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HIPAA-Compliant Email Marketing: FAQ

Tuesday, November 21st, 2023

Email is an essential channel for most marketers. However, HIPAA regulations raise many questions for healthcare marketers who need to execute email marketing campaigns without violating patient privacy.

HIPAA is a complicated law that offers a lot of guidance but does not require the use of any specific technologies to protect patient privacy. The ambiguity causes a lot of confusion for marketers trying to integrate email into their marketing strategy. This article addresses some frequently asked questions about HIPAA-compliant email marketing and offers advice for securing patient data and futureproofing your marketing.

Do generic practice newsletters need to be protected?

Some marketers assume practice newsletters do not contain health information and, therefore, do not fall under HIPAA requirements. However, this assumption is often incorrect. Many are surprised to learn that protected health information can be implied from seemingly benign information.

In this way, many generic email newsletters often indirectly contain PHI because they are sent to lists of current patients. Email addresses are individually identifiable and combined with the email content; it may imply that they are patients of the practice. For example, say you send a “generic” newsletter to the patients of a dialysis clinic. An eavesdropper may be able to infer that the recipients receive dialysis. Therefore, the email reveals information about an individual’s health treatment, is PHI, and should be secured in compliance with HIPAA regulations.

In some cases, it can be complicated to determine what is PHI and what is not. Using a HIPAA-compliant marketing solution is best to avoid ambiguity and ensure security.

How Do I Find a HIPAA-Compliant Email Marketing Vendor?

Unfortunately, using broadly popular email marketing platforms is not recommended. Many of these platforms were designed for e-commerce businesses and are not secure enough to meet HIPAA requirements. We do not recommend using a solution not specifically equipped to meet the healthcare industry’s unique security and compliance needs. To determine if your email marketing provider is compliant, they must meet three broad criteria at a minimum.

  1. The vendor must sign a Business Associate Agreement outlining how they plan to secure your data and what they will do in the event of a breach.
  2. Encrypt data at rest when it is stored in their systems.
  3. Encrypt email messages and data in transit as it is sent to the recipients.

 

email marketing vendor comparison

Not all vendors will be up to the task. Carefully vet your email marketing vendors to ensure they are taking steps to secure data and protect patient privacy.

What is an Email API?

API is an acronym that stands for “Application Programming Interface.” An email API gives applications (like CRMs, CDPs, or EHRs) the ability to send emails using data from the application. Email APIs also return campaign data to the platform or dashboards so you can assess the effectiveness of your marketing efforts. Trigger-based transactional or marketing emails are ideal for sending with an email API. In this situation, emails are sent when pre-determined conditions in the application are met. Healthcare organizations may use email APIs to send appointment reminders using electronic health records system data about a patient’s upcoming appointment.

Email APIs enable the automation of common email workflows. However, they are not interchangeable with email marketing platforms. Email APIs do not include the contact management systems standard in most email marketing platforms because all that data lives within the application they connect to. In addition, email API tools typically do not include drag-and-drop editor tools or other design features that help your emails stand out.

Does HIPAA permit providers to send unencrypted emails with PHI to patients?

Encryption is an addressable standard under the HIPAA Security Rule, but that does not mean it is optional. The HIPAA Privacy Rule does not explicitly forbid unencrypted email. Still, it does state that “other safeguards should be applied to protect privacy reasonably, such as limiting the amount or type of information disclosed through the unencrypted email.”

In addition, the Department of Health and Human Services also states that “covered entities are permitted to send individuals unencrypted emails if they have advised the individual of the risk, and the individual still prefers the unencrypted email.” Some organizations use waivers to inform patients of the risks and acquire permission to send unencrypted emails.

However, we do not recommend this approach for several reasons:

  1. Keeping track of waivers over time and recording status changes and updates is challenging.
  2. Signed waivers do not insulate you from the consequences of a HIPAA breach.
  3. And finally, using waivers to send unencrypted emails doesn’t eliminate your other HIPAA obligations like data retention and disposal. Using a HIPAA-compliant solution is more manageable and eliminates ambiguity.

Can patients exercise their right of access by receiving PHI via unencrypted email?

Yes, but they must be fully informed of the risks and sign waivers acknowledging them. The caveats in the previous answer apply. It’s always better to utilize an encryption tool to protect patient data.

Is Microsoft 365 or Exchange 365 encryption sufficient for marketing emails?

Microsoft 365 can be configured with Office Message Encryption (OME) to comply with HIPAA. However, the program is not well-suited to send marketing emails. OME primarily relies on portal pickup encryption, in which the message is stored securely on a server and requires the recipient to log in to the portal to read the email. If you are a marketer trying to increase engagement, the portal adds a barrier to access that many will not cross. Light-PHI marketing messages are best sent using TLS encryption. TLS-encrypted messages arrive in the recipient’s inbox just like a regular email and do not require a user to log in to read the message.

TLS versus Portal Pickup email encryption

In addition, Microsoft 365 is not configured to send high volumes of email. If you plan to send large marketing campaigns, you could unintentionally disrupt regular business communications by sending all the messages through the same infrastructure. You should separate your business and marketing email sending to protect your IP reputation and achieve your desired sending throughput.

What are common email marketing use cases for healthcare?

Email marketing in healthcare is not restricted to boring practice newsletters. When you utilize tools that enable the use of PHI in your targeting and personalization efforts, the sky is the limit. With consumer preferences shifting toward digital communications, marketers willing to utilize the email channel and tactics like segmentation and personalization can see better results.

Email is an excellent way to communicate with patients. A sampling of ways that healthcare marketers can use email include:

  • engaging patients in their healthcare journey
  • educating patients about their healthcare conditions and treatments
  • improving attendance and scheduling
  • retaining patients
  • increasing preventative procedures
  • collecting data on the patient experience
  • improving patient satisfaction

Conclusion

HIPAA can be difficult to understand, but choosing the right tools and adequately vetting your vendors makes it easy to execute HIPAA-compliant email marketing campaigns. If you are interested in learning more about LuxSci’s easy-to-use, Secure Marketing platform, please contact our sales team.

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.

hipaa compliant email marketing

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.

 

 

Quasi-HIPAA Compliance Podcast

Thursday, September 3rd, 2020

As a followup to our blog on Quasi-HIPAA Compliance, Erik recently had the chance discuss the topic in a podcast with Jason Karn of Total HIPAA.  They touched on some key topics including:

  • What exactly is “Quasi-HIPAA” compliance?
  • What are some common gaps in Business Associate Agreements (BAA)?
  • What are some best practices when choosing a BAA?
  • Best practices for setting remote work policies.

Listen to the podcast here or a mobile device on Apple Podcasts.

 

 

 

What We Call “Quasi-HIPAA-Compliance”

Thursday, March 26th, 2020

Are your organization’s service providers HIPAA-compliant, or are they only quasi-HIPAA compliant?

What do we mean? 

Okay, we’ll be honest quasi-HIPAA compliant isn’t an accepted term yet but it should be.

When we talk about quasi-compliance, we’re referring to setups and services that look HIPAA-compliant and share some of the features; however, they may not be entirely in line with HIPAA requirements if you actually use them in the way that you want.

Quasi-HIPAA compliance is common, particularly in popular services. It can also be hazardous for businesses because quasi-HIPAA compliance can lead organizations into a false sense of security while they may be violating the regulations unwittingly.

Quasi HIPAA-Compliance

What Is Quasi-HIPAA Compliance?

The best way to explain the concept of quasi-HIPAA compliance is through example. A quasi-HIPAA compliant service could come from an email-hosting provider, web hosting provider, or an organization that offers a range of other solutions. 

If these providers are quasi-HIPAA compliant, they will include elements of HIPAA compliance. Still, the services may not be appropriately tailored to keep their clients within the lines of the regulations when used in various ways. A provider may be willing to sign a HIPAA business associates agreement (BAA) with your company, but its services may not include the appropriate protections for compliance.

As a good example: Google is willing to sign a BAA with customers using its Google Workspace service. However, Google does not actually provide HIPAA-compliant email encryption — so using Google Workspace email in a HIPAA context can immediately leave you in non-compliance and subject to breach. This is quasi-HIPAA compliance. You assume that by signing a BAA, you can use the services as you like and be “all set.” In truth, you need to understand what is allowed and what is not allowed. You need to either (a) avoid performing non-compliant actions or (b) add additional measures to fill those gaps.

Quasi-HIPAA compliance

Business Associates Agreements & Quasi-HIPAA Compliance

A BAA is essential for HIPAA compliance. Your company can’t be completely HIPAA-compliant if it uses the services of another entity without a BAA in place. It doesn’t matter if the entity’s services are technically HIPAA-compliant; you will fall afoul of the regulations unless a BAA exists between the two parties.

Even if you have a BAA with your provider, that alone may not be enough to keep your organization on the right side of HIPAA. The provider may not have the security measures your organization needs and instead have a carefully worded BAA that will leave you vulnerable.

Let’s say your email marketing service provider is a quasi-HIPAA compliant provider. It may not offer email encryption, or the necessary access control measures your organization needs to send ePHI and other sensitive information safely. The “HIPAA Compliance” may be limited only to data stored at rest on their servers. You may be stunned to learn that an email marketing company offering “HIPAA compliance” does not recommend sending any sensitive data over email

The BAA offered by a company may be carefully worded to say that the service is technically HIPAA-compliant, but only if you don’t use it to send ePHI. This is legal, and the provider isn’t necessarily doing anything wrong by offering such a service, as long as this is clearly stated in the agreement. Without understanding clearly what is actually “covered,” you leave yourself at risk.

The compliance and breach danger comes when organizations use quasi-HIPAA compliant services without completely understanding them. If they don’t take the time to do their research or thoroughly read the agreement, they could use the service in a way that isn’t covered under the BAA.

Doctor Video Conference

Dangers of Quasi-HIPAA Compliance

In our example, an organization might subscribe to a quasi-HIPAA compliant service and use it to send ePHI. Suppose ePHI isn’t allowed to be sent via email or text under the BAA, and it’s sent without encryption and other security measures in place. In that case, the messages will violate HIPAA regulations.

This is an easy trap to fall into for several significant reasons. 

  1. BAAs can be complex and need to be studied carefully. 
  2. People make assumptions about what is covered by an organization’s “HIPAA compliance.”
  3. It’s very easy to send ePHI in an email accidentally. The definition of ePHI is broad, so employees can include ePHI in messages without even realizing it.

Even if your organization specifies that ePHI shouldn’t be sent through a particular service, all it takes is one mistake, and your company will have a costly HIPAA violation on its hands. Suppose your organization does use an email marketing service that’s only quasi-HIPAA compliant. In that case, the restrictions on ePHI will prevent your organization from being able to market effectively and communicate appropriately with its clients.

How Your Organization Can Avoid Quasi-HIPAA Compliance

The most important way to protect your organization is to do your research beforehand and ensure that any prospective provider will cover your intended uses. This means that you need to read through their BAAs to ensure that they align with your business’s requirements.

To save you some time, services like Google Workspace and the vast majority of email marketing services can be seen as quasi-HIPAA compliant. Only providers that specialize in HIPAA-compliant services will be able to deliver the solutions that healthcare organizations and those that process ePHI require.

If your company needs proper HIPAA compliance, then a provider like LuxSci is the best way to stay on the ride side of the regulations. We have been providing HIPAA-compliant secure email since 2005. Not only are our solutions tailored to abide by HIPAA, but we have also developed the services you need to conduct essential business tasks.

We provide HIPAA-compliant bulk email solutions for clients that need to send at scale. These services are set up over our secure infrastructure, and we provide dedicated servers for clients.

LuxSci focuses on both compliance and ease of use, so we have developed secure email hosting, email marketing, and transactional email solutions among our offerings. Our services help your organization comfortably market itself and conduct business while staying in line with HIPAA compliance.