September 21, 2021

A Guide to Developing HIPAA Compliant Chat for Telemedicine Apps

Nabeel Keblawi

A Guide to Developing HIPAA Compliant Chat for Telemedicine Apps
HIPAA Compliant Chat App showing a secure conversation between the doctor and patient

Violating HIPAA is surprisingly easy. All it takes is using non-secure chat software between a doctor and a patient.

And what happens when a healthcare provider violates HIPAA? 

They’re on the hook for a minimum of $50,000 fine per violation unless they take quick measures to correct it. Maximum penalties go up to $1.5 million per year, which is plenty enough to put a clinic under. The only way to defend against these potential liabilities is to develop and use HIPAA compliant chat software. 

This guide will show you how to ensure that you’re using HIPAA compliant chat. 

What is HIPAA?

HIPAA stands for Health Insurance Portability and Accountability Act. Enacted in 1996, HIPAA is a United States federal law that ensures your private health information stays secure.

HIPAA includes regulations for how healthcare providers and businesses should and can handle data and health information. Those regulations and standards are required to ensure PHI data is stored, managed, and accessed correctly at any time of the day.

HIPAA laws include specified penalties and fines for those organizations or individuals that opt not to comply with HIPAA standards.

How is HIPAA Related to Chat?

Sensitive personal information created in the context of healthcare, including IP addresses, file attachments, and images can be distributed easily to third parties through private chats, HIPAA compliant group messaging, and other collaboration channels.

Plenty of less-secure chat apps may have little or no encryption, weak authentication, and also lack controls or safeguards against bad actors. 

HIPAA was passed into law in order to protect patients from what might happen if and when their personal information and medical data find their way into malicious actors through non-secure text or video chats. 

Best Practices for Developing HIPAA Compliant Chat Software

Best Practices for Developing HIPAA Compliant Chat Software

We outline some best practices to make sure your chat software is HIPAA compliant in a way that will both protect your patients from harm and your clinics from both civil and criminal liabilities. 

1. Understand What PHI Is

The first thing to do is to understand what types of information are considered Protected Health Information (PHI). 

PHI includes information such as:

  • Medical records, including everything from an MRI scan to blood test results.
  • Billing records and payment methods at any medical office.
  • Any emails, notes, texts, video chats, and other correspondence created within a doctor-patient relationship.

Basically, any information that is linked to your patient within the context of a doctor-patient relationship or any background medical history is considered PHI and therefore subject to HIPAA.

2. Confirm if You Are Subject to HIPAA Compliance

The second thing to do is check whether you are a Covered Entity (CE) or a business associate of one.

When HIPAA was first enacted, the purpose was to provide a safe way for people to transfer employment and doctors using their same health insurance policies and information. Initially, it was only hospitals, doctors, and insurance companies that had to comply with HIPAA specifications.

The reason for this is because at first, these were the only people and places with access to PHI data. Under HIPAA law, these "covered entities" include any organization that provides treatment, payment, and health care operations, such as:

  • Hospitals
  • Doctors and medical offices
  • Pharmacies
  • Insurance Companies
  • HMOs

In 2013, HIPAA decided to take into account the fact that health care across the country was outsourcing and using cloud providers. Now, these services must all stay HIPAA compliant too. They're called "business associates," and they include any service that transmits, stores, or receives personal information and medical data of patients.

These business associates include:

  • SaaS companies that provide cloud-based and electronic health information and records for medical professionals.
  • Medical transcription services that provide services to doctors and other health professionals.
  • Analytics companies that process medical data.

Both covered entities and business associates, including chat software providers for the healthcare industry, are subject to HIPAA regulations.

3. Execute a BAA Contract

A covered entity or business associate must have a signed and executed Business Associate Agreement (BAA) with service providers in place to ensure PHI data stays secure.

The HIPAA privacy rule stipulates that covered entities may disclose PHI to business associates to help the covered entity to carry out their healthcare business functions, such as making appointments, updating prescriptions, and submitting diagnostic codes for insurance and billing. 

To ensure HIPAA compliance coverage onto third parties and business associates of covered entities, they must have a signed and executed BAA. To help facilitate this process, the Department of Health and Human Services provides a sample BAA provision agreement.

4. Address Safeguards to Protect PHI

The HIPAA security and privacy rules stipulate that covered entities and business associates need to have technical safeguards when PHI data always protected is both at rest and in transit. These safeguards include the following:

  • Integrity controls (end-to-end encryption)
  • Transmission security and accuracy
  • Access controls
  • Audit controls
  • Authentication

Integrity controls and transmission security likely require a high standard of end-to-end encryption of at least AES-256 or better. 

But HIPAA compliance goes further than just encryption. It includes restricting access to PHI data to only those employees or people needed to accomplish the purpose at hand. These audit and access controls entail policies and procedures to limit access to PHI data and to have the training to teach users and employees about privacy, data security, and proper authentication.

One other thing you can do, according to Paubox, to protect PHI is double-check that all live chat integrations within your app are HIPAA compliant, and disable the ones that are not compliant. 

You can take this a step even further by restricting access to your live chat solution only to relevant parties including physicians and patients with confirmed appointment times. You can also disable sending and receiving attachments in your chat functionality. 

Finally, to ensure that your data security and safeguards are robust and up to date, you can obtain SOC 2 certification. The principles of SOC 2 compliance have a lot of overlap with the safeguards necessary for HIPAA compliance. Therefore, if you are SOC 2 compliant, you are likely to be compliant with HIPAA or can easily get there with a few simple modifications to your controls and processes.

5. Ensure that Data Stays Within the United States

If any data being transmitted or stored by your live chat solution leaks to any servers or clients located outside of the U.S, that data is neither longer protected nor covered by HIPAA. To be sure that your data is safe and compliant with HIPAA, you can ensure that your live chat solution uses servers and data centers located within the United States. 

Lastly, you can also set up chat transcriptions to store on your facility servers, or if you really want to be safe, just turn off this feature.

Features & Components of a HIPAA Compliant Chat Client

In this section, we list some must-have features for a HIPAA compliant chat client as well as some specific features for text chat and video chat. 

Must-Have Features for Both Text, Video, and Web Chat

These must-haves are practically non-negotiable for all HIPAA compliant web chat and telehealth app software, as these help comply with data security and privacy requirements.

Enterprise-Grade Encryption 

All data, whether in transit or at rest, must be encrypted at AES-256 or higher using SSL to prevent security breaches into PHI data.

User Authentication System

Users must authenticate themselves using multi-factor authentication as well as a unique username and password before gaining access to PHI.

Automatic Logoff

In a fast-paced working environment, doctors may set their devices down without logging off or locking their screens, potentially exposing PHI data to security breaches. The auto-logoff feature prevents this from happening when devices are not in use. 

Nice-to-Have Features for Text, Video, and Web Chat

While not critical for security and HIPAA compliance, these features help enhance the user experience for both doctors and patients and thus drive more adoption of telehealth apps using text and video as well as HIPAA compliant web chat.

Notification and Reminder System

Both doctors and patients benefit from a notification system that sends reminders so that no one misses anything important. Particularly for patients, pre- and post-care reminders reduce no-shows, improve treatment compliance, and provide better patient outcomes.

Rich Media

Text and video chats with rich media, including a combination of audio, video, and images, can help replicate in-person appointments more closely during virtual consultations.

Secure File Sharing

File-sharing within secure and HIPAA compliant chat software allows doctors and patients to safely share lab test results, diagnostic scans, and other files containing PHI without fear of getting compromised.

Additional Features for Text-Based Chat

On top of the above, additional features can be added to HIPAA compliant text chat such as the following:

  • Saved chat history
  • User online status
  • Typing indicators
  • Synchronization across multiple devices

Additional Features for Video Chat

For video chat, the following features can also be included in a HIPAA compliant manner:

  • Live streaming
  • Screen sharing
  • HIPAA compliant group messaging (e.g. when a specialist is needed)
  • Screen recordings

Building a HIPAA Compliant Chat App

Before you build a HIPAA compliant chat app, it is worth conducting a risk assessment to see what security and privacy gaps may need to be filled in to ensure compliance. You can use a HIPAA compliance checklist to help expedite the process. Next, as discussed in the above best practices, you’ll want to set safeguards to ensure the protection of PHI, including encryption. 

Next, you’ll want to think about the type of app you want to develop and for whom. There are many different types of telehealth apps that can embed chat functionality. These include:

  • Interactive apps
  • Remote patient monitoring apps
  • Click-and-send apps

If you’re reading this article, you are most likely considering developing an interactive app with either text messaging or video chat functionality, or both. 

Get Started

We’ve created this comprehensive guide to developing telemedicine apps, which must be HIPAA compliant when dealing with PHI. Here you will find everything you need to know in order to design and develop a top-notch telemedicine app. 

If you want to dig in more, these articles will tell you the most interesting stats for the telehealth industry and the top 5 things that make telemedicine providers successful — indicating that telemedicine is an ongoing revolution. 

We've also built step-by-step tutorials to help you develop HIPAA compliant iOS telehealth chat apps and Android telehealth chat apps using our healthcare security SDKs and APIs.

How CometChat’s HIPAA Compliant Chat API Can Help

Of course, you can build HIPAA compliant chat functionality in-house. This approach, however, will take lots of time and resources. 

The faster way to incorporate this functionality in your app is to use the technology that’s already available, i.e., CometChat - a HIPAA compliant chat API with healthcare security SDKs ready to integrate text, voice, and video chat into your telemedicine app within minutes. 

CometChat provides a fast, affordable, and secure HIPAA-ready chat API that is rich with both must-have and nice-to-have features that allow you to scale as your app usage grows. In case you want to explore more, we also have an article that highlights the top APIs for telehealth apps that enhance their functionality and overall UX without compromising on medical or patient data. 

We make it very easy to get started with CometChat’s HIPAA compliant chat API — all you have to do is sign up to our developer dashboard and start building your chat app for free. 

If you still have questions, feel free to talk to our experts and get answers before you get started. 

About the Author

Nabeel Keblawi, a deaf entrepreneur, runs a Content Marketing and SEO agency that helps B2B SaaS companies grow organically in their industries around the world. His previous work experience involved software development, renewable energy, and cloud computing. In his personal life, Nabeel loves to go hiking with his family, and dust off his skis to hit the slopes given the chance. He is also an avid reader of fictional history.

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