Privacy is Paramount: Best Practices for HIPAA Compliant Text Messaging

Text messaging has become an integral part of healthcare communication, offering a convenient and immediate way for healthcare payers and providers to connect with patients and members. However, because patient and member privacy is paramount in healthcare, healthcare leaders must consider the strict privacy and compliance rules related to communication and protected health information (PHI). Understanding HIPAA and its regulations is important before utilizing a text messaging service for communication to mitigate any privacy concerns. 

Whether you are a marketer looking to drive better campaign performance, a quality improvement professional trying to improve member and patient adherence, or a digital marketer looking to drive adoption of your app and portal, having an effective channel for communication that doesn’t compromise the organization’s HIPAA compliant requirements can seem like a daunting task.

Relay has been at the forefront of member and patient communication, using our HIPAA compliant communication channel, the Relay Feed, to help various healthcare provider and payer clients to connect and engage with their member and patient populations. To see a Relay Feed in action, click the link below. 

This blog post will detail the recent growth of text messaging in healthcare, common misconceptions around HIPAA and text messaging, like whether iMessage is HIPAA compliant, and some best practices for HIPAA compliant communication. Use this as a guide as you look for compliant texting solutions and as a primer for any conversations you might have with your internal compliance team. As always, we recommend consulting your compliance team as you evaluate solutions for communicating with patients and members. 

Here is a breakdown of what’s in the blog:

We jump into the specifics of each one below.

Understanding HIPAA is crucial for anyone involved in healthcare, including covered entities and their business associates, but especially those who are managing patient and member communications. As many know, HIPAA serves as the standard for protecting sensitive patient and member information and therefore must be strictly followed when determining a communication strategy that involves text messaging. HIPAA provisions include the Privacy Rule, which establishes patients’ rights over their health information and sets boundaries on its use and disclosure, and the Security Rule, which sets standards for securing electronic protected health information (ePHI). With text messaging becoming an increasingly popular form of communication in healthcare settings, comprehending these rules is essential for ensuring that all text messaging exchanges remain HIPAA compliant. Visit the U.S. Department of Health & Human Services HIPAA for Professionals page to learn more about the Privacy Rule and the Security Rule. 

As healthcare communication continues to evolve, adhering to HIPAA compliance in text messaging is paramount for patient privacy. Text messaging offers unmatched convenience and immediacy, but it also poses significant risks if not properly managed. PHI is a central tenet of HIPAA regulations, particularly in the context of how it is used when text messaging patients and members. PHI encompasses a wide variety of information, in short, anything that could tie back to a patient’s identity. Demographic information, like name, address, and social security number, are considered PHI, as well as any medical history, payment history, provider information, insurance details, and more. In the realm of text messaging, this becomes particularly important as even a seemingly harmless message containing an appointment reminder or information about medication can inadvertently disclose PHI if not handled properly. It is crucial for healthcare providers and payers to recognize the boundaries of PHI to ensure that their communication practices remain secure and compliant with HIPAA standards. 

Text messaging in healthcare has experienced significant growth as a communication tool among patients, healthcare providers, and healthcare payers. A survey by FICO reported that 80% of people are interested in using text messages with their healthcare providers. This surge is driven by the convenience and immediacy of text messaging, which resonates with today’s fast-paced digital environment. Patients appreciate the ability to quickly interact with their healthcare providers and payers, whether for scheduling appointments, receiving test results, or asking questions about their care plans or coverage. For healthcare providers and payers, text messaging offers an effective channel to enhance patient and member engagement, improve adherence to treatment protocols, and streamline administrative processes. The capability to reach patients can improve patient and member access, care delivery, and overall outcomes. As the healthcare industry continues to evolve, the role of text messaging as a pivotal communication tool is expected to expand, so understanding the rules and regulations around HIPAA compliance is not just important but necessary to deploy a successful texting program. 

Many individuals mistakenly believe that text messaging within healthcare settings can never be HIPAA compliant. This may be due to the fact that simple texting alone does not abide by HIPAA rules and regulations. However, today there are several HIPAA compliant text messaging platforms that adhere to the many rules and regulations required by HIPAA that health payers and providers can confidently deploy. Some of the safeguards that these platforms have include: encryption, access control, audit trails, remote wipe capability, and consent management. You can dive into the specifics of these regulations in another one of our blog posts, “What is HIPAA Compliant Texting? Everything You Need to Know”. 

Another common misunderstanding is thinking that as long as you obtain patient or member consent, it is enough to ensure that text messaging is HIPAA compliant. While that is an important step in the process, consent alone is not enough to be HIPAA compliant. It is also often assumed that simply using any encrypted messaging service guarantees that the text messaging will be HIPAA compliant, ignoring the need for a more comprehensive assessment and for ensuring that business associate agreements (BAAs) are in place. For example, something like iMessage falls short of HIPAA compliance standards due to its lack of BAA enforcement, end-to-end encryption, and audit trails, among other things.

Lastly, there’s a misbelief that once a healthcare organization has implemented initial security measures for text messaging, no further steps are needed. Continuous monitoring, audits, training, and updates to security protocols are necessary to ensure ongoing HIPAA compliance after a text messaging program is launched.  

Read more about the guidance on identifying and implementing a HIPAA compliant text messaging platform on the U.S. Department of Health and Human Services Office of Civil Rights website. 

A common question that comes up frequently around this topic: Is iMessage HIPAA compliant? As the primary messaging platform for Apple products, it’s no surprise that this comes up often. The short answer is: no, iMessage is not HIPAA compliant. Although it does leverage end-to-end encryption, which is one of the best practices for HIPAA compliant solutions, iMessage is not inherently HIPAA compliant. There are essential features and assurances that do not fully comply with HIPAA requirements, making it a risky standalone solution for messaging patients and members.

For example, Apple does not offer a Business Associate Agreement (BAA), which is a fundamental requirement for any service handling PHI. Additionally, iMessage’s cloud backup functionality poses a potential risk to HIPAA compliance. As it stands, iCloud backups would store messages sent via iMessage on Apple servers, including messages that had PHI. To prevent any mishaps, Apple would have to instruct end users to proactively disable iCloud backups to prevent PHI sent via iMessage from being stored on Apple servers where they could be accessed without appropriate safeguards by unauthorized users.

Healthcare payers and providers seeking to use text messaging for patient and member communication should turn to purpose-built, HIPAA compliant texting platforms that ensure PHI security and include features such as audit trails, access controls, and signed BAAs and not rely on iMessage as a viable option for HIPAA compliant communication.

To ensure the highest levels of privacy and security, healthcare payers and providers should consider the following best practices for HIPAA compliant text messaging.

To consider leveraging text messaging to communicate with patients and members, healthcare payers and providers should use a HIPAA compliant messaging platform.  

In fact, the Relay Feed is a fully HIPAA compliant messaging platform that uses text messages to invite patients and members into a secure, scrolling feed of information that is personalized for them and their healthcare journey. Click below to see a Relay Feed for yourself!  

These platforms are specifically designed to protect sensitive patient information, offering encryption and other security features to safeguard against unauthorized access while also requiring a Business Associate Agreement (BAA).  By partnering with a HIPAA compliant messaging platform, healthcare payers and providers can more confidently exchange safe levels of PHI, knowing that they are meeting regulatory requirements. As part of their design, these platforms often incorporate robust security measures, such as access controls and audit trails, which help in maintaining and reviewing data safety.

To effectively use HIPAA compliant text messaging, it is important to obtain patient or member consent. Before sending any text messages containing PHI, healthcare providers and payers must obtain explicit, written consent whenever possible. In doing this, a healthcare payer or provider is demonstrating that they are complying with legal obligations and respect the patient or member’s privacy. The process of obtaining and documenting consent not only helps in maintaining trust with patients, but also positions healthcare providers to handle any disputes concerning data usage and compliance effectively. By prioritizing consent capture, healthcare organizations are demonstrating their member-first or patient-first approach to protecting sensitive information.

While HIPAA compliant text messaging enables a payer or provider to share sensitive information via SMS, it is important to limit how much is shared to minimize risk. To achieve this, healthcare providers and payers should include only minimal necessary information, adhering to the need-to-know basis principle. For instance, patient identifiers such as full names, medical record numbers, and detailed health information should be avoided unless absolutely necessary. As an alternative, providers and payers can utilize unique codes or reference identifiers that are already known to both entities to communicate efficiently while maintaining privacy. In addition, as part of staff training protocol, it should be made clear what information is deemed sensitive when drafting and sending messages.  

Encrypting messages is a fundamental component of maintaining HIPAA compliance in text messaging. This practice ensures that any PHI shared via text remains secure, even if the message is intercepted during transmission. To better understand its importance, encryption converts the content of a message into a coded format that can only be read by someone who has the decryption key, adding an essential layer of security that protects against unauthorized access. In the context of healthcare communication, where sensitive patient information is often discussed, implementing robust encryption standards is non-negotiable. By prioritizing encryption, healthcare providers and payers safeguard data integrity. 

Developing and implementing robust policies is crucial for utilizing HIPAA compliant text messaging in healthcare settings. These policies should detail protocols and procedures aimed at safeguarding patient or member information, which includes developing clear guidelines on what can and cannot be communicated through text based on sensitivity. In addition, those policies include formalizing the process of obtaining consent from patients or members. It is equally important to define the roles and responsibilities of staff members in handling communications, establishing access controls, and ensuring that audit trails are consistently maintained. Implementing regular reviews and updates of these policies is essential as the regulatory requirements are continuously evolving. 

Access controls and audit trails are fundamental components of maintaining HIPAA compliance in text messaging within healthcare settings. Access controls are the controls put in place that ensure only authorized personnel can access information being shared, preventing unauthorized users from viewing or altering data. As noted previously, text messages often contain PHI that must remain confidential. To reinforce access controls, it is crucial for healthcare organizations to create audit trails. Audit trails provide a detailed record of who accessed the data, what actions they performed, and when these actions occurred. This comprehensive logging is key for detecting any unauthorized access or attempts to breach data security. Implementing access controls combined with detailed audit trails not only protects sensitive patient information, but also reassures patients that their personal health data is handled with the highest level of care.  

By implementing access controls and audit trails for their HIPAA compliant text messaging program, healthcare payers and providers are setting themselves up for success during regular audits and compliance checks. Both audits and compliance checks serve to identify potential vulnerabilities and ensure that all technical and administrative safeguards are functioning properly. Regular audits help healthcare organizations verify that their messaging systems are protected against unauthorized access. Plus, they provide an opportunity to update policies based on potential new threats or regulatory changes. Thorough compliance checks also help in reinforcing best practices among employees, ensuring that staff members understand and adhere to the established privacy and security protocols. 

Lastly, employee training and education is crucial to ensuring HIPAA compliance when it comes to text messaging. Protecting patient information is of the utmost importance, so it’s essential that healthcare professionals are continually educated on the latest security protocols and technical safeguards. Training sessions should cover how to use secure messaging platforms effectively, address potential areas of vulnerability, and emphasize the importance of encryption. Ongoing education can keep employees aware of any changes in regulations or technology that might impact compliance, to preserve patient and member confidentiality and trust. 

In today’s digital age, the importance of safeguarding patient and member data in healthcare communication cannot be overstated. With the rise of text messaging as a channel being used between patients, members, providers, and payers, ensuring the privacy and security of PHI is a top priority. By leveraging HIPAA compliant text messages between these groups, healthcare organizations are demonstrating their commitment to meeting patients and members where they are today while ensuring that they are protecting privacy in the process. By adhering to the regulations imposed by HIPAA for their text messaging programs, healthcare organizations not only protect patient confidentiality but also build trust, ensuring patients feel secure when sharing their personal health information. This trust is pivotal in healthcare, fostering better patient engagement, and ultimately improving healthcare outcomes. 

To make sure that patient information is protected, healthcare providers and payers should always follow best practices for HIPAA compliant text messaging. Summarizing what was shared earlier, first and foremost, using a HIPAA compliant messaging platform is essential, as these platforms are specifically designed to meet security and privacy requirements that safeguard PHI. Obtaining explicit patient consent before any communication exchange is another vital step, to allow for patient and member input while also complying with the legal standards. Limiting the sharing of sensitive information to only what is necessary further minimizes potential risks. Encrypting messages adds an additional layer of defense, making data unreadable for unauthorized parties. Developing and implementing robust policies, including access controls and audit trails, ensure ongoing compliance and enable monitoring of all messaging activities.  

By adhering to these rules and regulations, healthcare payers and providers can leverage HIPAA compliant text messaging with their patients and members on a channel that they are familiar with. The immediacy by which they can share information using HIPAA compliant text messaging has the potential to drive better health outcomes for patients and members and create a delightful digital experience.  

If you are looking for, or already are using, a HIPAA compliant texting solution, consider asking the following questions to understand how they approach HIPAA compliance with their specific platform. 

If you are looking for a HIPAA compliant text messaging platform, look no further than the Relay Feed. To learn more about how Relay can help with your member and patient engagement, reach out to sales@relaynetwork.com

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