This guide covers how you can build a secure, fully-featured, HIPAA-compliant messaging application.

The convenience and efficiency of sending text messages and SMS messages on a mobile device—like an iOS iPhone or Android—has led to a shift in the way healthcare organizations interact with patients. 

Healthcare providers have adopted secure messaging solutions as a way to improve patient care and facilitate better doctor-to-patient communication. And in telemedicine apps, chat messages often contain protected health information (PHI), so it is crucial that you consider HIPAA compliance and HIPAA regulations when building your in-app chat. 

With HIPAA-compliant messaging apps, doctors and healthcare providers can share PHI with patients. This includes x-ray images, lab results, or information such as an address or telephone phone number. Rather than relying on sending paper records or phone calls, in-app HIPAA-compliant chat gives patients and healthcare providers a way to quickly and securely communicate with one another.

As secure messaging platforms continue to evolve at a fast pace, it’s important to understand that security measures must be in place to protect sensitive patient data and maintain compliance. In this guide, we will explore how to ensure HIPAA-compliant messaging in your application, and the key benefits they offer to healthcare organizations and patients. 

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What is HIPAA compliance and when is it required? 

HIPAA refers to the Health Insurance Portability and Accountability Act, a law established in 1996 to ensure that security is in place to protect patient privacy and sensitive information. 

To establish HIPAA compliance on your platform, you must follow the four HIPAA rules: Privacy, Security, Enforcement, and Breach Notification.

  • Privacy: Established to safeguard an individual's protected health information (PHI) and authorize when PHI can be used or disclosed. 

  • Security: Describes the physical, technical, and administrative security measures that are needed for securing the confidentiality of electronic protected health information.

  • Enforcement: Deals with compliance and enforcing HIPAA.

  • Breach Notification: Requirements that involve notifying HIPAA covered entities and their business associates if a security breach occurs.

Healthcare organizations are required to protect patient information through encryption and advanced password security, and any failure to follow these security rules and HIPAA regulations can result in fines depending on the violation.

HIPAA-compliant text messaging apps

Another important factor to take into account is that standard text messages and SMS messages are usually not considered a form of secure texting. This means that when you send or receive these types of messages, they are not presented as secure messages in transit and can be easily accessed by unauthorized users. 

For instance, some text messaging platforms are designed to specifically send appointment reminders or regular SMS text messages to patients. However, they do not always offer encrypted or secure text messaging for sharing protected health information. 

In-Text HIPAA-Compliant Messaging 1380x600

So if you’re developing a HIPAA-compliant texting app, you’ll want to ensure that there are secure features built-in to your texting solution to protect sensitive patient data. But to truly ensure security and compliance in your doctor-patient chat, choosing to build chat directly into your healthcare or telemedicine platform—like with PubNub—is your best bet. 

Protecting PHI with secure messaging

When it comes to ensuring HIPAA-compliance in your in-app chat, there are certain safeguards that need to be in place—from the way messages are sent in transit to security measures that must be implemented. 

For applications to be HIPAA-compliant from a technical standpoint, they must include: 

  • Encryption: Secure messaging, which is also known as message encryption, is required to protect messages and data containing PHI. Many applications rely on Transport Layer Security (TLS), which is an updated version of Secure Sockets Layer (SSL), a common security protocol used to establish secure communication. With this, the contents of a message are unreadable to those without access permissions. For example, messages and data in transit are encrypted as it travels to the intended recipient. Once enabled, only the sender and the authorized recipients can read the message. 

  • Password Protection: Safeguarding your application with access controls and user authentication is essential. Access controls allow you to manage read/write permissions for specific users, with the ability to grant permissions for who can access PHI. This can be done by enabling secure password protected logins and two-factor authentication to add an extra layer of security to your messaging app. Additionally with the PubNub Access Manager (PAM), you can grant and revoke access to channels instantly throughout the PubNub data stream network. Once PAM is enabled, an authorization token is required before any action can be taken to prevent unauthorized access. 

  • Audit Controls: Audit controls allow you to monitor user access and see activity logs. For instance, say an individual who is a part of the healthcare staff, like a nurse, logs in to access patient data. There will be a record of their actions in the system, and you’ll also have the ability to see who, when, and how long they were in the system. This is crucial for ensuring that healthcare information doesn’t fall into the hands of unauthorized parties. 

  • Automatic Sign-Out Features: In order to protect patient data, automatic sign-out features are implemented to detect inactive users. Using a timed log-off functionality, you can prevent unauthorized third-parties from accessing confidential information if a device with PHI is left unattended. 

  • Business Associate Agreement (BAA): A Business Associate Agreement covers the entity (the organization who is delivering the product) and the technology and services (the business associate) that you choose to store, transmit, or process PHI. This agreement outlines how both parties are practicing compliance. At PubNub, we offer a BAA to any and all of our customers who require HIPAA compliance. 

By meeting these security requirements, you guarantee that patient privacy is upheld on your application, which allows healthcare professionals to truly focus on delivering better patient care.  

Benefits of enabling HIPAA-compliant chat in your messaging app

Apart from the technical safeguards that are used to protect patient data, healthcare professionals and care teams can utilize HIPAA-compliant messaging solutions to enhance virtual and in-person communication between healthcare providers and patients. 

Below, we’ll dive into some of the key benefits of having HIPAA-compliant messaging in your app. 

Improved patient-doctor communication

With secure in-app text messaging, doctors and healthcare staff can quickly and easily engage with patients to share important details like PHI, lab results, and medical records. For example, if a patient wants to share a file or an image with their healthcare provider, they can instantly and securely do this in-app—fostering two-way engagement between patients and doctors.

Increased efficiency between care teams 

Another major benefit of implementing HIPAA-compliant messaging is that it gives healthcare organizations the ability to streamline administrative workflow, which improves care team productivity through user-friendly scheduling features and real-time patient Presence that help to reduce no-show follow-ups and wait times. This allows healthcare organizations to spend more time focused on delivering personalized patient care.

Reduced response times in emergency situations 

Real-time HIPAA-compliant texting allows healthcare providers to remotely communicate with patients regardless of physical barriers. And since the pandemic, this instant communication is vital, as it allows patients dealing with emergency situations to remotely connect with doctors via in-app chat—reducing overall response times—and helping to ensure that patients receive faster care.

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Learn how Zoll uses PubNub to guarantee that messages arrive in less than ¼ second

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Ultimately, if you’re developing an application where sensitive patient information is going to be exchanged between patients, doctors, or care providers, HIPAA-compliant messaging is needed for proper data protection. 

How to build a HIPAA-compliant messaging solution

PubNub’s fully compliant SDKs allow developers to quickly and easily get their application up and running. With our pre-built chat and UI components, you have full control over how you want to build—from the look and feel to the functionality.

Let's explore how you can build a customized HIPAA-compliant messaging solution to fit your needs with PubNub’s secure infrastructure. 

Data privacy and security

As mentioned above, the most important thing when developing a HIPAA-compliant texting app is that patient data is protected, so that unauthorized users are not able gain access to confidential information. Health systems must comply with HIPAA regulations to ensure that this data privacy is upheld. 

Using end-to-end encryption for every message running over the network and secure controls on the PubNub Access Manager (PAM), PubNub ensures that user data is fully secure so that you can focus on innovating your product offering instead of worrying about maintaining backend infrastructure. You can build a chat that is able to safely stream or store protected health information within our network using security features like:

  • End-to-end message encryption

  • Access controls and permission management

  • User authentication features  

  • Audit controls

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Go beyond just chat with additional features

A HIPAA-compliant messaging solution with real-time chat, secure file and image sharing, and scheduling features allows healthcare organizations to provide better quality care to patients. With PubNub’s infrastructure, you are able to build a feature-rich chat application that provides a way to instantly see when patients are online. Using features like notifications, typing indicators, and Presence detection, patients are notified when their doctor is available and vice versa, enabling faster response times. Additionally, presence can be used for real-time location tracking to make sure that patients get to the nearest care facility.

Integrations with third-party services 

Secure and easy-to-use features are crucial for healthcare applications, and to expand your care offerings, a HIPAA-compliant messaging solution should also be able to integrate with third-party services. Our pre-built integrations make it easy to implement additional features like HIPAA-compliant voice calls and video chat with Vonage, integrations with EHRs, real-time text-to-speech functionality, and much more to help improve continuity of care. 

Scalability and reliability 

A reliable chat infrastructure that is able to handle a large number of users and data is essential. PubNub offers flexible APIs and custom solutions that are fully HIPAA-compliant, so your platform can operate at scale and accommodate high volumes of PHI on any device. This reliability is crucial because it ensures that messages are sent and received without delays—which makes interactions between healthcare providers and patients feel more personal and connected. 

If you’re looking to build a secure, fully-featured, HIPAA-compliant messaging application, check out these resources to help get you started:

Looking to chat with one of our experts about building your real-time, in-app experiences? Contact our sales team here

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