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Rules for Using PHI in Patient Engagement

Friday, November 11th, 2022

As you know by now, we believe strongly in the benefits of using protected health information (PHI) to create highly targeted and personalized email campaigns. However, before you dive in and kick off your campaigns, you must be aware of the complex compliance requirements governing healthcare organizations’ marketing communications.

Reminder: What is PHI?

PHI, or protected health information, is “individually identifiable protected health information.” Protected health information refers specifically to three classes of data:

An individual’s past, present, or future physical or mental health or condition.
The past, present, or future provisioning of health care to an individual.
The past, present, or future payment-related information for the provisioning of health care to an individual.

For protected health information to be “individually identifiable,” the data can be linked to a specific individual (even if this is very indirect). There are 18 types of identifiers for an individual. Any one of these identifiers, combined with “protected health information,” would constitute PHI.

It’s often more complicated than it looks. For example, if you are running email campaigns, an email address is an individual identifier because it can be connected to a specific individual. That, combined with the email content, which often refers to the name of the provider, information about their health conditions, insurance coverage, or upcoming appointments, means that most communications from a healthcare practice could qualify as PHI.

HIPAA Rules for Using PHI in Patient Engagement

HIPAA regulates patient privacy. Healthcare organizations and their associates must obtain consent and implement technical safeguards before starting marketing campaigns.

HIPAA Privacy Rule

According to the U.S. Department of Health & Human Services, you must acquire consent to send marketing communications under the HIPAA Privacy Rule. It reads, “With limited exceptions, the Rule requires an individual’s written authorization before a use or disclosure of his or her protected health information can be made for marketing.”

The Privacy Rule defines “marketing” as “a communication about a product or service that encourages recipients of the communication to purchase or use the product or service.” This also applies to many patient engagement communications.

Generally, if the communication is “marketing,” then the communication can only occur if the covered entity obtains an individual’s authorization. Organizations must keep track of who has consented to receive marketing communications and allow them to opt-out at any time. We further discuss the nuances of patient consent for marketing communications here.

HIPAA Security Rule

All covered entities and their Business Associates are subject to the HIPAA Security Rule. If you are working with a vendor (like a marketing consultant, email marketing platform, or ad agency) that will have access to PHI, you need to enforce a Business Associate Agreement.

The HIPAA Security Rule categorizes the necessary safeguards into three categories: Physical, Administrative, and Technical Safeguards. More details about the requirements for each can be found here. Any vendor you choose to work with must follow these regulations. Some basic requirements include the following:

Physically protecting data and where it is stored,
Training staff on handling PHI, and
Setting up technology to protect PHI properly.

Assuming your patient engagement campaigns are primarily occurring via email, at a minimum, you must ensure that the email marketing vendor will:

Protect data at rest and
Protect data in transmission.

This means utilizing encryption to ensure that PHI cannot be eavesdropped on. Many popular email marketing vendors do not encrypt PHI in transmission. It’s extremely important to choose a provider who can protect PHI following HIPAA regulations.

The Benefits of Using PHI for Patient Engagement

Once you have established the proper policies and procedures, signed a BAA, and put any technical requirements in place, you can start segmenting and personalizing emails using PHI. Here are some segmentation and personalization ideas to get started.

By applying these techniques and using PHI in your patient engagement strategy, you can:

Design targeted patient journeys
Deliver better patient outcomes
Improve ROI and reduce costs

Tags: business associate agreement, email marketing, ePHI, hipaa compliance, hipaa privacy rule, hipaa security rule, patient engagement, personalization, phi, quasi compliance, segmentation
Posted in Email Marketing
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Healthcare Marketing & HIPAA: Are you in Compliance?

Wednesday, September 14th, 2022

Healthcare Marketing Today

Marketing is essential to growing any business successfully, but when you work in regulated spaces such as healthcare, there are compliance considerations. Whether responding to an online patient review or trying to increase patient engagement through marketing campaigns, misunderstandings in marketing best practices can lead to patient privacy breaches.

The Health Insurance Portability and Accountability Act (HIPAA), which controls what and when patient information may be shared for marketing purposes, was enacted before the electronic age. As a result, it can be challenging to find information regarding appropriate marketing practices using modern social and software technologies.

HIPAA and Healthcare Marketing

A large part of HIPAA regulates what is appropriate for the use or disclosure of patient information. There are certain instances where the use and disclosure of protected health information (PHI) is allowed without patient consent. These instances include sharing PHI for treatment, payment, or healthcare operations.

However, before you can use patient information for marketing efforts, you need to receive explicit written consent from the patient. The consent form must be specific to the marketing efforts you will use the patient’s PHI in. For instance, if you would like to share patient testimonials, photos, or videos on your website or social media accounts, the patient must sign a consent form stating that you will use their information in this way.

HIPAA-compliant marketing also largely depends on an employee’s understanding of the law. Employees responsible for handling PHI must be trained to use and disclose PHI within the scope of their job role. Improperly trained employees can expose your practice to HIPAA violations and costly fines.

8 Common Misunderstandings of Marketing and HIPAA

1. As long as patient consent is obtained, HIPAA doesn’t matter
Some organizations think they can use any marketing tool with a signed patient consent form. Still, the tool has to be HIPAA-compliant. Even if patients agree, it does not remove the organization’s obligations to secure PHI under the law. If protected health information is improperly accessed, it is still a breach and can lead to severe financial and reputational consequences.

2. Marketing emails do not need encryption
Many marketing emails imply a relationship between patients and providers and, as such, can often be classified as protected health information. PHI must be encrypted in transit and at rest to comply with HIPAA.

3. Personalizing marketing emails is a HIPAA violation
Marketing emails can be personalized as long as the proper safeguards and precautions are in place to protect patient privacy and meet compliance requirements.

4. Marketing companies do not need to sign Business Associates Agreements
As of 2013, the HIPAA Omnibus rule expanded HIPAA obligations to include business associates and subcontractors. Marketing agencies and vendors that process PHI on behalf of a covered entity must comply with HIPAA regulations, which include signing a BAA.

5. The only way to protect PHI is to use patient portals
TLS encryption meets HIPAA transport encryption requirements and provides a better user experience. Marketing emails sent with TLS encryption are more likely to be opened than those sent to a patient portal.

6. Using BCC is enough to keep patient identities private
BCC is NOT enough to protect patient identities. Although the end recipient cannot tell who else received the message, the entire list is visible as the messages are transmitted from server to server. The messages can be eavesdropped on by someone with technical abilities.

7. Always respond to social media reviews
Be extremely careful when responding to online reviews. Publicly confirming information about a patient’s health or treatment status is a HIPAA violation.

8. Healthcare marketing isn’t necessary or worth the hassle
Healthcare consumerism is rising, and patients are willing to change providers if they are unsatisfied with their experience. Educating and informing current and potential patients about your services is essential to improve new customer acquisition and retention.

How to be HIPAA-Compliant

The most crucial step is vetting marketing vendors and HIPAA compliance tools. Any vendor that handles PHI on behalf of a healthcare entity needs to sign a Business Associate Agreement that outlines how patient data will be stored, transmitted, and disposed of. Don’t choose a vendor who is unfamiliar with HIPAA’s stringent requirements. Also, watch out for quasi-compliance. Some self-identified “HIPAA-compliant” vendors can protect data at rest but not in transmission or require patient waivers to achieve compliance.

Next, always use encryption and default to security. Identifying PHI is often tricky, and the legal burden should not fall on the marketing team. By selecting technology that encrypts every marketing email, you can rest assured that messages are secure and compliant. A bonus tip- do not send marketing messages to an encrypted patient portal. Instead, send marketing messages with TLS encryption directly to patients’ inboxes. You will see much higher response rates and engagement.

Finally, to create the most effective marketing campaigns, use PHI to create segmented audiences and send them personalized content. These tactics are widely used outside the healthcare industry because they deliver results. *Remember that any tool you put PHI into must be HIPAA-compliant.

How LuxSci and Compliancy Group Can Help

LuxSci’s Secure Marketing tool is an email marketing platform designed to meet HIPAA requirements. It allows marketing teams to segment audiences and personalizes emails to engage patients and improve marketing ROI. If you are already using a third-party email marketing platform, no worries, we got you covered. LuxSci’s Secure High Volume Email solution can integrate with any third-party platform to make sure those emails are also HIPAA-compliant.

Compliancy Group enables healthcare organizations and vendors serving the healthcare industry to achieve HIPAA compliance through an automated software platform and live guided coaching. The Guard, its proprietary compliance platform, covers all the necessary parts of the HIPAA regulation. Compliancy Group awards clients the HIPAA Seal of Compliance upon successful completion of their process. The Seal can be displayed on a practice’s website, email signature, and signage, and proves they are dedicated to protecting patient information and have completed the steps required to satisfy the law.

Tags: business associate, business associate agreement, email encryption, email marketing, ePHI, healthcare marketing, mutual consent, patient consent, personalization, social media
Posted in Collaboration, Email Marketing
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5 Questions to Find the Right HIPAA-Compliant Email Marketing Platform

Tuesday, June 15th, 2021

If you are subject to HIPAA regulations- think twice before sending off that marketing email blast to your customers. If your emails contain ePHI, stop and make sure you are using a HIPAA-compliant email marketing platform before sending.

Not all email marketing platforms were designed with HIPAA compliance in mind. In fact, it can be difficult to figure out which vendors will allow you to send HIPAA-compliant emails on their platforms. We created this list of five questions to help you screen potential vendors for compliance.

1. Is your email marketing platform HIPAA-compliant and HITRUST certified?

It’s a simple question, but if the vendor does not mention anything about HIPAA or HITRUST certification on their website, it’s a good indicator that they are not secure enough to be compliant. As you probably know, HIPAA regulations can be onerous, and many companies do not have the time, expertise, or desire to update their technology. On the other hand, if they have taken the time and spent the money to invest in the serious security steps needed for HIPAA compliance, you should be able to find something about it in their marketing.

2. Will the vendor sign a Business Associate Agreement?

If you are sharing ePHI with a vendor (including lists of patient names and email addresses), you must have a BAA in place that outlines their responsibilities to protect your ePHI. If a vendor will not sign a BAA with you, it is an obvious sign that you cannot use their platform for HIPAA-compliant email marketing.

However, even if a vendor will sign a BAA, it does not mean that you can use their platform and comply with HIPAA. Read the fine print! Some companies have very restrictive BAAs that severely limit the functionality of the platform and prevent you from sending emails. We call these vendors “quasi” compliant. The only comply with HIPAA, if you abide by strict rules that prevent you from actually using their solution.

For an example, take Constant Contact. They will sign a BAA. However, they explicit state in their BAA that you:

“Should not use our systems for transmitting highly sensitive PHI (for example: mental health, substance abuse, or HIV information). Our application was not built for electronic medical records (EMR). If you have such information to send, please do not use Constant Contact.”

Constant Contact does not encrypt outbound emails, making it a poor choice for a HIPAA-compliant email marketing vendor. Depending on your email use cases, you could be unable to send any emails on their platform. Even worse, if you mistakenly send emails that contain ePHI you will be held liable for violating HIPAA, not Constant Contact, because you violated the terms of the BAA.

3. Does the email marketing platform protect data at rest and in transit?

Encryption is an addressable standard as part of the HIPAA Security Rule. Encryption is highly recommended to protect ePHI in all digital communications. Many email marketing platforms have adopted encryption methods that are secure enough to protect ePHI while it remains in their systems. However, that’s not enough to comply with HIPAA. You should specifically ask about their ability to encrypt outbound emails. Data in transit is extremely vulnerable to malicious actors, and therefore you need to encryption to protect emails containing ePHI. If a vendor does not provide encryption for outbound marketing emails then you should not consider using them.

4. How does the email marketing platform encrypt emails?

If a vendor says that they do encrypt outgoing messages, it’s important to consider these additional questions.

How are they encrypting those emails?
Do the encryption methods match your email use cases?

As a marketer, you want your emails to directly reach the recipient with as little friction as possible. If the recipient has to login to another platform to read the email, it’s unlikely to be read. A good HIPAA-compliant email marketing platform will use TLS encryption to send marketing messages directly to inboxes that support it. Emails sent with TLS encryption appear just like any other message directly in the recipient’s inbox.

However, there may be scenarios when you need to use more secure encryption methods. We recommend finding an email marketing vendor that is flexible and will let you select the right method of encryption for any type of message. For example, you may want to use a portal-based encryption method to send highly sensitive messages. Either way, make sure your vendor can support your needs with the right type of email encryption.

5. Does the platform allow you to send ePHI in the body of your emails?

Finally, the most important question to ask is: can I include highly sensitive patient information in an email? If you cannot, you can’t use the full power of the email marketing platform to create targeted, personalized and relevant messages. At best, you can only send generic office newsletters. If you want to create the types of marketing emails that will drive ROI and improve patient engagement, utilize your patient data for personalization and segmentation.

HIPAA-Compliant Email Marketing Platforms

LuxSci’s Secure Marketing platform was built from the ground up with HIPAA compliance in mind. If you would like to learn more about how to create compliant email marketing campaigns utilizing ePHI, please let us know.

Tags: business associate agreement, email encryption, email marketing, encryption, HIPAA-compliant email marketing, quasi hipaa compliance
Posted in Email Marketing
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Business Associate Agreement: Explained

Monday, October 26th, 2020

If your organization collects, stores or processes electronic protected health information (ePHI) it will need a clear understanding of business associate agreements (BAAs). This also applies to businesses that process ePHI on behalf of other organizations.

Business Associate Agreements

Each business associate agreement stipulates how a company will share its ePHI with the respective business associate, and where the responsibilities lie. Unless your organization is a rare breed that has its own web hosting, email service, lawyers, accountants and every other aspect of its business in-house, then it needs to have these agreements in place with every provider that it shares ePHI with.

Read the rest of this post »

Tags: baa, business associate agreement, hipaa
Posted in LuxSci Library: HIPAA
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Is Skype HIPAA Compliant? If not, what is?

Saturday, May 9th, 2020

In recent times we have seen a huge push toward telehealth, so many are wondering, “Is Skype HIPAA compliant?” While Skype is a practical tool that many people have access to, it’s important to consider any regulatory obligations you need to meet before you use it.

If your business collects, stores, transmits or processes electronic protected health information (ePHI), then it is subject to HIPAA regulations. Organizations that process ePHI on behalf of other parties also need to stick within the rules, otherwise they may face heavy fines.

Regardless of whether your organization provides health services through video or it uses video platforms to process ePHI in any other way, it needs to make sure it is using software that abides by the regulations.

Wondering, “Is Skype HIPAA compliant?” is a good starting point, but there are several things to consider before you commit to a video conferencing service.

Do You Need a BAA to Make Skype HIPAA Compliant?

A business associates agreement (BAA) is a contract between your organization and any others that process its data. In essence, these agreements outline how ePHI will be used, what control measures will be in place, and where the responsibilities lie between the two parties.

BAAs are absolutely necessary for HIPAA compliance. Even if your organization and its partner share ePHI with every control and security mechanism imaginable, as well as following all other aspects of the regulations, it would still be violating HIPAA if a signed BAA was not in place.

If your organization is going to be sharing ePHI over a video service, then it needs to be HIPAA-compliant.* However, the only way that it can be HIPAA compliant is if a BAA is in place.

Is Only the Business Version of Skype HIPAA Compliant?

Skype comes in several different versions, but the basic, consumer oriented one is not HIPAA compliant. The only type that offers BAAs and which could be made HIPAA compliant is Skype for Business, which is one of Microsoft Office’s business communication tools. Note that “Skype for Business” is a completely different service than consumer Skype.

However, it’s also worth noting that Skype for Business is currently being phased out in favor of Microsoft Teams. If you don’t already have a supported version of Skype for Business, you should look for HIPAA-compliant alternatives instead. Support for Skype for Business Online ends in 2021, while support for Skype for Business Server will be extended until 2025.

With this in mind, it’s probably not worthwhile pursuing any version of Skype for HIPAA compliance. If you use the basic version of Skype, you will be violating the regulations, and even if you can get Microsoft to sign a Skype for Business BAA, you may have to switch your software in 2021 anyway.

HIPAA-Compliant Alternatives to Skype

Considering that Skype for Business doesn’t have much time left and that it is not even the same as “regular Skype,” your organization will be better off finding a HIPAA-compliant alternative. One option is LuxSci’s SecureVideo, which was designed specifically to make it easy to stay within the regulations.

SecureVideo was developed from the ground up with HIPAA compliance in mind, ensuring that it became a practical video calling service that made security and compliance simple. The Zoom for Healthcare-based platform is great for telemedicine and other forms of sharing ePHI.

SecureVideo includes handy features like screen-sharing, file-sharing, and virtual clinics, with a capacity of up to 100 participants. This makes LuxSci’s SecureVideo a convenient and compliant alternative to Skype.

* During the Covid-19 pandemic, HHS has waived responsibility for breaches through non-compliant video conferencing services, like Skype. So, while Skype may not be compliant, it is OK to use during the pandemic. However, as the pandemic subsides and this waiver is lifted, you should have transitioned to a service that is actually HIPAA compliant.

Tags: business associate agreement, chat, ePHI, hipaa, hipaa compliance, microsoft, phi, skype, telemedicine, video, video conferencing
Posted in Business Solutions, LuxSci Library: HIPAA
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