Understanding HIPAA-Compliant Texting: Guidelines & Compliance for Healthcare Communication

You send a quick text to coordinate care, but is that text putting patient privacy at risk? HIPAA regulations are clear about protecting patient information, and texting can be a gray area if you’re not careful.

In this blog, we’ll help you understand what HIPAA-compliant texting entails, how to implement it, and how it contributes to the larger landscape of secure healthcare communications. 

What Is HIPAA and Its Purpose? 

The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, is a U.S. federal law designed to protect sensitive patient health information (PHI). Its primary goal is to ensure the privacy and security of individuals' medical data while enabling the efficient flow of healthcare information for proper treatment, billing, and healthcare operations. 

Who Does HIPAA Apply To? 

HIPAA applies to covered entities, including healthcare providers (e.g., doctors, hospitals, pharmacies), health plans (e.g., insurance companies), and healthcare clearinghouses. It also extends to business associates, such as third-party vendors that handle PHI.

Why Is HIPAA Important?

HIPAA plays a crucial role in the modern healthcare system by balancing privacy with the need for information sharing. It fosters trust between patients and providers while reducing the risk of identity theft and medical fraud. In today's digital era, HIPAA ensures that health information remains secure despite increasing threats from data breaches and cyberattacks. 

Texting and HIPAA Compliance

At the heart of HIPAA is the right for individuals to control who has access to their personal health information, with stringent standards and regulations imposed on healthcare entities to protect this data from unauthorized exposure and use. 

But HIPAA hit the scene when the internet was still new, and “texting” wasn't common.

Thankfully, as healthcare communication methods have grown and evolved, so has the application of HIPAA. Email, text messaging, video conferencing, and digital health records are now standard, drastically improving efficiency and fostering better patient-provider communication. 

However, these digital advancements also come with unique challenges, particularly around privacy and security. The use of electronic communications in healthcare has raised serious concerns about how these real-time, digital conversations can stay compliant with HIPAA regulations while still reaping the benefits of modern technology.

Understanding and implementing HIPAA-compliant communication methods, such as text messaging, have become more critical than ever. 

HIPAA-Compliant vs. Secure Texting

HIPAA-compliant texting and HIPAA secure texting, while overlapping in certain aspects, entail distinct features and protocols in safeguarding electronic Protected Health Information (ePHI). 

HIPAA-compliant texting refers to a set of guidelines that govern the security measures taken for transmitting ePHI via text messages. This includes processes like adequately training the workforce to understand HIPAA regulations, ensuring the unique user identification of all employees, and implementing a system to monitor and control emergency access procedures to ePHI. 

HIPAA-compliant texting can technically be accomplished via SMS and other standard messaging platforms (more on this later), although this is generally not recommended due to inherent security risks. As long as no ePHI is shared via SMS, then the text is compliant. 

On the other hand, HIPAA secure texting specifically refers to the appropriate use of technology to protect ePHI while it's being sent or received. HIPAA secure messaging incorporates encryption, recipient authentication, and tamper-proof measures to safeguard data during transmission. Generally, this is achieved via specialized applications or platforms designed with these specific security controls. 

What this subtly suggests is that while all HIPAA secure texting is HIPAA-compliant, not all HIPAA-compliant texting is necessarily secure. 

The recommendation generally inclines towards adopting a secure messaging solution that not only meets HIPAA compliance standards but further reinforces the security measures guarding ePHI.

The Risks of Texting PHI 

Texting Protected Health Information (PHI) can be convenient, but it comes with significant risks if not handled in a HIPAA-compliant manner. Below are the key risks associated with texting PHI:

1. Data Breaches and Unauthorized Access 

One of the most significant risks of texting PHI is the potential for unauthorized access to sensitive information. If a device is lost, stolen, or accessed by an unauthorized individual, PHI could be exposed. Data breaches can result in severe legal, financial, and reputational consequences for healthcare organizations.

Examples of risks:

• Sending messages to the wrong recipient due to human error.
• PHI being intercepted during transmission over insecure networks.
• Devices without proper security safeguards being accessed by unauthorized users.

2. Lack of Security Controls in Standard Texting Apps 

Most standard messaging apps, such as SMS or iMessage, lack the encryption and other security features necessary to protect PHI. These apps do not provide the level of control required to ensure HIPAA compliance, such as user authentication, audit logs, or automatic message expiration.

Examples of vulnerabilities:

• Messages stored on unsecured servers or devices.
• Inability to control or delete messages once sent.
• Lack of encryption, leaving messages vulnerable to interception by hackers.

3. Unencrypted Communication Channels 

Unencrypted communication is one of the primary risks when using standard texting methods. Without encryption, messages can be intercepted during transmission, exposing PHI to unauthorized individuals. Secure messaging platforms address this by encrypting data both in transit and at rest. 

Consequences:

• Increased likelihood of cyberattacks targeting unsecured messages.
• Violation of HIPAA’s Security Rule requiring encryption for PHI in electronic form.

4. Lack of Audit Trails 

HIPAA requires organizations to maintain audit trails for all electronic communication involving PHI. Standard texting apps do not provide the ability to track message delivery, access, or deletion, making it impossible to verify compliance.

Potential issues:

• Inability to identify the source of a breach or unauthorized access.
• Noncompliance with HIPAA documentation and reporting requirements.

5. Difficulty in Preventing Message Retention 

Many standard texting apps retain messages indefinitely on devices, servers, or in the cloud. This retention increases the risk of exposure, particularly if a device is lost, stolen, or accessed by an unauthorized user.

Risks of retained messages:

• PHI stored in unsecured locations, such as personal devices.
• Lack of control over deleting sensitive information from all recipients' devices.

6. Lack of Monitoring and Control 

Without proper monitoring, healthcare organizations cannot ensure that employees follow HIPAA-compliant texting practices. Noncompliance can occur inadvertently or deliberately if no oversight mechanisms are in place.

Risks from poor oversight:

• Employees sending PHI via unapproved platforms.
• Failure to identify and correct improper texting habits before they result in breaches. 

The Dangers of Noncompliant Texting

Navigating noncompliance with HIPAA regulations is like walking a minefield blindfolded—every misstep carries the risk of devastating consequences. The exposure of sensitive patient information or a single instance of noncompliant communication can result in severe repercussions, turning into a ticking time bomb for any healthcare provider.

Due to HIPAA’s stringent penalties, healthcare organizations face fines ranging from $141 to as much as $2.1 million annually, depending on the severity and frequency of violations. 

And the stakes don’t stop there—severe violations can escalate to criminal charges, potentially resulting in imprisonment, making compliance not just a legal requirement but a critical safeguard for the organization's survival.

Here’s what you can expect from the financial penalties: 

Penalty Tier	Level of Culpability	Min. Penalty per Violation	Max. Penalty per Violation	Annual Penalty Limit
Tier 1	Lack of Knowledge	$141	$35,581	$35,581
Tier 2	Reasonable Cause	$1,424	$71,162	$142,355
Tier 3	Willful Neglect	$14,232	$71,162	$355,808
Tier 4	Willful Neglect not Corrected within 30 days	$71,162	$2,134,831	$2,134,831

But the aftermath isn't just about financial losses and potential jail time. There are significant reputational costs, too. 

In a sector where trust is priceless and reputation is the cornerstone, the aftermath of a breach can be harmful. The consumers' trust, once broken, can take years to rebuild, and some patients may choose to seek care elsewhere, leading to a substantial loss in business. 

So, why is texting not HIPAA secure? Here’s why: 

• SMS text messages lack encryption capabilities. 
• All text messages are archived as data on telecom service providers' servers.
• The data from the text messages are stored locally on the recipient's device when not in transmission.
• Interception of text messages by unauthorized entities is possible on public Wi-Fi networks.
• Once a text message is dispatched, it cannot be retracted or canceled.
• There's usually a lack of robust password protection on most personal mobile phones.
• The risk of Protected Health Information (PHI) being stolen increases with the potential loss or theft of mobile devices. 

How Can I Text Patients Securely? 

According to HIPAA’s Privacy Rule, all "individually identifiable health information" is classified as Protected Health Information (PHI). This includes personal identifiers, ranging from names, addresses, dates (such as birthdate, admission date, discharge date), Social Security numbers, medical record numbers, to any other information that could potentially identify the individual.

The HIPAA Security Rule, on the other hand, addresses electronic PHI (ePHI) and requires that appropriate administrative, physical, and technical safeguards are in place to ensure the confidentiality, integrity, and security of electronically protected health information.

Business entities and healthcare providers can text patients if:

• You’ve obtained written consent from the patient to text them, explaining in great detail the risks inherent in texting.
• Provide an option for the patient to opt out at any time.
• You must sign a business associate agreement (BAA) with a HIPAA-compliant texting app.

Examples of HIPAA-Compliant Text Messaging

Compliant text messages pass as HIPAA-compliant primarily because they communicate necessary health information without revealing identifiable patient details. 

On the other hand, noncompliant messages go against both the Privacy and Security Rules. When full names are used in conjunction with medical information, it directly contravenes HIPAA by revealing PHI. 

Sharing passwords breaks the crucial aspect of maintaining and ensuring technical safeguards for ePHI. Lastly, HIPAA emphasizes the need for secure communications to the correct recipient, so misdirected text messages are also a noncompliant act. 

Below, we’ll cover some common examples of compliant vs. noncompliant texting and what HIPAA has to say about it. 

Compliant Text Messages 

• Incident-based Message: Dr. Smith sends a text to Nurse Johnson saying, "Patient in Room 3 is showing symptoms of elevated heart rate and shortness of breath." This message does not directly identify the patient and only communicates necessary health information.
• Consultation Messages: A specialist receives a text message from a primary care doctor that reads, "I have a 35YO male patient showing signs of persistent low mood, feelings of worthlessness, and difficulty sleeping. Suspected depression. Advice?" This message again doesn't include specifics that reveal the patient's identity, making it HIPAA-compliant.
• Appointment Reminders: A patient receives a text message from their healthcare provider stating, "Reminder of your appointment tomorrow at 2 PM with Dr. Robertson. Reply Y to confirm." The message doesn't disclose any sensitive health information.

Below are a few more examples to emphasize how to text securely:

• General Patient Update: "Physiotherapy for the patient in Room 305 went well today."
• Non-specific Medical Consultation: "Would like to discuss a case involving juvenile rheumatoid arthritis."
• Treatment Query: "I received your request for medication changes for the patient in Room 101. We should convene to discuss options."
• Efficiency Update: "The new physiotherapy schedule for wards 101-109 is now in operation."
• Patient Feedback: "Patient in Room 202 is showing progress post-surgery."
• Patient Discharge: "The patient in Room 405 has been discharged today."

Noncompliant Text Messages

• Identifiable Information: A radiologist sends a text message saying, "John Smith's X-ray shows possible fractures. He needs attention immediately." This is noncompliant because the message includes identifiable details.
• Sharing of Passwords: A text that reads, "Hey, Sophia, I forgot my password again. It's 'hosp321'." This breaks the rules because it reveals security information in a non-secure way.
• Texts to Wrong Recipient: A message meant for a patient's family member gets sent to the wrong number. This kind of accidental sharing of details would be considered noncompliant under HIPAA.
• Discussions with Family: "Hi Jane, your father's health has worsened. Hospitalization is urgently required."
• Direct Patient Consult: "Hello Mrs. Smith, your blood glucose levels are consistently high. We need to discuss your insulin dosage."
• Transportation Arrangements: "Patient Jane Doe needs an ambulance at her residence - 123 Cherry Lane."
• Insurance Confirmation: "John's insurance has been confirmed. His policy number is ABC12345."
• Patient Condition: "Mrs. Smith's hip surgery was successful. She'll recover in Room 205."
• Prescription Details: "Can you fill this prescription: John Doe- Zoloft 50mg."
• Medical Records: "The patient in Room 206's ECG shows multiple irregular beats. I'll forward the report." 

Guidelines for HIPAA-Compliant Texting Practices 

To ensure the confidentiality, integrity, and security of Protected Health Information (PHI), organizations must adopt robust texting practices. Below are essential guidelines to help maintain compliance with HIPAA regulations:

1. Train Your Employees 

Compliance starts with awareness. All employees handling PHI must undergo comprehensive HIPAA training to understand the regulations and their responsibilities. Training should cover proper communication practices, common pitfalls, and how to handle potential breaches. 

Employees who are uninformed about HIPAA rules are more likely to make errors that could lead to violations. Consider scheduling regular refresher courses to ensure continued awareness and compliance.

Best Practices:

• Conduct interactive training sessions using real-world scenarios.
• Provide resources like guides or checklists for quick reference.
• Test employees' understanding through assessments or role-play exercises.

2. User Authentication 

To prevent unauthorized access to PHI, strong user authentication protocols are essential. Ensure that only authorized personnel can access sensitive information by implementing multi-factor authentication (MFA), such as a combination of strong passwords, biometric authentication (like fingerprint or facial recognition), or device tokens. 

Regularly review and update access permissions to account for role changes, terminations, or other organizational shifts.

Best Practices:

• Enforce password complexity requirements and expiration policies.
• Use audit logs to track and monitor user access to PHI.
• Prompt users to log out of shared devices after each use.

3. Implement a Secure Messaging Platform 

Investing in a secure messaging platform specifically designed for healthcare settings is critical. These platforms must comply with HIPAA standards by offering end-to-end encryption to protect PHI in transit and at rest. 

Additionally, features such as automatic log-offs, time-limited message visibility, and access control settings provide further layers of security.

Best Practices:

• Choose platforms certified as HIPAA-compliant, such as TigerText or Imprivata Cortext.
• Enable features like "read receipts" to confirm message delivery.
• Use platforms that integrate seamlessly with your organization's EHR system.

4. Regular Audits 

Auditing is a proactive approach to identify vulnerabilities and ensure ongoing compliance. Regularly scheduled audits should include a review of messaging practices, device configurations, and access logs. 

These audits can help detect potential breaches or weaknesses before they result in violations. Document audit findings and implement corrective actions promptly.

Best Practices:

• Use audit tools to generate detailed compliance reports.
• Include surprise audits to assess real-time compliance.
• Align audits with updates to HIPAA regulations or organizational policies.

5. Disable Message Preview 

Message previews on lock screens may inadvertently expose PHI to unauthorized individuals. To mitigate this risk, configure devices to disable message previews, especially in public or shared spaces. 

Additionally, a policy should be implemented where sensitive messages disappear after a set period, such as 24 hours, to further reduce exposure risks.

Best Practices: 

• Educate employees on how to adjust notification settings for added security.
• Use platforms with built-in ephemeral messaging features.
• Encourage the use of personal devices only when necessary and under strict compliance guidelines.

Best Practices for Healthcare Providers 

HIPAA-compliant text messaging doesn't have to be intimidating. By following these best practices, healthcare providers can streamline communication while protecting patient privacy and avoiding costly violations. 

1. Use Approved Platforms 

Not all messaging tools are created equal when it comes to HIPAA compliance. Standard SMS or common apps like iMessage, WhatsApp, or Facebook Messenger lack the encryption and security features required to protect Protected Health Information (PHI). 

Always use secure messaging platforms specifically approved for healthcare use. These platforms ensure end-to-end encryption, audit trails, and user authentication, all of which are required under HIPAA.

Best Practices:

• Select platforms certified as HIPAA-compliant, such as TigerConnect or OhMD.
• Regularly update the software to ensure the latest security patches are in place.
• Provide training for staff on how to use these platforms correctly and securely.

2. Keep Messages De-Identified 

Whenever possible, avoid including identifiable patient information in your text communications. HIPAA’s minimum necessary standard encourages healthcare providers to limit the amount of information shared. 

Use unique non-identifiable codes or internal reference numbers to discuss patients or cases in text messages, ensuring that PHI remains protected even if the text is intercepted or misdirected.

Best Practices:

• Exclude names, Social Security numbers, or other identifying details in text messages.
• Create a system for assigning de-identified codes to patients for text communications.
• Provide staff with examples of appropriate and inappropriate ways to phrase messages.

3. Double Check Recipient Information 

Human error is one of the leading causes of HIPAA violations. Before sending any text, verify the recipient’s contact information to ensure it is accurate and up to date. A misdirected text containing sensitive information could result in a reportable data breach.

Best Practices:

• Implement a policy of double-checking recipient details before sending messages.
• Use secure contact lists maintained within HIPAA-compliant messaging platforms.
• Train staff on what to do if a text is accidentally sent to the wrong recipient.

4. Be Mindful of Sharing Images/Videos 

Sharing patient-related images or videos comes with additional risks. These files may contain identifiable information, such as a patient’s face or medical records visible in the background. If such media must be shared for clinical purposes, it should only be done through a secure messaging platform that is HIPAA-compliant and encrypted.

Best Practices:

• Blur or crop images to remove identifiable details when possible.
• Use secure platforms with specific features for image and video sharing.
• Obtain patient consent if images or videos are to be used for purposes beyond direct care (e.g., training or research).

5. Periodic Reviews 

Text messaging policies and practices should be reviewed periodically to ensure ongoing compliance with HIPAA regulations. Regular reviews help identify potential risks and correct them before they lead to violations. This also provides an opportunity to update practices in response to changes in technology or regulations.

Best Practices:

• Conduct quarterly or semi-annual reviews of text messaging practices.
• Include text message audits in your overall HIPAA compliance assessments.
• Use feedback from staff to identify areas where additional training or tools may be needed. 

HIPAA-Compliance With 360training

Remember, HIPAA compliance isn't just about escaping penalties; it's about upholding trust, providing the best care to patients, and fostering a communication environment that marries convenience, speed, and security seamlessly. 360training makes it easy to stay HIPAA-compliant with a wide variety of HIPAA training courses. Check out our full catalog on our website today!