June 9th, 2016

How to breach your HIPAA-compliant email in 5 minutes while getting coffee

Who knew that a quick cup of coffee could lead to the report of a HIPAA beach to the Secretary of Health and Human Services … and a bad day, overall.

Here is what happened:

  1. A nurse was writing an email to another nurse, giving medical information about a patient.
  2. The message was all composed and ready to go, but the nurse didn’t hit send yet. She wanted to get a cup of coffee and think a little more about the content.
  3. She got coffee and chatted with her coworkers.
  4. When she sat back down at her laptop, she saw the email up there and just pressed “Send” without thinking.
  5. The message was sent … but it was sent insecurely because the nurse forgot to add the special trigger text to the message subject that would signal that encryption was needed.
  6. Because this message with ePHI went out insecurely (i.e. without encryption) to another medical professional, the delivery of that message breached the HIPAA requirements for the proper transport of ePHI.
  7. Because of this, the message could have been eavesdropped upon or viewed by unauthorized people.
  8. The HIPAA Compliance Officer saw this and decided that it should be reported.

This is a significant problem with most HIPAA-complaint email systems these days.  For simplicity, they put the burden of determining which messages need encryption on the sender.  If the sender does not actively trigger message encryption, then the message can go out insecurely.

It is so easy to make this mistake! Everyone is busy, distracted, and multitasking.  Any lapse in attention, like in the example above, will cause messages to be sent in violation of HIPAA requirements.  Even simply misunderstanding exactly what is considered ePHI can result in similar breaches.

Switching from Opt-In to Opt-Out Email Encryption

With this in mind, the solution is really quite simple. You have to change how email encryption is selected.  Instead of allowing senders to choose which messages need encryption … you force all messages to be encrypted unless the sender explicitly indicates that encryption is not needed.   With this simple change:

  1. As messages are sent encrypted by default, mistakes generally result in messages going encrypted instead of being sent insecurely.  There is no breach.
  2. When messages do go insecurely, the sender must have willfully indicted that the message does not contain ePHI. There is a much smaller chance of error here, and with these decisions being logged and tracked, users can be directly “on the hook” for what is sent insecurely.  They can’t blame a mistake nearly as legitimately as they can with “opt in” encryption.

So — when choosing your HIPAA-complaint email vendor, choose one that does opt-out encryption and stay away from the risks involved with opt-in encryption.

Want it “both ways” — see: The next generation of Opt-in email encryption.

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