The Complete Guide to HIPAA-Compliant Chat


As healthcare professionals adapt to telemedicine, and patient habits evolve around remote and hybrid interactions, the need for secure and accessible HIPAA-compliant chat is critical. 

For any healthcare interaction to be effective, patients inevitably must share sensitive information, which is referred to as protected health information (PHI). As per HIPAA compliance, any data that is created, transmitted, received, or stored electronically is considered electronic protected health information (ePHI). 

ePHI can be as simple and direct as a patient’s real name, which might be displayed in patient-doctor chat to create clarity and familiarity. But things like contact information, patient addresses, and medical records also need protection. 

In the United States, this is mandated by HIPAA regulations, which lay out provisions that guide the secure development of apps for remote care. That means that, if you’re developing a telemedicine app to facilitate sensitive conversations and the exchange of ePHI between patients and care professionals, HIPAA-compliant chat is a must to ensure the security and privacy of patient data.

This article is a short guide to help those that want to build telemedicine applications with end-to-end HIPAA compliance in mind. While this piece won’t review the regulation in its entirety, it’ll cover:

  • Which kinds of apps must comply with HIPAA regulations, and why. 

  • Best practices for building chat for HIPAA compliance.

  • How to choose a chat building solution that makes it easy to deliver HIPAA-compliant chat.

By the end, you’ll have a roadmap to develop a HIPAA-compliant chat solution with ease, so you can better deliver your approach to remote-first care. 

HIPAA-Compliant Chat Features to Consider

Beyond supporting patient-doctor communications, HIPAA-compliant chat apps form the core of a telemedicine experience that removes barriers to communication, enabling new efficiencies for patients and staff, and paving the way for greater patient engagement and satisfaction. Some key features include:

Benefits to Doctors and Healthcare Providers

  • Optimized care coordination: With the protected flow of ePHI across entire care teams, physicians and specialists can coordinate swiftly via chat. This makes it easier to access specialty advice, and helps doctors reach the correct diagnosis more quickly.

  • Improved staffing efficiency: Ease-of-access means fewer late arrivals and no-shows, while scheduling and real-time patient presence reduce wait-times and uncertainty for remote patients. Altogether, these efficiencies save resources without cutting the quality of care.

  • Friendly reminders: HIPAA-compliant live chat and in-app alerts enable excellent follow-up care, giving doctors a simple way to ensure that patients are following prescribed treatments. This also builds warmer relationships between medical professionals and their patients, driving patient satisfaction and treatment adherence. 

Benefits to Patients

  • Expanded remote care options: HIPAA-compliant chat forms the core of real-time telemedicine apps that allow patients to easily escalate their consultations to voice and video, and receive immediate recommendations for care.

  • Enhanced patient communication: HIPAA-compliant chat bridges the communication gap that arises between examinations and actionable advice. For example, the minute medical professionals receive test results, they can forward and explain them to patients instantly via chat.

  • Enhanced patient engagement: When patients come to a single application for their care, consultations, and EHR, they can participate in their own health with full context and greater confidence. 

In all, real-time, HIPAA-compliant chat apps ensure the best patient care possible by expanding access to doctors and information. Likewise, it benefits healthcare providers by increasing efficiency and lowering the cost of providing care. Overall, improved efficiency and accuracy pave the way for patient-friendly, effective mobile health.

HIPAA Compliance and the Business Associate Agreement (BAA)

In the context of telemedicine apps, let’s consider what HIPAA itself does for remote healthcare. 

HIPAA stands for the Health Insurance Portability and Accountability Act, initially passed in 1996 to establish national standards for electronic healthcare administration. It was subsequently updated with provisions, called the privacy rule and the security rule, that protect patients’ sensitive information. 

At its core, HIPAA is fundamentally all about building trust by protecting patient privacy and ensuring data security. When they have a HIPAA-compliant application, doctors, patients, and care teams all work with the confidence that their data is secure, and they’re able to use the open channels within that app to communicate more naturally. This trust and openness in turn directly improves the adoption of your app, patient engagement with chat, and treatment outcomes. Not only is it your obligation to protect patient data under the law, but doing so will result in a better experience for your patients. 

When is HIPAA-compliant chat necessary?

On a high level, there’s a simple test to see whether you need HIPAA-compliant chat:

  1. Will your telemedicine app host sensitive conversations between doctors, patients, and their care team?

2. Will those conversations require the exchange of specific, private information? 

If the answer to either question is “yes,” then you need HIPAA-compliant chat.

Even though that answer seems cut and dry, it’s worth diving in a little deeper. First and foremost, let’s explore the role of chat in healthcare and define the scenarios where HIPAA comes into play.

Quality care, especially when delivered remotely, begins with open and honest communication. For patients, this means that it’s important to have a communication method that feels comfortable and familiar, while extending ease-of-use and accessibility. Live chat is a natural choice to fulfill this need. It offers instant, real-time messaging, and is something almost everyone can use.

We use chat every day, but the apps we commonly use for our conversations are not uniformly protected or regulated, and they simply don’t offer the privacy and control of data needed to protect the sensitive conversations inherent to remote care. Yet, due to the ease of use and familiarity, many patients will prefer chat experiences that look and feel like the common consumer chat applications they know and love.

As a result, teams delivering effective telemedicine apps have two major requirements:

  1. Emulate the familiar experience of common instant messaging apps, especially on mobile devices. 

2. Implement all the security measures necessary to protect sensitive information.

The way to meet both of these needs at once is to build HIPAA-compliant chat. Doing so meets security regulations and brings essential benefits for both patients and doctors to your healthcare solution.

What is a Business Associate Agreement (BAA) and why does it matter

To outline the ways that a business associate complies with HIPAA, a Business Associate Agreement (BAA), covers the responsibilities and risks that the business associate is taking on.

A BAA is a contract between a HIPAA-covered entity (the organization that is delivering the product), and HIPAA business associates (the healthcare organization or vendor working with the entity to store, transmit, or process protected health information). It’s essentially a contract between you (the entity) and the technology and services (the business associate) you choose to power your app.

This agreement outlines how both parties are practicing compliance. BAAs include:

  • Services the business associate provides

  • Types of data they are interacting with

Ultimately, a business associate agreement (BAA) is mandated in order to meet HIPAA requirements and ensure that data security standards are upheld and that data is used appropriately.

Best Practices for HIPAA-Compliant Chat

Achieving HIPAA compliance involves the proper use of technology, proper training and usage by staff, and the physical security of data. To address these three dimensions, the HIPAA security rule provides guidance for technical, administrative, and physical safeguards. These guidelines cover everything from the way messages are sent to the security checks put in place to prevent data tampering. 

When it comes to delivering familiar, comfortable chat experiences for healthcare, you’ll have two priorities. First, it’s important to satisfy the core HIPAA security requirements. But, it’s just as important to find a solution to chat that feels accessible to your patients, supports ongoing development, and offers quality communications. 

Address technical safeguards 

In the scope of secure chat development, your first task will be to address the full range of technical safeguards. This boils down to ensuring the presence of five essential features:

  1. Encryption: Messages in transit need to be encrypted, so that unauthorized parties can’t view or use intercepted data. End-to-end encryption ensures privacy since it allows only the sender and the recipient to decrypt and read messages. 

  2. Secure and accurate transmissions: Tamper-proof messaging is vital for healthcare, where the content of messages may include life-saving advice or specific care instructions. You must ensure that unauthorized third parties, including healthcare are unable to alter messages in any way. Crucially, this includes preventing access by unauthorized staff members within the healthcare organization itself.

  3. Access controls: Any HIPAA-compliant chat messaging solution must have access controls and secure logins. Password-protected logins for patients are one way to implement this requirement. Some organizations add an extra layer of security with two-factor authentication measures.

  4. Timed sign-out features: In a high-speed working environment, medical professionals may set tablets or smartphones down momentarily. This can expose ePHI to HIPAA violations if someone else accesses the unlocked device and sends messages or reviews past chats. Timed sign-out features prevent this kind of unauthorized access when devices are left idle.

  5. Audit controls: Another HIPAA security rule technical safeguards, and one that disqualifies many “free” chat apps, is being able to audit communications. Administrators must have the ability to check patient access and activity. 

Of course, technology is only as secure as the people using it. To truly follow HIPAA guidelines, healthcare organizations must train their personnel on the proper way to send, store, and share ePHI. Staff needs to understand the importance of following the correct sign-in protocol. And, administrators must select a chat platform that enables administrative control of security settings, so that policies can’t be altered by individual patients.

The easiest way to achieve HIPAA compliance is to use a secure chat solution, which incorporates these technical safeguards across a portfolio of features that make it easy to build secure chat right out of the box. 

Find a HIPAA-Compliant Alternative to Texting

Every party involved in telemedicine has an interest in making communication as easy and accessible as possible. On the surface, a communication channel like text messaging meets patient expectations for mobile access and would seem like a solution for care teams to easily contact patients. 

Yet, native SMS texting and common instant messaging apps present multiple liabilities when it comes to ensuring HIPAA-compliant chat communication, and it’s worth addressing their shortcomings directly:

  • Lack of encryption: SMS isn’t encrypted, and because text messages can be intercepted on public networks, this means potentially exposing patient information to interception. 

  • Risk of exposure: Text messages can’t be recalled or globally erased if sent to the wrong recipient, whether in SMS or IM apps. This means that ePHI exposed this way is permanently known outside of otherwise secure databases.

  • Unaccountability: Copies of all messages, whether SMS or IM, remain on service provider servers indefinitely.

  • No guarantee of authorization: Sending a text message via SMS doesn’t require authorization, and most consumer chat apps remain logged-in between sessions by default.

  • Limited security controls: Even IM apps that do have authentication often lack required safeguards like audit access for providers or timed logouts.

All of these liabilities come down to a lack of control, which is a product of using publicly available messaging services optimized for convenience. Together, this means that there is no such thing as HIPAA-compliant text messaging as it’s normally understood, and healthcare providers cannot rely on texting (including instant messaging apps) for remote care. 

But that doesn’t mean they have to sacrifice accessibility, comfort, or quality of communications in pursuit of security—this is where live chat comes in. 

[Read more on : HIPAA Guidelines for Texting]

Use a Secure Solution for HIPAA-Compliant Live Chat

Live chat, another term for in-app chat, is a secure and extensible alternative to texting that captures many of its benefits, and is at home in any telemedicine app. It offers the same instant messaging experience as texting, but brings communications into a secure, reliable environment.

To deliver HIPAA-compliant live chat, remote care providers should turn to dedicated messaging platforms with a philosophy of extreme usability. This means providing a custom chat experience that has all the necessary safeguards, but that also makes it as easy as possible for patients to access, engage with, and control their care. Modern chat solutions make it easy to deliver live chat that’s accessible from both mobile devices and the web while granting providers full control over sensitive data. This offers a secure alternative to texting, IM, and email that ensures both HIPAA compliance and patient security. 

In addition, a dedicated chat solution brings the expanded feature-set of a modern chat application to your healthcare communications. Features like group chats, secure notifications, patient presence, voice, and video all support quality care by offering an expanded suite of communication options. These channels in turn give patients and doctors more opportunities to engage, setting the stage for better, more effective care overall.

How to Choose a HIPAA-Compliant Messaging Solution

Any HIPAA-compliant chat application inherently aims to create an open and honest communication channel to discuss sensitive topics, usually between patients, doctors, and an expanded care team. To be successful, this channel must provide a communication experience that emulates the comfortable, confidential atmosphere of a real clinic, giving virtual conversations the authenticity of in-person care.

The first step to building this seamless communication experience is to select a secure messaging solution that provides HIPAA-compliant messaging off the shelf. A HIPAA-compliant chat API lets you build chat that satisfies patients’ need for quality and accessibility, while giving healthcare organizations full control over the flow and storage of sensitive information. This approach ultimately safeguards patient privacy while taking advantage of the flexibility, speed, and features of modern chat applications.

When evaluating a HIPAA-compliant chat solution, look for:

Availability of multiple SDKs   

In healthcare, you need to make your app as accessible as possible for patients no matter what kind of device they use. HIPAA-compliant chat SDKs for iOS, Android, web, and desktop, make it easy to build a fully-featured, secure chat to reach patients—wherever they are. 

A full set of security features  

A chat solution should solve the core security needs of HIPAA compliance by directly addressing the pillars of data security by offering features like:

  • End-to-end encrypted messaging

  • Fine-grained access management

  • The ability to set patient timeouts 

  • Extensive audit features 

Integrations with crucial services

If you’re building a unique offering for healthcare, you need the ability to implement a broad range of tools and technology without arbitrary limits. Beyond the fundamentals of chat, integrations with crucial services allow you to extend what your chat can do. For instance, voice and video integrations let patients and doctors connect in the way that suits them best, getting even closer to the comfort of in-person care. Additionally, powerful AI services for comprehension and translation of medical terms, give you the tools to build cognitive telemedicine solutions, or to simply integrate with the tools and services you love.

Quickly Build Secure, HIPAA-Compliant Chat

Worldwide, healthcare businesses trust PubNub to provide the best HIPAA-compliant messaging and real-time chat. With a combination of fully-featured, flexible APIs and reliable chat infrastructure, PubNub makes customized, comfortable, HIPAA-compliant chat a possibility for companies of any scale.

If you’re ready to take the first steps to offer seamless, quality remote care, try PubNub’s live-code tour.