How to safeguard against violations and breaches in email

The Health Insurance Portability and Accountability Act (HIPAA) has established clear guidelines for maintaining the confidentiality and integrity of protected health information (PHI), and email has become a primary means of transmitting this data. However, many healthcare providers struggle to fully understand the nuances of HIPAA compliance, leading to preventable email-related violations and data breaches.

Understanding HIPAA compliance for email

Regulatory requirements for HIPAA compliant email

The foundation of HIPAA compliant email lies in adherence to the HIPAA privacy and security rules. These regulations outline healthcare organization requirements for confidentiality, integrity, and availability of PHI transmitted via email. The main aspects of HIPAA email compliance include:

• Policies and procedures: Healthcare organizations must establish and document policies and procedures for the handling of email communications containing PHI, including consent, secure email practices, and employee training.
• Email retention: Healthcare organizations must implement a secure and accessible email retention system to maintain a record of email communications for a minimum of six years, as required by HIPAA and various state laws.
• Audit and access controls: Administrative access settings must be in place to maintain the integrity of the email system, limiting access to only those individuals who require it for their job functions.
• Employee training: All employees within the healthcare organization must be trained on their responsibilities and best practices for handling and transmitting PHI via email, including an understanding of the minimum necessary rule.
• Business associate agreements (BAAs): Healthcare organizations must have a BAA in place with any vendors or service providers that handle or process PHI on their behalf, ensuring that the appropriate administrative, physical, and technical safeguards are in place.

Implications and common mistakes

HIPAA email compliance requirements have several implications that healthcare organizations must consider:

• Free email services: Commonly used free email services, such as Gmail, Yahoo, and Outlook, are not HIPAA compliant.
• Paid email services: Even paid email solutions, including Google Workspace and some versions of Microsoft Office, may not be HIPAA compliant in their default settings, as they prioritize message delivery over end-to-end security.
• Fulfillment of HIPAA obligations: Inadequate email retention and limited email search functionality can hinder an organization's ability to produce email records for audit or legal requests, despite being HIPAA compliant in theory.

Cybersecurity considerations for HIPAA compliant email

Ensuring the security of email communications is a fundamental component of HIPAA compliance. While the HIPAA security rule outlines specific security measures, healthcare organizations must stay informed about new threats and implement cybersecurity practices to protect against any reasonably anticipated risks or disclosures.

HIPAA compliant email service providers

In recent years, several vendors have developed email services specifically designed to meet HIPAA compliance requirements. These solutions incorporate the necessary security features and management tools, ensuring that protection is in place for both staff and patients.

Cybersecurity measures

The cybersecurity requirements for HIPAA compliant email extend beyond the regulations and include the following elements:

• Encryption: Implement encryption protocols to secure email content, ensuring information remains private and secure.
• Email phishing protection: Deploy technological solutions and user education to detect and block phishing attempts that could lead to data breaches or system compromises.
• Spam protection: Implement email spam filtering systems to identify and block unwanted or potentially harmful messages, including advertisements, phishing attempts, and other malicious emails.
• Virus protection: Integrate antivirus software to scan emails, including attachments and links, for the presence of malware, preventing the spread of viruses and protecting the integrity of the organization's systems.
• Ransomware protection: Implement a ransomware security strategy, including endpoint protection and network-level monitoring, to prevent, detect, and respond to ransomware attacks that could encrypt or lock down data.

HIPAA-friendly email technology solutions

The successful implementation of HIPAA compliant email requires adopting appropriate technology solutions that address the unique challenges and requirements of the healthcare industry. Outdated, insecure, or overly complicated email systems can hinder compliance efforts and increase the risk of human error-related violations.

Outdated email solutions to avoid

Healthcare organizations should steer clear of the following outdated email technologies that can undermine HIPAA compliance:

• Encryption as an option: Email services that require users to manually encrypt individual messages increase the likelihood of human error and overlooked PHI in unencrypted communications.
• Security portals: Cumbersome email security portals that require patients to log in to a separate webpage to retrieve messages can be frustrating for users and lead to decreased adoption.
• Smartphone email apps: Mobile email apps that require patients to use their phones to access secure communications can be inconvenient and may not provide the same level of security as desktop-based solutions.
• Reliance on passwords: Solely relying on password protection for documents containing PHI is insufficient and has resulted in HIPAA violations and fines in the past.

Recommended HIPAA compliant email solutions

To address these challenges, healthcare organizations should consider adopting HIPAA-friendly email technologies that provide security and compliance features, including:

• Zero-step email encryption: Solutions that automatically encrypt email communications, eliminating the need for senders to manually encrypt messages or for recipients to log in to a portal or enter a password.
• HITRUST CSF certified vendors: Selecting email service providers that have achieved HITRUST CSF Certification, which demonstrates their ability to meet regulatory and industry-defined requirements for managing risk and protecting sensitive data.

Developing a HIPAA compliant email strategy

Achieving and maintaining HIPAA compliance for email communications requires an approach that addresses the regulatory requirements, cybersecurity best practices, and the implementation of appropriate technology solutions. Healthcare organizations should consider the following elements when developing their HIPAA compliant email strategy:

Establish policies and procedures

Begin by creating comprehensive policies and procedures that outline the organization's requirements and expectations for handling email communications containing PHI. These policies should cover:

• Obtaining patient consent for email communications
• Implementing secure email practices
• Defining email retention and archiving protocols
• Establishing access controls and audit mechanisms
• Providing employee training on HIPAA compliance and best practices

Implement comprehensive cybersecurity measures

Ensure the organization's email infrastructure has the necessary cybersecurity controls to protect against evolving threats, including:

• Deploying encryption protocols
• Implementing email phishing and spam protection
• Integrating antivirus and ransomware protection solutions
• Regularly reviewing and updating security measures to address new vulnerabilities

Select HIPAA-friendly email technology

Carefully evaluate and select email service providers that offer HIPAA compliant solutions. Look for vendors with HITRUST CSF Certification and features such as zero-step email encryption, secure archiving, and administrative controls.

Provide ongoing employee training and awareness

Educate all employees on their responsibilities and best practices for handling email communications containing PHI. Training should cover the organization's policies and procedures, the minimum necessary rule, and consequences of non-compliance.

Conduct regular assessments and updates

Regularly review the organization's HIPAA compliant email practices, policies, and technology solutions to ensure they remain up-to-date and effective. Conduct annual risk assessments and make necessary adjustments to address new threats and regulatory changes.

Learn more: HIPAA Compliant Email: The Definitive Guide 

Our recommendation: Paubox

Paubox’s HIPAA compliant email service delivers encryption on 100% of emails that go out—even if the recipient’s provider doesn’t support encryption. 

Paubox Email Suite enables HIPAA compliant email by default and automatically encrypts every outbound message. You don’t have to decide which emails to encrypt, and your patients can conveniently receive your messages right in their inbox—no additional passwords or portals are necessary. 

It's a seamless and stress-free experience. Unlike other providers, Paubox makes HIPAA compliant email behave like regular email for both senders and recipients. Paubox’s Encrypted Email allows users to write and send emails as normal from a laptop, desktop, and mobile device. Your recipients can view messages and attachments without needing to enter extra passwords, download an app, or login to a portal. 

In the news

Email is a common communication tool in healthcare, as evidenced by the 361.6 billion emails sent daily. According to Paubox’s January 2024 breach report, email breaches affected 137,008 people, marking it as the third most common type of breach. These breaches occurred through unauthorized access to or disclosure of protected health information (PHI) via email.

FAQs

Can healthcare providers use email to discuss health issues with patients?

Yes, healthcare providers can use email to discuss health issues with patients as long as they apply reasonable safeguards, comply with the minimum necessary standard, and ensure the transmission of electronic PHI is in compliance with the HIPAA regulations.

What should healthcare providers do if they suspect a HIPAA violation in email communications?

If a healthcare provider suspects a HIPAA violation in email communications, they should conduct a thorough investigation to determine the nature and extent of the violation. They should also take appropriate corrective measures and report the incident to the relevant authorities, such as the Office for Civil Rights (OCR) within the Department of Health and Human Services (HHS).

Read also: Top 10 HIPAA compliant email services