Using E-mail at Your Medical Practice: 5 Security Tips

April 5, 2015

Forget patient portals, faxes, and snail mail. E-mail is more accessible, so here are five ways to securely communicate with patients and peers.

Methods for transferring protected health information (PHI) have been broken for a long time. Even with the advent of EHRs, data exchange methods haven't kept pace with industry expectations for privacy and convenience.

It's time to retire the usual stable of secure alternatives to e-mail, like patient portals, faxes, or snail mail. They're far too burdensome for both practitioner and patient. Like it or not, e-mail is synonymous with accessibility. To deliver the best care possible, it's essential to meet patients on their terms. It's harder than ever to ignore e-mail, just as it's becoming more difficult to embrace it in good conscience.

Most e-mail security solutions focus on simple text, but the real risk comes with files and attachments. That's because sensitive data typically resides in files. Files, in turn, often get duplicated and cached on devices, making them hard to easily track or protect. So when we talk about the risks facing medical practices when it comes to communicating, it's about files-not simple text messages. The question, of course, is where all that leaves most practices.

The key lies with file encryption. Encryption essentially scrambles messages so that they're only legible by intended users. That's why encryption is so often the means through which healthcare providers guarantee HIPAA compliance. Although most secure e-mail tools focus on the body text of an e-mail, that part might not even be necessary to encrypt. After all, the real threat lies in what comes appended to the e-mail. Whether they're voice recordings, digital X-rays, intake forms, or medical bills, it's essential to encrypt the files themselves.

Seeking Solutions

Finding the right solution, though, is another story. E-mail encryption services exist for handling simple text correspondence with patients by scrambling the messages and sending them through a secure connection. But even these have risks. Many HIPAA-compliant e-mail providers are simply adding yet another system to your already disconnected work flows, rather than integrating seamlessly or solving some of the other problems you have, like storing files and auditing access. What's more, they aren't foolproof.

Here are five tips to help practices communicate with patients and other provider and business associates while maintaining airtight security.

1. Look for file encryption. File-level encryption ensures that protections follow the file no matter where it ends up. With built-in authentication controls, file-level encryption also eliminates the threats associated with mistakenly entering the wrong e-mail address.

2. Don't forget about secure file storage. Many encrypted e-mail services that purport to comply with HIPAA destroy messages after a set period of time. The issue, of course, is that practices need to keep detailed records - and the best place for that, in my humble opinion, is the cloud. Which brings us to …

3. The best solutions will integrate seamlessly with other work flows. The cost of inconvenience is too high, because inconvenience often leads users to seek out workarounds that aren't compliant, including popular cloud services like Dropbox. So the expensive EHR system you've built or bought is nothing more than a loophole to circumvent. In some ways, the cloud presents the ideal all-in-one solution, eliminating the need for e-mail attachments by allowing you to store and share links or folders themselves. In those deployments, it's essential to ensure that your Dropbox files are encrypted and HIPAA-compliant. If you have file encryption, you can use e-mail and Dropbox the same way you would in your personal life - just more securely.

4. Many easy-to-use secure providers don't include a safety net for mistakes. We're all familiar with the horror stories and HIPAA fines that have been levied against practices that mistakenly e-mailed lab results to the wrong patient or faxed a form to the wrong number. That's why the best HIPAA-compliant sharing tools will help prevent or create solutions for mistakes by showing just what was attached and offering the ability to revoke access to the wrong recipient. If a file itself is encrypted, access and modification can be audited even if it was mistakenly downloaded.

5. You don't need to encrypt everything. It isn't necessary - and maybe even inappropriate - to treat all information equally. Flexible solutions that allow you to set permissions according to their sensitivity are ideal.

There's no shortage of options for communicating, but many secure e-mail technologies can leave much to be desired. The key in striking a balance between convenience and compliance lies in finding a solution that does the hard work of communicating securely for you. The onus should be on the technology - not the patient or your employees - to strike that balance.

Asaf Cidonis the co-founder and CEO of Sookasa, a cloud security and encryption startup. He previously worked at the Web search engineering team at Google and led a team in an elite unit in the Israeli intelligence. Cidon holds a Ph.D. and MS in electrical engineering from Stanford University, and a BS in computer engineering from the Technion. He can be reached at asaf.cidon@sookasa.com.