To meet HIPAA email compliant requirements for secure email transmission, the level of SSL/TLS (Secure Sockets Layer / Transport Layer Security) used must ensure the confidentiality and integrity of Protected Health Information (PHI) in transit.
What Does HIPAA Says about TLS and SSL
HIPAA doesn’t specify exact SSL/TLS versions, but industry standards — including NIST (National Institute of Standards and Technology) guidelines — effectively set the floor:
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TLS 1.2 or 1.3: Required for HIPAA-compliant email.
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SSL 2.0, 3.0, and TLS 1.0/1.1: Obsolete and insecure. Use of these protocols is not HIPAA-compliant.
The Department of Health and Human Services has published guidance for TLS to secure health information in transit. In particular, they say:
Electronic PHI has been encrypted as specified in the HIPAA Security Rule by “the use of an algorithmic process to transform data into a form in which there is a low probability of assigning meaning without use of a confidential process or key” (45 CFR 164.304 definition of encryption) and such confidential process or key that might enable decryption has not been breached.
To avoid a breach of the confidential process or key, these decryption tools should be stored on a device or at a location separate from the data they are used to encrypt or decrypt.
The encryption processes identified below have been tested by the National Institute of Standards and Technology (NIST) and judged to meet this standard.
They go on to state what valid encryption processes for HIPAA compliance are:
Valid encryption processes for data in motion are those which comply, as appropriate, with NIST Special Publications 800-52, Guidelines for the Selection and Use of Transport Layer Security (TLS) Implementations; 800-77, Guide to IPsec VPNs; or 800-113, Guide to SSL VPNs, or others which are Federal Information Processing Standards (FIPS) 140-2 validated.
The FIPS specifications refer back to NIST 800-52 to define what cipher suites and settings are “FIPS-approved.” In other words, TLS usage must comply with the details in NIST 800-52 rev 2. This implies that other encryption processes, especially those weaker than recommended by this publication, are not valid and are thus non-compliant.
Is TLS Email HIPAA compliant?
SSL and TLS are not monolithic encryption entities that you use or do not use to securely connect to email servers, websites, and other systems. SSL and TLS are evolving protocols with many nuances to how they may be configured. The “version” of the protocol and the ciphers used directly impact the level of security achievable through your connections.
Some people use the terms SSL and TLS interchangeably, but TLS (version 1.0 and beyond) is the successor of SSL (version 3.0). See SSL versus TLS – what is the difference? In 2014 we saw that SSL v3 was very weak and should not be used going forward by anyone; TLS v1.0 or higher must be used.
Among the many configuration nuances of TLS, the protocol versions supported (e.g., 1.0, 1.1, 1.2, and 1.3) and which “ciphers” are permitted significantly impact security. A “cipher” specifies the encryption algorithm, the secure hashing (message fingerprinting / authentication) algorithm to be used, and other related things such as how encryption keys are negotiated. Some ciphers that have long been used, such as RC4, have weakened over time and should never be used in secure environments. Other ciphers protect against people who record a secure conversation from being able to decrypt it in the future if somehow the server’s private keys are compromised (perfect forward secrecy).
Given the many choices of ciphers and TLS protocol versions, people are often at a loss as to what is specifically needed for HIPAA email compliance. Simply “turning on TLS” without configuring it appropriately is likely to leave your transmission encryption non-compliant.
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SSL and TLS play critical roles in securing data transmission over the internet, and AES-256 is integral in their most secure configurations. The original standard was known as Secure Sockets Layer (SSL). Although it was replaced by Transport Layer Security (TLS), many in the industry still refer to TLS by its predecessor’s acronym. While TLS can be relied on for securing information at a high level—such as US Government TOP SECRET data—improper or outdated implementations of the standard may not provide much security.
