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Josh Ablett

HIPAA Compliant Email: 7 Tips

November 5, 2020,

You can use email securely and still remain compliant with HIPAA. Here are seven tips for securely using email in a HIPAA-compliant organization.

1) Get consent

Get a patient's written consent before sending them email. A good email consent form will explain the risks of communicating via email, explain how and why you’ll use email, explain how patients should safeguard their computer, and get the patient's signature.  Search the internet for “email consent form” to find lots of templates you adapt. It also can't hurt to have your lawyer review the form before you start using it.

Do something with the patient’s consent.

Write a procedure for staff to follow when handling consent forms that patients fill out.  This is important for two reasons: (1) It's the only way to be sure that you're actually honoring the patient's wishes about email communication, and (2) If you are ever audited or experience a security breach, it will be important to have a written procedure as evidence to prove that you're handling email securely.

2) Policy: define what staff are allowed to do with email.

Your policy should define which email addresses and devices should be used to send PHI, what information should never be sent via email (e.g., mental health and substance abuse info), and who they are allowed to email (patients, other providers, etc.).

3) Have a privacy statement at the end of HIPAA compliant emails.

A privacy statement should be automatically appended to the end of every outgoing email. Your statement reminds recipients that email is inherently insecure, states that the email is privileged and confidential, and tells the recipient who to contact if they are not the right person. Speak with your email / IT provider - they should be able to set this up for you.

4) Say yes to Business Associate Agreements.

HIPAA Business Associate Agreements are required under HIPAA. Don’t use an email provider who refuses to sign HIPAA Business Associate agreements for your medical practice. Paid Google and Microsoft365 services will sign such an agreement, as part of making them HIPAA compliant email. Free services like free Gmail, Yahoo Mail, Hotmail/ won’t.

5) Say no to any company that won’t sign a BAA.

Companies will give you all sorts of reasons as to why they won’t sign a Business Associate agreement. Here are a few that we’ve heard:

  • “Our lawyers say we don’t need one.”
  • “We never open your emails, so we’re not a Business Associate.”
  • “None of our thousands of customers have ever asked us to do that.”
  • “We’re a ‘conduit’, not a business associate.”

These are all nonsense. There are plenty of providers out there who are willing to sign a Business Associate agreement. If a vendor’s not, you’re either speaking to the wrong person within the company, or there’s a reason that they won’t. Walk away and go find a vendor that knows how to support healthcare organizations.

6) Encrypt HIPAA Compliant email with PHI or PII.

Let’s say you’re emailing a patient with the results of a lab test. You need to be as sure as can be that your patient is actually sitting at the computer when that email is opened AND that nobody else read the email in between your computer and theirs.

Using a secure email service gives you that level of assurance – the message is encrypted when it leaves your computer, and can’t be read by anyone except your patient who has a password that only she or he knows. That means anyone trying to read it along the way will only see nonsense.  You can read about our favorite secure email services here.

7) Better yet, automatically encrypt any sensitive email.

The best systems will automatically read your email on the way out, look for sensitive terms (like social security numbers, diagnoses like “diabetes,” medication names like “Zoloft,” etc.), and automatically send these encrypted and securely. These systems are great because they remove the chance of making mistakes – emails to your spouse about dinner plans are sent normally, but emails about patients, treatments, diagnoses, and lab tests are sent securely.  Learn more here.

Still feeling a bit overwhelmed?

Get some free help!  Check out our free 42-Point Checklist for ways to make your practice HIPAA compliant.

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