Integrity in HIPAA compliant email

Integrity in HIPAA compliant email refers to ensuring that the content of the email has not been altered or tampered with during transmission. This maintains the confidentiality and reliability of protected health information (PHI). 

Ensuring the integrity of PHI transmitted via email involves several critical measures to prevent unauthorized access, alteration, or tampering

What is email integrity?

“Since 2004, a total of 17.9B accounts have been breached, and approximately 7.1B of them have unique email addresses,” says SurfShark. This translates to one email address being breached at least three times. 

Email integrity refers to the assurance that an email's content has not been altered or tampered with during transmission. For healthcare providers, maintaining email integrity protects the confidentiality and reliability of PHI contained in the email. Any compromise in email integrity can lead to significant legal and financial repercussions and damage to patient trust.

Key components to ensure email integrity 

Encryption

Encryption is the process of converting data into a code to prevent unauthorized access. For HIPAA compliance, it's essential to encrypt emails both in transit and at rest. This ensures that even if an email is intercepted, its content cannot be easily read or modified by unauthorized parties.

• Transport Layer Security (TLS): TLS is a widely used protocol that encrypts emails during transmission. It ensures that the data sent from one server to another is secure and protected from eavesdropping and tampering.

Related: Why should ePHI be encrypted at rest and in transit?

Digital signatures

Digital signatures are a cryptographic tool used to verify the authenticity and integrity of an email. They ensure that the email has not been altered since it was signed and confirm the identity of the sender.

• Public key infrastructure (PKI): PKI involves the use of a pair of keys (a public key and a private key). The sender signs the email with their private key, and the recipient uses the sender's public key to verify the signature. This process ensures the email's authenticity and integrity.

See also: What is cryptography?

Secure email gateways

Secure email gateways (SEGs) are systems that monitor and control email traffic to prevent unauthorized access and ensure secure transmission of emails.

• Content filtering: SEGs can filter email content for sensitive information, ensuring that PHI is not sent in an insecure manner.
• Threat protection: SEGs provide protection against email-borne threats such as phishing, malware, and ransomware, which can compromise email integrity.
  
  

Audit trails

Audit trails are detailed records of email communications that track any changes or access to emails. They are essential for maintaining accountability and transparency.

• Logging: Comprehensive logging of email activities helps in tracking who accessed or modified an email, when it occurred, and what changes were made.
• Monitoring: Continuous monitoring of email systems ensures that any suspicious activities are detected and addressed promptly.
  
  

Authentication protocols

Strong authentication protocols are crucial for ensuring that only authorized personnel can send and receive HIPAA-sensitive emails.

• Multi-factor authentication (MFA): MFA requires users to provide two or more verification factors to gain access to an email account, significantly reducing the risk of unauthorized access.
• Single sign-on (SSO): SSO allows users to log in once and gain access to multiple systems without needing to authenticate separately for each one, enhancing security and user convenience.
  
  

Data integrity controls

Data integrity controls ensure that any changes to the email content can be detected and addressed promptly.

• Hashing: Hashing involves creating a unique digital fingerprint of the email content. Any alteration in the content changes the hash value, indicating tampering.
• Checksums: Checksums are used to verify the integrity of data by comparing the current value with a previously calculated value.

Best practices for ensuring email integrity

To maintain the highest level of email integrity and HIPAA compliance, healthcare organizations should adopt the following best practices:

• Regular training: Educate staff on the importance of email integrity and HIPAA compliance. Regular training ensures that employees are aware of the latest security protocols and threats.
• Policy development: Develop and enforce comprehensive email policies that outline acceptable use, encryption requirements, and protocols for handling PHI.
• Periodic audits: Conduct regular audits of email systems to identify vulnerabilities and ensure compliance with HIPAA regulations.
• Incident response plan: Develop and maintain an incident response plan to quickly address any breaches or compromises in email integrity.

See also: HIPAA Compliant Email: The Definitive Guide

FAQs

What is integrity in HIPAA?

According to the Security Rule, at § 164.304, integrity refers to “the property that data or information have not been altered or destroyed in an unauthorized manner.” 

What is the difference between encryption in transit and encryption at rest?

Encryption in transit refers to encrypting data while it is being transmitted over a network, such as an email traveling from the sender to the recipient. Encryption at rest refers to encrypting data stored on a device or server. Both types of encryption are necessary to protect PHI from unauthorized access and tampering during both transmission and storage.

What are the consequences of failing to maintain email integrity under HIPAA?

Failing to maintain email integrity under HIPAA can result in:

• Data breaches and exposure of PHI.
• Legal penalties and fines.
• Loss of patient trust and reputation damage.
• Increased scrutiny and audits from regulatory bodies.

See also: What are the consequences of not complying with HIPAA?