HIPAA Compliance and Mobile Health Apps

Mobile Health Apps Today

Healthcare application development is steadily on the rise and this trend is not slowing down anytime soon. According to a 2019 Global Market Insights Report, the mHealth market size was valued over USD 30.2 billion in 2018, and the Compound Annual Growth Rate (CAGR) is expected to reach 38.5% by the year 2025. Additionally, in 2020 alone, over 70% of healthcare providers in the U.S. utilized mobile health apps.

Why is this?

The answer is rather simple; mobile health apps have enabled patients to take control of their own health both safely and securely through the simple tap of a touchscreen. Most importantly, these apps have allowed them to do so in a critical year when social distancing has become a necessity due to the COVID-19 pandemic.

So how do mobile health apps play into the larger conversation of HIPAA compliance in software? This is a necessary question for all healthcare providers to consider when deciding whether or not to develop a mobile health application. We'll answer this question, explore related questions around HIPAA compliance in software development, and provide valuable resources to guide you through the first stages of the medical app developer vetting process.

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Defining HIPAA

HIPPA stands for the Health Insurance Portability and Accountability Act of 1996, a law enacted by the United States government to protect sensitive Patient Health Information (PHI) and monitor the use, storage, and distribution of such information. HIPAA applies to “covered entities” (CE's) which include health plans, healthcare providers, and healthcare clearinghouses.

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Further Reading: For more information, see The HIPAA Journal.

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What are Examples of HIPAA-Compliance in Mobile Health Apps?

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Three important examples of HIPAA compliance for mobile health apps include:

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1. Secure and Private Messaging

This includes secure and integrated messaging tools that enable two-way communication between a provider and a patient.

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2. Secure and Private Hosting Services

This refers to hosting services that provide security against cyberattacks at a minimum, but may also provide security against more malicious attacks like DDoS.

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3. Secure Data Cloud Storage Services

‍This refers to outsourced data storage management services like AWS, Microsoft Azure, and Google Cloud.

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Note: These are just three primary examples of HIPAA compliance in software. For a thorough overview of HIPPA safeguards and requirements read on or see the HIPPA Journal Compliance Checklist.

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Does Your Mobile Health App Need to be HIPAA Compliant?

If you're unsure as to whether or not your application will be regulated by HIPAA, ask yourself these three critical questions:

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1. What Type of Entity Will Use Your Application? 

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If you're a covered entity (such as a physician, hospital, or insurance provider that works directly with patients), your software must be HIPAA compliant. Business associates (that collect, store, process or share PHI) are also subject to HIPAA. Additionally, under the 2013 Omnibus Rule, third party vendors (including but not limited to developers), assume liability for HIPAA violations.

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Note: There are some scenarios where entities do not need to be HIPAA compliant; if your software holds PHI, but is not able to transmit this data to a CE, then you do not need to be HIPAA compliant. A classic example of this scenario includes wellness tracking devices like bracelets or watches that track steps or count calories.

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2. What Type of Data Will Your Application Use, Share, and Store?

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If your mobile health app uses, shares, or stores protected health information (PHI), HIPAA compliance is not optional. Protected health information includes any medical information that could identify a patient and is exchanged between a covered entity and a business associate.

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When protected health information is combined with personal identifiable information (PII), it can expose large risks for HIPAA violations. Make sure you have a clear understanding of exactly what patient data will be gathered and how that data will be managed to protect your patients' privacy and to mitigate risk.

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3. Is Your Mobile Health Application Encrypted or Not?

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Application encryption specifically refers to the type of technology that your application uses and its security standards. If your mobile health application handles PHI, at a bare minimum, you'll need to have a data security solution that encrypts sensitive patient data. Additionally, this data must only be accessible by authorized parties.

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By encrypting your patients' sensitive data at the application level, you can secure it before storing it in a database or cloud environments. App Transport Security (ATS) can also force your mobile health app to link back-end servers on HTTPS (SSL Certificate). This allows you to encrypt data while it's in transit.

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Tip: Contrary to popular belief, short message services (SMS) and multi-media messaging services (MMS) are not encrypted.

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Now that you have a clear understanding about what entities will utilize your application, how you application will handle sensitive patient data, and the security standards for your application, you can make a clear determination about where you fall in regards to HIPAA compliance. Let's dig deeper into the requirements for covered entities and business associates for building mobile health apps.

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What are the Rules for Developing HIPAA Compliant Mobile Health Apps?

Under HIPAA, there are four rules pertinent to compliance: the Privacy Rule, the Security Rule, the Enforcement Rule, and the Breach Notification Rule. Detailed summaries of each rule can be found here, but they essentially outline the expectations and requirements for covered entities and business associates. Respectively, they establish best practices for compliance, standards for data security, repercussions for noncompliance, and requirements for self-accountability.

1. Information Selectivity

‍To mitigate risk and ensure compliance, make sure your mobile health application is designed to only collect necessary PHI. Collecting superfluous information will only expose you to extra requirements and potential risks.

2. Proper Access Controls

‍This is key for security measures. Your app should have physical, technical, and administrative safeguards in place to ensure the privacy of users’ information. These can include identity authentication (two-factor and facial recognition being examples), device controls (like session timeouts and hidden push notifications), access controls for all relevant personnel, and protocols for destroying PHI once it’s no longer needed.

3. Self-Audits

‍In order to be HIPAA compliant, it’s important for CE’s and BA’s to hold themselves accountable. This is done by recording and tracking any actions involving PHI, then assessing any associated risks. You can use the risk assessment tool provided by the Department of Health and Human Services in order to determine any potential security risks to your mHealth app. 

4. Backup Methods

‍Just as you should have safeguards in place to destroy unnecessary PHI, it is also recommended to have methods for retrieving PHI in case of an emergency. This includes any situation that leads to any accessibility issues with the main system.

5. Clear Policies

‍Be fully transparent about your policies and procedures involving HIPPA and how they relate to your users' information. Ensure this information is easily accessible to users and remain as clear as possible when providing information about an individual’s PHI.

For more tips on compliance, check out our article “HIPAA Compliance vs. User Experience for mHealth Apps.” 

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How Do You Vet Vendors for HIPAA Compliance?

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The process of selecting an app developer for your mobile healthcare app does not have to be an arduous one, but you should be confident in the selected vendor’s ability to comply with HIPAA. When researching app developers for your healthcare application, don't be afraid to ask detailed questions, to see work samples, or to speak with references.

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Here are 3 tips to consider when vetting medical app developers:

1. Look at Their Work

Be very selective and make sure the app developer you're interviewing has specific experience in developing medical apps. Better yet, ask to to see their full portfolio of work or to speak with a client reference. Check out their online resources to get a better idea on how well-versed they are in the subject matter.

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2. Ask About Their Security Testing

A well-versed medical app developer will easily be able to speak to their security standards and testing processes. Important functions and roles to be aware of include static and dynamic tests, security audits, a HIPAA compliant specialist that can monitor your app's documentation, and pen testing (penetration testing) that simulates a cyber attack. Pen testing is especially important when you launch updates to your application.

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3. Make Sure They Use a HIPAA-Compliant Cloud Stack

It's important to note that there are two major components to this qualification; 1) The cloud platform itself and 2) How the platform will be used. It's not enough for a business associate to be HIPAA certified and/or a Cloud Service Provider to be HIPAA certified. These two entities must work together to integrate a HIPAA compliant process for managing patient data.

A knowledgeable app developer will be able to guide you through a HIPAA-compliant risk analysis. They also will have a deep understanding of the cloud computing environment and the service being offered by the chosen platform provider.

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Further Reading: For more information on HIPPA-compliance and cloud computing platforms, see the HIPPA Journal.

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Why Are HIPAA-Compliant Vendors Necessary?

To put it simply, the repercussions for violation of HIPAA regulations are enormous. Beyond the damage done to patient privacy, security, and trust, there are considerable punishments you could face as a healthcare provider. Among those punishments are jail time and large fines, ranging from $10 to a maximum penalty of $1.4 million a year. The financial penalties are determined by a tier system based on a CE’s knowledge of the infraction. The HIPAA Journal lists out each of the four tiers and their qualifications, along with the range of fine amounts. 

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Additionally, when you or your vendor fails to comply with HIPAA, you risk losing the trust and confidence of your patients. They will appreciate the convenience of a mobile healthcare app, but at the same time, they expect their PHI to be treated with the same level of care on mobile apps as it is in the physical world.

Conclusion

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HIPAA in the tech world can be a daunting topic, but it’s well worth your time and effort to work with a development team you can trust. If you have any questions or would like to speak to an expert about your healthcare app project, schedule a 30-minute call with a member of our team. For more information on HIPAA compliance, you can find a full compliance checklist on the HIPAA Journal webpage, along with a wealth of other resources.