdiction, the covered entity must notify prominent media outlets serving that area.
Mitigation and prevention
- Implement mitigation strategies, such as requesting the recipient to delete the email, remote deletion, or monitoring for potential misuse of PHI.
- Prevent future breaches by providing staff training, implementing HIPAA compliant email, double-checking recipients before sending sensitive information, and conducting regular HIPAA audits and assessments.
Understanding the nature of HIPAA email breaches, reporting responsibilities, and steps for managing such incidents is crucial for healthcare organizations to protect patient privacy and maintain compliance. In a Smart Brevity style, this guide offers a concise yet comprehensive overview of handling accidental HIPAA email breaches.
Dean Levitt
