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How Online Tracking Technologies & Data Collection Threaten Patient Privacy

Tuesday, October 10th, 2023

Many healthcare marketers use online tracking technologies to gather user information as they interact with a website or mobile application. After several breaches tied to improper uses of third-party tracking pixels, the Department of Health and Human Services has clarified that data collected via online tracking technologies are often PHI and must be secured according to the Privacy Rule. This decision has put many organizations at a crossroads- how can they balance patient privacy with the financial pressures to grow their business and provide a superior digital experience?

online tracking technologies

What are Online Tracking Technologies?

Tracking technologies collect information about website visitors in various ways, many of which are invisible to the user. Some of the most common types of tracking technologies include cookies, web beacons or tracking pixels, session replay scripts, and fingerprinting scripts. Mobile apps also include tracking codes within the application to enable the collection of user information.

After collecting the information, it is analyzed to create insights about users’ online activities. Marketers often use the data to create highly targeted advertising campaigns. In the case of third-party tracking technologies, they may continue to track users and gather information about them even after they leave and visit other websites. You’ve likely experienced this when online shopping. You look at a pair of shoes on a retailer’s website, and then they continue to follow you and appear as ads as you browse other websites and social media platforms. However, if you replace ads about shoes with advertisements for treatments for an individual’s medical conditions, this raises serious patient privacy concerns.

What Does HIPAA Say About Online Tracking Technologies & Data Collection?

Online tracking technologies have been widely utilized for over a decade but have only recently been considered in the context of health data privacy. The Dobbs vs. Jackson Women’s Health Organization decision by the Supreme Court in June 2022 kicked off a wave of reporting on how reproductive health information was collected and sold online. Some worried that this information could be used in court cases to convict people who sought abortions, leading to significant concerns over digital health data privacy.

In this context, researchers began looking at the websites of major health systems to explore how they used trackers to collect and transmit data. A study revealed that 99% of US hospitals employed online data trackers that transmitted visitors’ information to a broad network of outside parties, including major technology companies, data brokers, and private equity firms. Some hospitals even employed these trackers on internal patient portal web pages, potentially exposing highly sensitive patient data to advertisers.

As a result of the confusion surrounding this issue and the seemingly clear violation of HIPAA rules, OCR issued a bulletin explaining how covered entities can and cannot use tracking technologies on their websites.

You would think that is the end of the story. However, there is still a lot of confusion surrounding the proper use of these technologies. In July 2023, the FTC and OCR issued another warning to 130 hospital systems that continued deploying online tracking technologies despite the bulletin.

Gray areas still exist in how the bulletin is interpreted. The American Hospital Association recently asked OCR to reconsider its guidance, stating it contradicts interoperability efforts. As this situation evolves, healthcare providers must be aware of the risks of online tracking technologies and how they can balance risk with their business objectives.

How is this Data Protected Health Information?

One of the reasons this issue flew under the radar for so long is that it is not necessarily obvious that the information collected by these pixels qualifies as PHI. It may not be evident to end-users, but tracking technology vendors can infer a lot of personal data through tracking technologies placed on a healthcare provider’s website. Some of the information that can be captured by tracking technology could include:

  • medical record numbers
  • email addresses
  • appointment dates or requests
  • IP addresses
  • medical device IDs
  • geographic locations

Marketers may not realize that individually identifiable information collected on a covered entity’s website or mobile app is often protected health information (PHI). Even if the individual has no pre-existing relationship with the healthcare provider, DHHS’s recent update is clear that this information is protected. Collecting this information establishes a relationship between a covered entity and an individual relating to their past, present, or future provisioning of health care. A visit to a healthcare provider’s website may be the first step taken by a future patient in accessing healthcare treatment.

There is always some gray area when defining PHI, but it’s better to be safe than sorry in this case. If you are using any online tracking technology, you must confirm that it is processing and transmitting data in a way that aligns with HIPAA regulations.

How Healthcare Marketers Can Protect Patient Privacy

First of all, if you plan to use tracking technology on your website, the vendor needs to be a business associate of your organization. In these circumstances, covered entities must ensure that the disclosures made to such vendors are permitted by the Privacy Rule and enter into a business associate agreement (BAA) that outlines how PHI will be protected.

Think carefully about what data needs to be collected and why. In other industries, collecting user data and selling it to third parties or using it in advertising efforts is very common. Healthcare marketers must be more intentional in using online tracking technologies and take additional steps to ensure the data is processed and transmitted securely. Do not install tracking pixels without careful consideration. As many hospital systems learned, failing to do so can have profound privacy and compliance implications.

If you want to follow up with patients who browsed your website for available appointments, you must ensure their data is secure from when it is collected through the transmission to other systems. For example, a patient may enter their name, email address, phone number, and desired appointment time into an online form. When they click “Submit,” where and how is this data transmitted and stored? As they browse the available appointments and doctors, your system may log which web pages they visit and store them in a CRM, CDP, or another platform. If they leave without making an appointment, what do you do with the data you collect? If you transmit this data to other advertising or marketing platforms, you will also need business associate agreements with those vendors. As you can see, it can get complicated very quickly.

HIPAA-Compliant Marketing Technology

LuxSci’s Secure Form and Secure Marketing technologies offer a few ways to address the patient privacy issues associated with online data collection and transmission. Our fully HIPAA-compliant solutions enable you to securely collect data on your website and use secure email to engage prospects. Contact our sales team to learn more today.

Tags: data collection, email marketing, ePHI, hipaa compliance, online tracking, online tracking technology, patient privacy, phi, pixel tracking, tracking pixel
Posted in LuxSci Library: HIPAA, HIPAA Marketing
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Digital Strategies to Address Health Equity

Wednesday, July 5th, 2023

According to a HIMSS Market Insights study, nine out of ten healthcare executives see health equity as a top business priority. Improving health equity can drive value for other business metrics, including patient satisfaction, provider retention, health outcomes, and cost reduction. Email is an excellent way to address health equity issues, thanks to its widespread adoption across different ethnic and demographic groups.

 

doctor sending an email to patient

What is Health Equity?

According to the CDC, health equity is “achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances.”

 

Under President Biden, the Department of Health and Human Services has prioritized health equity in response to the COVID-19 pandemic. COVID-19 highlighted the healthcare system’s racial, economic, and social disparities. For example, COVID-19 killed Black, Latino, and Indigenous people at double the rate of White people. Native Hawaiians and Pacific Islanders remain three times more likely to contract the illness than White people. Addressing the social, cultural, racial, and economic factors contributing to this disparity is essential to improving individual and population health.

Improve Health Equity with Email Communications

Email is an excellent tool for patient engagement because of its widespread adoption across different demographic groups. As you can see in the data below, email has an overall adoption rate of 92%, and across all age and ethnic groups surveyed, adoption rates are above 80%.

email usage charts by age and ethnicity

Unlike phone numbers and addresses, email addresses seldom change because of economic instability. Email addresses are free to create and are typically accessed at least once a day. Broadband access continues to expand, though it still presents a barrier to email communication. However, even when broadband is unavailable, slower connections still permit text-based emails to be sent and received. Email is reliable, easy to use, and widely accessible to most individuals, making it an excellent channel for patient engagement.

The Technical Advantages of Email

Email also offers several advantages on the technical side to address digital health equity. Email’s main benefit is its ability to be personalized at scale. When using a secure email provider like LuxSci, you can create groups or segments of patients and send them relevant information about their health conditions or risk factors. These workflows can be automatically triggered when certain criteria are met to streamline operations and improve efficiency.

Thanks to the nearly universal use of EHR systems, healthcare marketers can access a wide variety of first-party patient data. Health records not only contain information about health conditions, but also information about patient demographics and preferences.

Intelligent marketers can use this data to close care gaps and improve health equity. Let’s take a look at an example.

An Example of Personalization and Segmentation to Address Health Equity

There are so many options when it comes to segmenting your patient population. To address health equity, you can use information like the patient’s native language and communication preferences to create personalized messaging. By doing so, you can increase response rates and close care gaps.

 

For example, say you have a significant portion of your patient population that speaks Spanish, and they are more likely to miss an appointment or not schedule a follow-up. How can you drive appointment attendance and reduce churn? The first step is to create an audience segment composed of patients who speak Spanish as their first language. Next, create email messages that are designed for the audience. This means writing the subject line and email contents in Spanish and using imagery they can identify with. But you can do more than that. Point people in this audience to schedule appointments with doctors who are fluent in Spanish. If there are other reasons this audience struggles to attend appointments, extend opportunities to help them with transportation, child/elder care, or access healthcare outside of regular working hours. Once you understand the barriers to attending appointments, you can extend personalized offers that help increase attendance and improve health outcomes. 

 

Most importantly, email allows you to test messaging and see what’s working. Review your campaign statistics and adjust your messaging to reach the most people and improve health equity among your patient population.

Conclusion

As we have seen, email is a highly effective way to engage marginalized patient populations. However, don’t forget about HIPAA compliance! Communications personalized and segmented using ePHI need to be secured.

 

LuxSci offers secure email services designed to meet HIPAA requirements. If you want to learn more about addressing health equity with secure communications, please contact us today.

Tags: covid19, diversity, email engagement, email use, ePHI, health equity, inclusion, patient engagement, personalization, phi, segmentation
Posted in HIPAA Marketing
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The Future of Protected Health Information

Wednesday, May 10th, 2023

HIPAA was introduced in 1996 to protect patient privacy and enable individuals to control their health records. However, over the last 30 years, the proliferation of technology has enabled patients to collect, transmit, and store personal health data in ways that were unimaginable to the original authors of the legislation. This article discusses how the definition of protected health information may expand in the future to account for new types of data, covered entities, and technologies.

the future of phi

Protected Health Information Today

Under the current iteration of HIPAA, protected health information, or PHI, is defined as “individually identifiable protected health information.” Protected health information refers specifically to three classes of data:

  1. An individual’s past, present, or future physical or mental health or condition.
  2. The past, present, or future provisioning of health care to an individual.
  3. 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 must 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 health data, would constitute PHI.

protected health information

In addition, under today’s HIPAA rules, only covered entities and business associates must abide by the regulations. Covered entities fall into three categories:

  1. Healthcare providers include hospitals, doctors, clinics, pharmacies, nursing homes, psychologists, and other providers.
  2. Health plans – Health insurance companies, company health plans, HMOs, and Government-paid health care plans such as Medicare are all considered health plans.
  3. Healthcare clearinghouses – These entities either process or facilitate the processing of health information they receive from other entities.

Business associates include a wide range of companies, but most importantly, they are contracted by a covered entity to perform a business function involving PHI. Business associates can include web hosts, billing companies, marketing agencies, legal firms, accountants, and more.

The Future of Protected Health Information

As the world has rapidly changed, new technologies that challenge how we think about personal health data have evolved. IT security teams must consider future security challenges and regulatory changes to futureproof their organization and mitigate risks. Below we explore how technology and PHI have progressed in a way that is pressuring regulators and legislators to protect patient privacy.

Technological Advances

The smartphone was still a decade away from being invented when HIPAA was introduced. In today’s world, the success of the iPhone has trickled down to other internet-connected smart devices like watches, scales, and other wearable devices. Even medical devices, including heart rate monitors and remote patient monitoring devices, can be found in people’s homes today. When medical providers ask patients to use these devices to capture biometric data, HIPAA rules apply.

But what about when healthcare providers do not recommend these technologies? If a consumer wants to use an application to record their daily activity, record their weight, or monitor their heart rate without direction from a doctor, HIPAA does not apply. However, due to the sensitivity of the data and lack of consumer understanding, some are calling for additional privacy protections for device and application manufacturers. It is not hard to imagine that any application designed to collect, store, or transmit health data will become subject to stricter regulations regardless of whether they are involved in an individual’s healthcare.

New Types of Data

When HIPAA was envisioned, genetic science was progressing but still confined to the upper levels of academia and research. Improvements in genetic testing and increased knowledge of the human genome could completely alter what is defined as PHI and how individuals interact with their healthcare providers. In 2013, amendments to the Privacy Rule clarified that genetic information is PHI and needs to be secured. However, over the past decade, genetic testing capabilities have exploded. Anyone can order a genetic test from numerous consumer-facing companies. As a result, personalized medicine is thriving and is likely to grow over the next decade.

As doctors have more access than ever before to information about our genomics, it’s of the highest importance to ensure it is secured.

Change is On The Way: Are You Ready?

Covid-19 rapidly accelerated many of these technological changes, and recent events in the news have already sparked changes to HIPAA enforcement. For example, the use of online tracking pixels to collect and transmit PHI recently caused OCR to issue a statement on their proper use. In addition, last year’s Supreme Court decision in Dobbs vs. Jackson Women’s Health spurred many reproductive health-tracking apps to take additional steps to protect users’ data. The incident highlighted just how much personal health data is contained in unregulated applications.

Even without government intervention, organizations that process health data must secure it to build consumer trust and differentiate from the competition. With breaches and cyberattacks on the rise, only the best-prepared organizations will be able to grapple with future challenges and regulatory changes.

Tags: dna, ePHI, genomics, health applications, health apps, hipaa privacy rule, patient privacy, phi, smartphone
Posted in LuxSci Library: HIPAA, LuxSci Library: Security and Privacy
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The Benefits of Using PHI in Patient Communications

Wednesday, March 15th, 2023

Some healthcare organizations do not allow PHI to be sent outside the patient’s health record. However, by allowing your marketing and administrative teams to use PHI in patient communication, you can streamline operations, improve the patient experience, and increase revenue.

Although the healthcare industry is traditionally slow to adopt new technologies, the past few years have rapidly accelerated the shift to digital communications. The reasons for these shifts are varied and will be explored in detail below. No matter the reason, one thing is certain- organizations adapting to the modern digital age are thriving, while those resisting change are falling behind in meeting patient expectations.  

Changing Technology Preferences

Rapid technological innovation has made it possible to communicate securely at scale. As broadband access has increased, people are incorporating it into their daily lives. In 2022, 92% of Americans reported using email, and 49% checked it every few hours. Many people now prefer to receive business communications via email because it is asynchronous and can be engaged with when it fits into their schedules.

healthcare technology preferences stats

Healthcare organizations that utilize email for external communication are experiencing better response rates and fewer patient no-shows. Email already fits into the daily lives of many patients and doesn’t require them to take extra steps to receive information about their healthcare journey.

The Rise of Healthcare Consumerism

Healthcare consumerism refers to patients’ personal choices and responsibility in paying for and managing their health. Patients are no longer stuck with one provider or practice. They have more choices than ever and will shop around for new providers if unsatisfied with their experience. 

If healthcare providers are not delivering a digital experience that meets patient expectations, they could risk losing patients and revenue.

reasons to change providers

In addition, as younger generations are taking control of their healthcare, they are used to digital-first experiences that are personalized to their needs. If organizations are unwilling to invest into personalized digital patient experiences, they will not adequately serve the next generation of healthcare consumers. 

Staffing Challenges

The healthcare industry is not immune to recent staffing challenges. Staffing shortages have left fewer employees available to do more tasks, including patient care. Introducing digital technology into your patient communication strategy can help automate and streamline common communication workflows like:

  • Appointment reminders
  • Pre- and post-procedure instructions
  • Health education messages
  • Vaccine reminders
  • Medication adherence reminders
  • Billing

Automating common workflows frees up time for staff to focus on urgent patient needs and improves the patient experience. 

How to Safely Use PHI in Patient Communications

Patients are already communicating with their healthcare providers one-on-one via email. The question is, how can you protect this data while communicating at scale for marketing and educational purposes? There are tools (like LuxSci’s Secure Marketing and Secure High Volume Email solutions) that are designed to support the unique security needs of the healthcare industry while providing the personalized digital experience that patients desire.

Protecting PHI in Patient Communications

PHI needs to be protected in emails with advanced encryption technology. TLS encryption should be used as often as possible because it provides a user experience like regular email without requiring a portal login. For marketing and patient education emails, TLS is sufficient to protect data and allows patients to readily engage with the email content. By properly vetting and choosing the right vendors, marketing and administrative teams can communicate with patients via email without violating HIPAA. 

Personalization at Scale

The power of PHI is undeniable. When healthcare marketers can harness healthcare data to create ultra-personalized campaigns, it increases their relevance and the likelihood that the content will be engaged with, delivering a better ROI. Our solutions integrate via API to securely personalize messages and trigger emails when specific conditions are met. This allows marketers to send relevant messages at the right time when it is relevant to the patient’s healthcare journey.

personalization stats 

Modern technology is needed to serve today’s patients. Meeting patients where they are with the information they need on the channels they prefer is vital to improving healthcare outcomes for the most vulnerable populations. Using PHI in patient communications gives your organization a comparative advantage by providing a better patient experience. 

 

Tags: automation, email encryption, patient communication, patient experience, personalization, phi, secure email, secure marketing, tls encryption
Posted in Email, HIPAA Marketing
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Futureproof Your Data Loss Prevention Strategy with Always On Email Encryption

Wednesday, March 1st, 2023

The threats to sensitive data keep increasing, and organizations are struggling to stay secure. With the government considering new cybersecurity requirements for critical infrastructure, many organizations are reviewing their data loss prevention policies and are looking for ways to improve their security stance. This article reviews standard data loss prevention methods, their shortcomings, and how adding always-on email encryption to your toolbox can help futureproof your communications.

data loss prevention gaps

What is Email Data Loss Prevention?

Data loss prevention, also known as DLP, ensures that sensitive data is not lost, misused, or accessed by unauthorized users. DLP software allows users to classify business-critical data and take specific actions when those data are present in email messages. If sensitive data is identified, data loss prevention tools take some action to prevent users from accidentally or maliciously sharing data that could put the organization at risk.

How does DLP Technology work?

There are two main types of data loss prevention tools available:

  • Rules-based DLP
  • AI and Machine Learning based DLP

We will primarily discuss rules-based DLP in this article. But first, DLP tools that use AI or machine learning are trained on an extensive data set to identify when email messages sent by your employees contain sensitive information.

In rules-based DLP software, administrators create rules that trigger the data loss prevention technology to take a particular action. Some examples of rules include:

  • Encrypting emails that contain social security numbers.
  • Not sending emails that contain health data (as identified by the organization).
  • Flagging emails that include specific keywords like “contract,” “financial report,” or “confidential information.”

Once the rules are in place, the DLP software will scan every outgoing email message to search for data that meets the criteria. When the DLP detects sensitive data, it takes an action that the administrator also determines. Some common protective actions include:

  • Not sending the email at all.
  • Adding a warning label or sending a notice to the email sender.
  • Encrypting the email and sending it to a web portal.

Why is DLP technology insufficient for security and compliance?

While DLP technology may capture most sensitive data, it is not infallible. In industries like healthcare and finance, even one mistake could lead to a breach with severe financial penalties.

PHI data risk

Looking at how most data loss prevention software works, it’s easy to see how it can fail. Rule-based DLP requires administrators to thoroughly document and catalog every possible variation of the keywords and number formats that could indicate the presence of sensitive data. Even one typo could throw off DLP software and cause data to be sent without protection. Sensitive healthcare and financial data do not always fall cleanly into pre-determined categories, and there are always exceptions to rules.

Conversely, false positives from extremely strict rule-making can result in delayed business communications and inefficiency. If DLP rules are too restrictive and too many messages are not sent or locked behind a portal, employees may use less secure channels to get around DLP technology.

How to Close Data Loss Prevention Gaps with Always-On Email Encryption

Highly regulated industries should consider sending all messages with a baseline of TLS encryption instead of relying on DLP technology to trigger it. TLS encryption is secure enough to meet most compliance requirements and has added usability benefits. TLS-encrypted messages appear just like regular, unencrypted emails in the recipient’s inbox, making them easy to read and respond to but without the risk of interception or eavesdropping. When all messages are automatically encrypted, you can worry less about DLP failure and data leakage.

DLP scanning can also trigger web portal pick-up encryption for more sensitive messages. Sending highly confidential information like financial statements, medical records, and board meeting minutes requires added security that can be triggered by DLP technology. Reducing the number of rules required makes data loss prevention tools easier for administrators to manage. Also, removing encryption choices from employees improves their productivity and reduces risk.

Message encryption may only be optional for a little while longer. In 2022, CISA issued Cross-Sector Cybersecurity Performance Goals, which recommended TLS encryption as part of prioritized cybersecurity practices that critical infrastructure owners and operators can implement to reduce the likelihood and impact of known risks and adversary techniques. Prepare for the future and protect your sensitive data by using LuxSci’s easy-to-use email encryption tools today.

Tags: content filters, data loss prevention, dlp, email encryption, email security, financial data, futureproof, keyword filtering, phi
Posted in Email, LuxSci Library: Security and Privacy
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