HIPAA Compliant Texting: Features, Examples & Violation Penalties

What Is HIPAA Compliant Texting?

HIPAA-compliant texting refers to text messaging practices that adhere to the Health Insurance Portability and Accountability Act (HIPAA) standards. These regulations ensure the protection and confidential handling of Protected Health Information (PHI) during electronic communication. HIPAA-compliant texting requires secure methods to prevent unauthorized access to patient data, rigorous controls, and proper employee training to ensure compliance with federal regulations.

To be HIPAA compliant, texting solutions must include encryption, access controls, audit trails, and other security measures. Encryption ensures that even if the message is intercepted, the data remains unreadable to unauthorized parties. Access controls limit who can view and send messages containing PHI. These measures combined ensure the integrity and confidentiality of patient data during communication.

Benefits of HIPAA-Compliant Texting 

Secure Communication

HIPAA-compliant texting provides secure communication channels for healthcare providers. Implementing these solutions ensures that PHI shared via text is protected against unauthorized access, breaches, and other security threats. Encryption protocols transform text content into unreadable formats unless accessed by authorized users, thereby maintaining patient confidentiality.

Limit Information Sharing

Limiting information-sharing through HIPAA-compliant texting helps maintain patient confidentiality. By implementing access controls and user authentication methods, healthcare organizations can ensure that only authorized personnel can access specific information. These measures prevent accidental or intentional data breaches, safeguarding patient privacy.

Additionally, structured information-sharing protocols limit the amount of PHI shared via text. This minimizes risks associated with data exposure while still allowing necessary communication to occur efficiently. Effective management of information-sharing practices strengthens the security and integrity of patient data.

Improve Patient Engagement

HIPAA-compliant texting improves patient engagement by providing a secure and convenient method for communication. Patients can receive appointment reminders, prescription updates, and health tips directly on their phones. This timely and accessible communication fosters a stronger connection between patients and healthcare providers.

What Are HIPAA-Compliant Texting Apps? 

HIPAA-compliant texting apps are mobile applications designed to meet HIPAA regulations for secure communication of PHI. These apps incorporate multiple security features including encryption, access controls, and audit trails to ensure that the transmission of PHI remains secure and compliant with federal laws.

These apps also support secure user authentication and role-based access to limit who can send or receive sensitive information. By using these specialized applications, healthcare providers can safely communicate with patients and other healthcare professionals, eliminating the risks associated with standard text messaging.

Tips from the expert

Steve Moore is Vice President and Chief Security Strategist at Exabeam, helping drive solutions for threat detection and advising customers on security programs and breach response. He is the host of the “The New CISO Podcast,” a Forbes Tech Council member, and Co-founder of TEN18 at Exabeam.

In my experience, here are tips that can help you better implement and manage HIPAA-compliant texting:

Establish a clear incident response plan for texting-related breaches: Create a specific incident response plan that addresses potential breaches involving texting. This plan should include immediate actions, notification procedures, and steps for mitigating damage. Regularly test the plan to ensure readiness.

Enforce automatic message expiration: Implement policies that ensure messages containing PHI automatically expire and are deleted after a specified period. This minimizes the risk of unauthorized access to outdated information and aligns with the principle of data minimization.

Use geo-fencing for additional security: Geo-fencing technology can restrict access to HIPAA-compliant texting apps based on location. This can prevent unauthorized access to PHI if the device is taken outside of designated secure areas, like the healthcare facility or predefined work zones.

Integrate secure texting with your EHR system: Secure integration with your Electronic Health Record (EHR) system can help streamline communication while maintaining compliance. This integration can ensure that all communication is logged appropriately and tied back to the patient’s records, reducing the risk of errors and ensuring comprehensive documentation.

Regularly audit access logs and usage patterns: Regularly review audit trails for any unusual access patterns, such as repeated failed logins or access from unrecognized devices. These audits should be part of routine monitoring to detect unauthorized attempts to access PHI and to take corrective actions swiftly.

What Is the Penalty for Breaking HIPAA SMS Regulations? 

HIPAA violations involving SMS and texting can result in significant financial penalties. 

Four Penalty Tiers

Fines are determined based on the nature and severity of the violation, divided into four penalty tiers:

1. Tier 1: Lack of knowledge: If a violation occurs without the knowledge of the offending entity, fines range from $137 to $34,464 per violation. Even though the entity was unaware, it is still expected to have reasonable safeguards in place to avoid breaches.
2. Tier 2: Reasonable Cause: This applies when an organization should have known about the violation but did not act with willful neglect. Fines here range from $1,379 to $68,928, depending on the severity and the entity’s corrective actions.
3. Tier 3 & 4: Willful Neglect: For willful neglect of HIPAA requirements, fines can be particularly steep. If the violation is corrected within 30 days, penalties range up to $68,928. However, if left uncorrected, the fines can reach up to $2,067,813 annually for each violation type.

Criminal penalties are also possible if violations involve malicious intent, including jail terms ranging from 1 to 10 years depending on the extent of the wrongdoing.

Exemption for SMS Violations

In some emergency situations, such as natural disasters like hurricanes or earthquakes, the U.S. Department of Health and Human Services (HHS) may temporarily relax certain HIPAA rules related to text messaging. During these events, a limited set of regulations may be waived, and the HHS may exercise “enforcement discretion” for a specified period. 

This waiver typically applies only to healthcare providers in the affected geographic areas. However, it’s important to note that these waivers are never comprehensive, and core privacy and security standards generally remain in effect to protect patient information.

Features to Look For in a HIPAA Compliant Texting App 

Encryption

Encryption ensures that messages containing PHI are transformed into unreadable formats during transmission and storage. Only authorized users with the appropriate decryption key can access the message contents, thereby preventing unauthorized access.

End-to-end encryption is also essential. This ensures that data remains encrypted throughout the entire transfer process, from the sender to the recipient. Implementing strong encryption protocols is vital for maintaining data integrity and preventing potential breaches, aligning with HIPAA’s stringent security requirements.

Audit Trails

Audit trails provide detailed logs of who accessed specific data, when it was accessed, and what actions were taken. These logs are essential for monitoring compliance, identifying suspicious activities, and responding to potential breaches.

Having transparent audit trails helps organizations demonstrate adherence to HIPAA regulations during audits and investigations. Additionally, they enable continuous monitoring and real-time alerts for unauthorized access attempts, enhancing overall security and accountability in data management.

Business Associate Agreement

A Business Associate Agreement (BAA) is vital for HIPAA-compliant texting apps. It legally binds the app provider to comply with HIPAA regulations and safeguards PHI. The BAA outlines each party’s responsibilities, ensuring that the app provider handles PHI securely and appropriately.

Without a BAA, healthcare providers risk non-compliance with HIPAA regulations. This agreement ensures that both parties understand their roles and responsibilities in protecting patient data, providing a clear framework for managing PHI securely and mitigating legal risks associated with data breaches.

Remote Wiping Capabilities

Remote wiping capabilities are an important feature for HIPAA-compliant texting apps. This function allows organizations to remotely delete data from a device that is lost, stolen, or otherwise compromised. By doing so, they can prevent unauthorized access to PHI stored on the device, maintaining data security even in adverse situations.

Implementing remote wiping capabilities reduces the risk of data breaches resulting from lost or stolen devices. This feature ensures that patient information remains protected, aligning with HIPAA’s stringent guidelines for maintaining data security and integrity in health communication.

Multi-Factor Authentication

Multi-factor authentication (MFA) requires users to provide two or more forms of verification before accessing sensitive information, adding an extra layer of protection beyond just a password. Common MFA methods include something the user knows (like a password), something the user has (such as a phone or security token), and something the user is (biometric verification like fingerprints).

MFA reduces the risk of unauthorized access to PHI by making it significantly harder for attackers to compromise accounts. Even if a password is stolen or guessed, the additional verification steps ensure that only authorized users can access or send sensitive data. This extra safeguard is vital in healthcare settings, where protecting patient information is paramount.

Examples of Text Messages That Need to Be HIPAA Compliant 

When dealing with Protected Health Information (PHI), it is essential to use HIPAA-compliant messaging solutions to ensure data privacy. Below are several examples of the types of text messages that must follow HIPAA guidelines:

Patient Information Requests
“Hi [Name], we noticed that your address is missing from your records. Please send it over so we can update your file.”

Insurance Details
“To complete your registration, please send us your insurance ID number so we can verify your coverage.”

Post-Surgery Follow-Up
“Hello [Name], how are you feeling after your surgery? Please let us know if you have any concerns.”

Test Results Sharing
“Your test results are ready. You can view them using this link: [link]. Let us know if you’d like to discuss them.”

Appointment Reminders
“Hi [Name], this is a reminder for your appointment on [date] at [time]. Please confirm or reschedule using this link: [link].”

New Patient Inquiries
“Thank you for reaching out to [Practice Name]. Please complete this form [link], and we’ll get back to you shortly.”

These messages involve sensitive health information, requiring encryption, access controls, and other security measures to prevent unauthorized access in compliance with HIPAA standards.

How to Ensure Your Text Messages Are HIPAA Compliant 

Use a HIPAA-compliant app

Using a HIPAA-compliant app is the foundational step in ensuring your text messages are secure. These apps are specifically designed to meet HIPAA regulations, incorporating necessary features such as encryption, access controls, and audit trails. By utilizing such applications, healthcare providers can be confident that PHI shared through text messaging is protected against unauthorized access and breaches.

Get Explicit Consent to Text Messages

Before sending any text messages containing PHI, it is essential to obtain explicit consent from the patient. This ensures that patients are aware of and agree to receive information via text messaging, aligning with HIPAA’s patient privacy protections. Consent should be documented and include details about the type of information that will be shared, the purpose of the communication, and any potential risks involved.

Set Up Access Controls

Implementing robust access controls is vital for securing text messages that contain PHI. Access controls limit who can view, send, and receive sensitive information, ensuring that only authorized personnel have access to PHI. This can include setting up role-based permissions, requiring multi-factor authentication, and regularly updating access rights based on changes in staff roles or responsibilities.

Limit PHI in Texts

Limiting the amount of PHI shared in text messages reduces the risk of data breaches and enhances patient privacy. Text messages should only contain the minimum necessary information required for the intended purpose. Avoid including sensitive details such as social security numbers, full medical records, or extensive health histories.

Instead, use texts for brief, essential communications like appointment reminders, prescription alerts, or general health tips. For more detailed discussions, direct patients to secure portals or in-person consultations. This practice minimizes exposure and ensures compliance with HIPAA’s minimum necessary rule.

Train Employees

Regular employee training is critical to maintaining HIPAA compliance in text messaging. Training programs should cover the importance of protecting PHI, the features and use of HIPAA-compliant texting apps, and organizational policies on secure communication practices. Employees should be aware of the potential risks associated with improper handling of PHI and the consequences of non-compliance.

HIPAA Compliance with Exabeam

Noncompliance with HIPAA can result in heavy fines from OCR and other consequences. When patch management, access controls, and monitoring are not fully implemented with the right solution stack, it leaves the organization vulnerable to ransomware and other attack vectors that can impact patient care. 

Exabeam Security Operations Platform telemetry combines logs with context, security intelligence feeds, and AI analysis to identify anomalous behaviors that indicate potential attacks. Pre-built Dashboards make HIPAA Compliance reporting easier. Whether you are using a framework like NIST or MITRE ATT&CK^Ⓡ, Exabeam offers a clear path to track your compliance and governance request needs — while all establishing what normal looks like in your environment and for every entity logged in. 

The Outcomes Navigator offers continuous visualization and insight into your detection coverage and improvements made, which provides suggestions for improvements in log parsing as well as showing which sources and detections are most effective against which parts of the ATT&CK framework and use cases are most indicative of network penetration, persistence, and lateral movement.