have access to all text messages on the device without the need
to enter a password.
Texts also are generally not subject to central monitoring by
the IT department. Although text messages communicated
wirelessly are usually encrypted by the carrier, interception
and decryption of such messages can be done with inexpensive
equipment and freely available software (although a substantial
level of sophistication is needed). 3
The HIPAA privacy rule provides an individual with the right
to access and amend protected health information (PHI) about
the individual that is maintained in a designated record set. 4 The
designated record set includes PHI “used, in whole or in part, by
or for the covered entity to make decisions about individuals.” 5
Accordingly, if text messages are used to make decisions about
patient care, then they may be subject to the rights of access and
amendment. There is a risk of noncompliance with the privacy
rule if the covered entity cannot provide patients with access to
or amend such text messages.
Include Texting in Compliance Programs
Under the HIPAA security rule text messaging may be addressed
as part of an organization’s comprehensive risk analysis and
As part of its risk analysis, a healthcare provider may identify
where electronic PHI, or ePHI, is created, received, maintained,
and transmitted. 6 For texts, ePHI will primarily be created,
received, and maintained on mobile phones (although text
messages may also reside on workstations or cloud-computing
Texts also may be temporarily maintained on a telecommunications provider’s servers while the message awaits delivery to
the recipient’s device (e.g., if the recipient’s device is powered
off or out of range). Texts primarily will be transmitted through
the wireless cellular networks of telecommunications providers,
although they also may get routed through the Internet in certain situations. 7
The next step is to identify and document any reasonably anticipated threats to ePHI, the security measures already in place
It is worth keeping in mind that the threat of external interception is likely far smaller than the threat of theft or loss of the
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