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The Complete Guide to HIPAA Compliant Chat

As a result of COVID-19, the demand for remote healthcare has quickly accelerated. In March 2020, telemedicine app Doxy.me hosted treatment for 1.35 million patients, with a peak of 600,000 daily remote medical consultations. It’s clear that, as healthcare professionals adapt to telemedicine, and patient habits evolve around remote-first interactions, the need for secure and accessible communication in healthcare is here to stay.

Critically, telemedicine apps must offer these accessible, quality communications while ensuring the security and privacy of patient data. In the United States, this is mandated by HIPAA regulations, which lay out provisions that guide the secure development of apps for remote care. 

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. 

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 HIPAA compliance for?

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 heart, HIPAA compliant data handling protects communications containing sensitive and private information. Specifically, any data that could be used to identify a patient, either in isolation or in conjunction with other data points, is considered electronic protected health information (ePHI). It’s the presence and transmission of this information by a covered entity that triggers the need for HIPAA compliance.

Many kinds of information qualify as ePHI, and almost any telemedicine use case will require this class of protected information. 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. That means that, if you’re building a telemedicine app that augments consultations with EHR lookup, or if it offers in-app prescriptions, you must also secure the records central to these use-cases—even if those records aren’t directly transmitted via chat. 

At its core, HIPAA is fundamentally all about building trust by protecting patient privacy and ensuring data security. 

For any healthcare interaction to be effective, patients inevitably must share sensitive information. 

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. 

In short, if you’re developing an application to facilitate sensitive conversations and the exchange of ePHI between patients and care professionals, HIPAA compliant chat is a must. 

Unlocking the benefits of HIPAA compliant chat

But, in addition to ensuring data security, doing the groundwork of establishing HIPAA compliant software and personnel practices unlocks the benefits of modern messaging technology across the spectrum of care.

Beyond supporting patient-doctor communications, HIPAA compliant chat forms 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 benefits 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 enables 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, in-app live chat ensures 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.

User with Telemedicine

Best practices for building 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 first

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 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 technical safeguard, 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 like PubNub, 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 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. 

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 like PubNub 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 like PubNub 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. With a portfolio of fully HIPAA compliant chat SDKs for iOS, Android, web, and desktop, PubNub makes it easy to build full-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. PubNub directly addresses 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 

With PubNub, you can build chat swiftly with the confidence that your app will be HIPAA compliant.

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, PubNub offers extensive integrations with best-in-class services to extend what your chat can do.

Our 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, PubNub offers a bridge to powerful AI services for comprehension and translation of medical terms, giving you the tools to build cognitive telemedicine solutions, or to simply integrate with the tools and services you love. 

Doctor-telemedicine-illustration

Giving patients their choice of communication makes their consultations more authentic and genuine.

Worldwide, healthcare businesses trust PubNub to provide the best HIPAA compliant messaging and realtime 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 offering seamless, quality remote care, get in touch with our experts. Our solution architects will walk you through the best ways to implement security controls right alongside chat. We’ll work with you to speed your development, so you can reach patients, and provide care, with ease. 

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