Is HIPAA Compliant Texting Possible? Guide for Healthcare Professionals

Updated on September 25, 2024 by Jordan McGlone

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Texting is generally not HIPAA compliant due to the lack of encryption, access controls, and audit trails in standard SMS messaging, making ePHI vulnerable to unauthorized access. While text messaging in healthcare can offer convenience, it often lacks the security to protect electronic protected health information (ePHI).

Standard SMS messaging usually fails to meet HIPAA compliance requirements due to its lack of encryption, access controls, and audit trails, making ePHI vulnerable to unauthorized access. However, under certain conditions—such as when a patient initiates contact or requests communication by text—texting may be permissible, provided the patient’s consent is documented. There are exceptions to HIPAA rules in emergencies like natural disasters, but providers generally must exercise caution to avoid HIPAA violations.

Is Texting HIPAA Compliant?

Standard SMS texting is usually not HIPAA compliant because it lacks required security measures like encryption, access controls, and audit trails to protect patient information. Messages containing protected health information (PHI) could be easily intercepted or accessed by unauthorized individuals.

However, it may be permissible for providers to text patients in limited circumstances, such as when the patient initiates contact by text or requests communication by text after being warned of the risks. The patient’s consent must be documented.

There are some limited exceptions where HIPAA rules on texting may be waived, such as during a natural disaster or public health emergency. Providers need to be very careful about texting PHI to avoid HIPAA violations.

Are Text Messages Prone to Breaches?

While text messages can be a convenient way to communicate, the current SMS infrastructure and common security gaps leave text messaging data vulnerable to breaches that can expose private information on a massive scale. Implementing stronger encryption, authentication, and security best practices is critical for better protecting this sensitive data.

From 2009 to 2022, 4,746 reported medical data breaches affected over 342 million records. In 2018, lost and stolen mobile devices led to the exposure of 15.1 million healthcare records, the highest number ever reported at the time.

Although HIPAA does not prohibit texting in healthcare, it requires appropriate safeguards.

Is HIPAA-Compliant Texting for Medical Professionals Possible?

Yes, text messaging services can be HIPAA-compliant. To be compliant, texting solutions need features like end-to-end encryption, access controls, audit trails, and the ability to remotely delete messages containing PHI.

Note that the general rule is that SMS texting is not HIPAA compliant, and a secure messaging platform is required to protect patient privacy. Violations can result in violations and substantial fines for healthcare organizations.

What Are the HIPAA Rules for Texting Patients?

The HIPAA Security Rule provides the most relevant controls for text messaging, ensuring that electronic protected health information (ePHI) is secure. While HIPAA does not prohibit texting patients, covered entities must implement several safeguards to maintain compliance when communicating PHI via text.

1. Establish Access Controls
   • Limit access to PHI in text messages to only authorized individuals.
   • Each user must have unique login credentials to access the texting platform.
   • Implement automatic logoff after a period of inactivity to prevent unauthorized access.
2. Use a Secure, Encrypted Texting Platform
   • Standard SMS texting is not HIPAA compliant due to a lack of encryption.
   • Messages must be encrypted in transit and at rest to prevent interception.
   • Secure texting platforms designed for healthcare have the necessary encryption.
3. Obtain Patient Consent
   • Get the patient’s written consent before texting them PHI.
   • Inform patients of the risks of communicating PHI via unencrypted channels.
   • Document the patient’s consent and preferences (e.g., appointment reminders only).
4. Implement Audit Controls
   • Monitor and log all texting activity involving PHI.
   • Establish audit trails to detect any unauthorized access.
   • Regularly review audit logs to identify any security risks or abnormal patterns.
5. Ensure Data Integrity of PHI
   • Protect PHI in texts from being improperly altered or destroyed.
   • Implement safeguards to maintain the integrity of PHI sent via secure texting.
6. Require User Authentication
   • Users must verify their identity before accessing PHI in the texting platform.
   • Authentication methods may include passwords, PINs, smart cards, or biometrics.
7. Have a Signed Business Associate Agreement (BAA)
   • Covered entities must have a signed BAA with any secure texting platform vendor.
   • The BAA specifies the required safeguards for protecting PHI.
8. Adhere to the Minimum Necessary Standard
   • Only share the minimum PHI necessary in text messages to perform a given function.
   • Avoid texting highly sensitive medical information whenever possible.

Choose PatientCalls for secure text messaging and HIPAA compliance, as our platform offers end-to-end encryption. Our services include advanced security features that meet HIPAA compliance standards.

We ensure that patient information remains confidential and protected with user authentication, audit trails, and secure access controls. With PatientCalls, you can communicate with patients efficiently while maintaining the highest level of data security.

Risks of Texting ePHI in Healthcare

Texting electronic protected health information (ePHI) poses several risks that can jeopardize patient privacy and compliance with HIPAA regulations. These risks stem from the inherent limitations of standard SMS messaging and the use of personal devices.

Understanding these risks is crucial for healthcare organizations to ensure secure communication and protect sensitive patient data.

Lack of Encryption

Standard SMS text messages are not encrypted end-to-end, making the content vulnerable to interception by unauthorized parties during transmission. If a mobile device with unencrypted ePHI texts is lost or stolen, the information could be accessed by whoever possesses the device.

Inability to Control Message Retention

Text messages containing ePHI may be stored indefinitely on mobile carriers’ servers, outside the control of the healthcare organization. This could allow future unauthorized access to ePHI and create challenges for managing data retention policies.

Difficulty Authenticating Recipients

It can be challenging to verify the identity of the person receiving the text message and ensure that ePHI is being sent to the right individual. Accidentally sending ePHI to the wrong recipient via text poses a major privacy risk.

Inability to Remotely Delete Messages

If a mobile device with ePHI texts is lost or stolen, the healthcare organization may not have the ability to remotely wipe the messages from the device. This could lead to a data breach if the device ends up in the wrong hands.

Lack of Audit Controls

Standard texting platforms do not provide the detailed audit trails needed to monitor who is accessing and sharing ePHI for HIPAA compliance. Without these audit controls, it is difficult to investigate any security incidents involving texted ePHI.

Use of Personal Devices

If staff use personal mobile devices to text ePHI, the security of that data is at higher risk than with managed corporate devices. Personal devices may lack encryption, secure authentication, remote wipe capabilities, and other necessary safeguards.

What Types of Healthcare Entities Need to Use HIPAA-Compliant Texting?

Any organization or individual that meets the definition of a covered entity or business associate under HIPAA must implement secure texting practices when transmitting PHI electronically. This broad umbrella covers most traditional healthcare providers as well as a range of supporting service companies and vendors.

HIPAA’s secure texting requirements also bind employees and affiliates of these organizations.

1. Covered entities

• This includes health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically.
• Examples are doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies.

2. Business associates

• These are vendors and third-party contractors that provide services to covered entities and have access to PHI.
• Examples include billing companies, IT providers, shredding companies, lawyers, accountants, and cloud storage services.

3. Healthcare professionals

• Physicians, nurses, technicians, and other medical staff within covered entities must use HIPAA-compliant texting when discussing patient information.

4. Affiliates and employees of covered entities

• Any employee, volunteer, trainee, or other person under the direct control of a covered entity must follow every HIPAA text messaging policy.
• Affiliates could include students, visiting nurses, temp workers, and remote employees.

5. Insurers and health plans

• Health insurance companies and employer-sponsored health plans are covered entities under HIPAA.

Best Practices to Maintain HIPAA-Compliant Text Messaging

The first step to maintaining compliance with HIPAA regulations is to familiarize your team with the appropriate safeguards. By understanding these regulations, your team can create strong policies that will help protect patient’s sensitive information.

Below are some of the best practices to adopt for maintaining HIPAA-compliant messaging.

1. Use Encrypted Messaging Platforms
   • Choose a secure texting platform that provides end-to-end encryption for messages both in transit and at rest. This protects ePHI from unauthorized access.
2. Implement Access Controls
   • Limit access to ePHI to authorized individuals only. Ensure that each user has unique login credentials and enforce automatic logoff after periods of inactivity.
3. Obtain Patient Consent
   • Get explicit, written consent from patients before sending them PHI via text. Inform patients of the risks involved and document their preferences.
4. Enforce Strong Authentication
   • Require multi-factor authentication to access the messaging platform. This adds an extra layer of security by verifying user identity.
5. Establish Audit Trails
   • Maintain detailed logs of all text messaging activity involving ePHI. Regularly review these logs to monitor for unauthorized access and potential security incidents.
6. Control Message Retention
   • Implement policies to manage how long text messages containing ePHI are retained. Ensure that messages are deleted in accordance with data retention policies and HIPAA guidelines.
7. Train Staff
   • Provide regular training for staff on HIPAA requirements and secure texting practices. Ensure they understand how to handle ePHI safely and comply with organizational policies.
8. Utilize Remote Wipe Capabilities
   • Ensure that the texting platform or mobile device management system allows for remote wiping of ePHI if a device is lost or stolen.
9. Trust HIPAA-Compliant Outsourcing Services
   • Partner with trusted HIPAA-compliant outsourcing services like PatientCalls to handle secure messaging. These services offer specialized solutions and additional safeguards to ensure compliance and protect patient data. PatientCalls offers a HIPAA-compliant messaging platform for healthcare organizations.

By adhering to these best practices, healthcare organizations can mitigate risks and maintain compliance with HIPAA regulations while effectively using text messaging to communicate with patients.

Secure ePHI with HIPAA Compliant Text Messaging and Answering Services from PatientCalls

Ensure the highest level of security for your electronic protected health information (ePHI) with PatientCalls’ HIPAA-compliant secure text messaging and answering services. Our state-of-the-art secure messaging platform provides end-to-end encryption, safeguarding your communications against unauthorized access and ensuring that sensitive data remains confidential.

PatientCalls offers more than just secure texting; our comprehensive services include comprehensive access controls, detailed audit trails, and compliance with all HIPAA requirements. We manage patient consent, enforce strong authentication, and provide tools to remotely wipe data if a device is lost or stolen.

Our dedicated team ensures that your organization stays compliant while you focus on delivering exceptional patient care. Trust PatientCalls to protect your ePHI with the highest standards of security and reliability.

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About The Author

Jordan McGlone

Jordan has more than seven years of experience working for PatientCalls and a strong background in the healthcare answering service industry. He designs directive plans to fit the unique structure and activities of healthcare organizations, while ensuring that communications are efficient, compliant with HIPAA privacy and security regulations, and support optimal patient care.