Electronic Communication of Protected Health Information: Privacy, Security, and HIPAA Compliance
Abstract
Purpose Technology has enhanced modern health care delivery, particularly through accessibility to health information and ease of communication with tools like mobile device messaging (texting). However, text messaging has created new risks for breach of protected health information (PHI). In the current study, we sought to evaluate hand surgeons' knowledge and compliance with privacy and security standards for electronic communication by text message.Methods A cross-sectional survey of the American Society for Surgery of the Hand membership was conducted in March and April 2016. Descriptive and inferential statistical analyses were performed of composite results as well as relevant subgroup analyses.Results A total of 409 responses were obtained (11% response rate). Although 63% of surgeons reported that they believe that text messaging does not meet Health Insurance Portability and Accountability Act of 1996 security standards, only 37% reported they do not use text messages to communicate PHI. Younger surgeons and respondents who believed that their texting was compliant were statistically significantly more like to report messaging of PHI (odds ratio, 1.59 and 1.22, respectively).Discussion A majority of hand surgeons in this study reported the use of text messaging to communicate PHI. Of note, neither the Health Insurance Portability and Accountability Act of 1996 statute nor US Department of Health and Human Services specifically prohibits this form of electronic communication. To be compliant, surgeons, practices, and institutions need to take reasonable security precautions to prevent breach of privacy with electronic communication.Clinical relevance Communication of clinical information by text message is not prohibited under Health Insurance Portability and Accountability Act of 1996, but surgeons should use appropriate safeguards to prevent breach when using this form of communication.
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Medical information requires a degree of insensitivity and is regulated by medical rules like HIPAA.
“Medical information requires a degree of insensitivity and is regulated by medical rules like the Health Insurance Portability and Accountability Act (HIPAA) [64].”
From A comprehensive survey on federated learning techniques for healthcare informatics (2023) · cites this paper as [64]
Cites
Behavior change interventions delivered by mobile telephone short message service
Fjeldsoe, B. S., Marshall, A. L., & Miller, Y. D. (2009) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2008.09.040 · Cited by 1,213 · see citing works
Mobile Telephone Text Messaging for Medication Adherence in Chronic Disease: A Meta-analysis
Thakkar, J., Kurup, R., Laba, T.-L., Santo, K., Thiagalingam, A., Rodgers, A., Woodward, M., Redfern, J., & Chow, C. K. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.7667 · Cited by 685 · see citing works
Chow, C. K., Redfern, J., Hillis, G. S., Thakkar, J., Santo, K., Hackett, M. L., Jan, S., Graves, N., de Keizer, L., Barry, T., et al. (2015) · JAMA · doi:10.1001/jama.2015.10945 · Cited by 676 · see citing works
Electronic Communication With Patients
Balas, E. A. (1997) · JAMA · doi:10.1001/jama.1997.03550020084043 · Cited by 277 · see citing works
Houston, T. K., Sands, D. Z., Jenckes, M. W., & Ford, D. E. (2004) · PubMed · Cited by 137 · see citing works
Ueckert, F., Goerz, M., Ataian, M., Tessmann, S., & Prokosch, H. (2003) · International Journal of Medical Informatics · doi:10.1016/s1386-5056(03)00052-2 · Cited by 111 · see citing works
Przybylo, J. A., Wang, A., Loftus, P. D., Evans, K. H., Chu, I. M., & Shieh, L. Y. (2014) · Journal of Hospital Medicine · doi:10.1002/jhm.2228 · Cited by 106 · see citing works
Technology-mediated interventions for enhancing medication adherence
Mistry, N., Keepanasseril, A., Wilczynski, N., Nieuwlaat, R., Ravall, M., & Haynes, R. (2015) · J. Am. Medical Informatics Assoc. · doi:10.1093/jamia/ocu047 · Cited by 102 · see citing works
Shah, D. R., Galante, J. M., Bold, R. J., Canter, R. J., & Martinez, S. R. (2012) · Journal of surgical education · doi:10.1016/j.jsurg.2012.05.003 · Cited by 47 · see citing works
Koivunen, M. H., Niemi, A., & Hupli, M. (2014) · Journal of Advanced Nursing · doi:10.1111/jan.12529 · Cited by 36 · see citing works
HIPAA Compliance with Mobile Devices Among ACGME Programs
McKnight, R. R., & Franko, O. I. (2016) · Journal of Medical Systems · doi:10.1007/s10916-016-0489-2 · Cited by 31 · see citing works
Goldfarb, J. W., Kayssi, A., Devon, K. M., Rossos, P. G., & Cil, T. D. (2016) · Surgical Innovation · doi:10.1177/1553350615624788 · Cited by 16 · see citing works
Frizzell, J. D., & Ahmed, B. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.11.001 · Cited by 15 · see citing works
Patient-Centered Care and Population Health
Harwood, J. L., Butler, C. A., & Page, A. E. (2016) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.15.00752 · Cited by 15 · see citing works
Electronic Communication and Text Messaging Among Nephrology Providers
Norfolk, E. R., Glazier, J., Hamilton, E., & Maddux, F. W. (2013) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2013.04.024 · Cited by 3 · see citing works
We are physicians first, orthopedic surgeons second.
Rhee, P. C. (2012) · PubMed · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Federated Learning for Internet of Things: A Comprehensive Survey
Nguyen, D. C., Ding, M., Pathirana, P. N., Seneviratne, A., Li, J., & Vincent Poor, H. (2021) · IEEE Communications Surveys & Tutorials · doi:10.1109/comst.2021.3075439 · Cited by 1,503 · see citing works
“Indeed, compared to other domains, data in healthcare systems are highly sensitive subject to health regulations such as United States Health Insurance Portability and Accountability Act (HIPPA) [109].”
BackgroundFederated learning for the Internet of Things: Applications, challenges, and opportunities
Zhang, T., Gao, L., He, C., Zhang, M., Krishnamachari, B., & Avestimehr, A. S. (2022) · IEEE Internet of Things Magazine · doi:10.1109/iotm.004.2100182 · Cited by 412 · see citing works
A Survey on Intelligent Internet of Things: Applications, Security, Privacy, and Future Directions
Aouedi, O., Vu, T.-H., Sacco, A., Nguyen, D. C., Piamrat, K., Marchetto, G., & Pham, Q. (2024) · IEEE Communications Surveys & Tutorials · doi:10.1109/comst.2024.3430368 · Cited by 318 · see citing works
Federated learning for secure IoMT-applications in smart healthcare systems: A comprehensive review
Rani, S., Kataria, A., Kumar, S., & Tiwari, P. (2023) · Knowledge-Based Systems · doi:10.1016/j.knosys.2023.110658 · Cited by 228 · see citing works
A systematic analysis of failures in protecting personal health data: A scoping review
Pool, J., Akhlaghpour, S., Fatehi, F., & Burton‐Jones, A. (2023) · International Journal of Information Management · doi:10.1016/j.ijinfomgt.2023.102719 · Cited by 160 · see citing works
A comprehensive survey on federated learning techniques for healthcare informatics
Dasaradharami Reddy, K., & Gadekallu, T. R. (2023) · Computational Intelligence and Neuroscience · doi:10.1155/2023/8393990 · Cited by 126 · see citing works
Analysis of Cybersecurity Standard and Framework Components
Syafrizal, M., Selamat, S. R., & Zakaria, N. A. (2022) · International Journal of Communication Networks and Information Security (IJCNIS) · doi:10.17762/ijcnis.v12i3.4817 · Cited by 55 · see citing works
Evaluation of Secure Messaging Applications for a Health Care System: A Case Study
Liu, X., Sutton, P. S., McKenna, R., D, M. N. S. M., Fellner, B., Leu, M. G., & Ewell, C. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1678607 · Cited by 54 · see citing works
Social Media Use for Orthopaedic Surgeons
Jildeh, T. R., Okoroha, K. R., Guthrie, S. T., & Parsons, T. W. (2019) · JBJS Reviews · doi:10.2106/jbjs.rvw.18.00085 · Cited by 45 · see citing works
Patients, pictures, and privacy: managing clinical photographs in the smartphone era
Nettrour, J. F., Burch, M. B., & Bal, B. S. (2018) · Arthroplasty Today · doi:10.1016/j.artd.2018.10.001 · Cited by 42 · see citing works
Federated Learning on Internet of Things: Extensive and Systematic Review
Aggarwal, M., Khullar, V., Rani, S., Prola, T. A., Bhattacharjee, S. B., Shawon, S. M., & Goyal, N. (2024) · Computers, materials & continua/Computers, materials & continua (Print) · doi:10.32604/cmc.2024.049846 · Cited by 38 · see citing works
Anderson, C. S., Baskerville, R., & Kaul, M. (2023) · Information and Organization · doi:10.1016/j.infoandorg.2023.100455 · Cited by 23 · see citing works
Pourmand, A., Roberson, J. L., Gallugi, A., Sabha, Y., & O’Connell, F. (2018) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2018.06.067 · Cited by 22 · see citing works
Antibiotic Use in Hand Surgery: Surgeon Decision Making and Adherence to Available Evidence
Dunn, J. C., Means, K. R., Desale, S. Y., & Giladi, A. M. (2018) · Hand · doi:10.1177/1558944718812161 · Cited by 21 · see citing works
The Role of Text Messaging and Telehealth Messaging Apps
Ganapathy, S., de Korne, D. F., Chong, N. K., & Car, J. (2020) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2020.04.002 · Cited by 17 · see citing works
Generative Artificial Intelligence-Based Medical Entity Data Extractor Using Large Language ModelsPreprint
Ghali, M.-K., Farrag, A., Sakai, H., baz, H. E., Jin, Y., & Lam, S. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5063216 · Cited by 11 · see citing works
Pool, J. K., & Akhlaghpour, S. (2019) · SSRN Electronic Journal · doi:10.2139/ssrn.3584865 · Cited by 10 · see citing works
BUNET: Blind Medical Image Segmentation Based on Secure UNET
Bian, S., Xu, X., Jiang, W., Shi, Y., & Sato, T. G. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-59713-9_59 · Cited by 9 · see citing works
Information Security in Nursing
Kang, J., & Seomun, G. (2020) · Advances in Nursing Science · doi:10.1097/ans.0000000000000330 · Cited by 8 · see citing works
Smart Healthcare Ecosystem for Elderly Patient Care
Abugabah, A., & Nizamuddin, N. (2020) · International Convention on Information and Communication Technology, Electronics and Microelectronics · doi:10.23919/mipro48935.2020.9245404 · Cited by 8 · see citing works
Enhanced privacy governance in Health Information Systems throughbusiness process modelling and HL7
Rahmouni, H. B., Essefi, I., & Ladeb, M. F. (2019) · Procedia Computer Science · doi:10.1016/j.procs.2019.12.239 · Cited by 8 · see citing works
Information Technology and Telemedicine Services in Community Oncology Practices
Loh, K. P., Wang, Y., Yilmaz, S., Nightingale, C. L., Parsons, S. K., Braun‐Inglis, C., Gada, U., Montes, A., Magnuson, A. M., Culakova, E., et al. (2023) · JCO Clinical Cancer Informatics · doi:10.1200/cci.23.00086 · Cited by 6 · see citing works
Enhancing security in patient medical information exchange: A qualitative study
Manns, A., Pezziardi, T., Kadlub, N., Burgun, A., Destrez, A., & Tsopra, R. (2025) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2025.105841 · Cited by 5 · see citing works
Recent Trends of Federated Learning for Smart Healthcare Systems
Handa, T., Singhal, I., Chakraborty, P., & Kaur, G. (2023) · Advances in healthcare information systems and administration book series · doi:10.4018/979-8-3693-1082-3.ch005 · Cited by 5 · see citing works
A Survey on Privacy-Preserving Enabled Healthcare Services Focusing on Robust Aggregation
Aggarwal, M., Khullar, V., Goyal, N., Jayaprakash, B., Bharathi, B., Sahu, P. K., Sharma, G., & Bhardwaj, V. (2025) · International Journal of Computational Intelligence Systems · doi:10.1007/s44196-025-01020-1 · Cited by 4 · see citing works
Generative AI for Threat Hunting and Behaviour Analysis
Sindiramutty, S. R., Jhanjhi, N. Z., Akbar, R., Hussain, M., Ray, S. K., & Amsaad, F. (2024) · Advances in digital crime, forensics, and cyber terrorism book series · doi:10.4018/979-8-3693-8944-7.ch007 · Cited by 4 · see citing works
Jin, F., Wang, B., Liao, X., Wang, K., Huang, W., & Wang, T. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-085221 · Cited by 3 · see citing works
Towards a model for understanding failures in health data protection: a mixed-methods study
Pool, J., Akhlaghpour, S., Hassandoust, F., Fatehi, F., & Burton‐Jones, A. (2025) · Behaviour and Information Technology · doi:10.1080/0144929x.2025.2551568 · Cited by 3 · see citing works
Navigating Communication: Crafting Guidelines for Epic Secure Chat in an Academic Medical Center
Howard-Williams, E. L., Dreesen, E. B., Downs, J., Schiff, L. D., Dangerfield, C., & Mock, C. (2025) · Quality Management in Health Care · doi:10.1097/qmh.0000000000000547 · Cited by 3 · see citing works
Mobile Messaging Communication in Health Care
Samora, J. B., BLAZAR, P. E., Lifchez, S. D., Bal, B. S., & Drolet, B. C. (2018) · JBJS Reviews · doi:10.2106/jbjs.rvw.17.00070 · Cited by 3 · see citing works
Self-citationHIPAA and Access to Medical Information by Medical Examiner and Coroner Offices
Weedn, V. W. (2022) · Academic Forensic Pathology · doi:10.1177/19253621221102039 · Cited by 3 · see citing works
Can Clinical Empathy Be Communicated by Text Message? A Case Report
Bottino, C. J., & Manji, K. (2019) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2018.0283 · Cited by 3 · see citing works
Tovino, S. A. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108759458.061 · Cited by 3 · see citing works
Mwangi, E. (2023) · SSRN Electronic Journal · doi:10.2139/ssrn.4709459 · Cited by 3 · see citing works
Carlson, S. F., & Mandel, J. R. (2017) · The Journal Of Hand Surgery · doi:10.1016/j.jhsa.2017.04.014 · Cited by 2 · see citing works
Texting Protected Health Information: A Survey of Academic Plastic Surgeons
Kumar, N. G., Drolet, B. C., & Janis, J. E. (2018) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000004763 · Cited by 2 · see citing works
Self-citationFederated Autonomous Deep Learning for Distributed Healthcare System
Pujahari, R. M., Khan, R., & Yadav, S. P. (2025) · Wiley eBooks · doi:10.1002/9781394271382.ch2 · Cited by 2 · see citing works
Texting Among Academic Psychiatrists: What Does HIPAA Allow?
Kumar, N. G., & Drolet, B. C. (2019) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000385 · Cited by 1 · see citing works
Self-citationShrestha, S. T., & Ghosh, A. K. (2025) · IEEE SoutheastCon · doi:10.1109/southeastcon56624.2025.10971504 · Cited by 1 · see citing works
Bashi, Z. S. M. A., Basri, A. B., & Senan, S. (2025) · International Journal on Perceptive and Cognitive Computing · doi:10.31436/ijpcc.v11i2.528 · Cited by 1 · see citing works
von Santen-Tambasco, S., Vess, J., & Johnson, E. (2019) · Professional Case Management · doi:10.1097/ncm.0000000000000383 · Cited by 1 · see citing works
Competitor analysis in health care marketing.
Salvatore, T. (1984) · PubMed · Cited by 1 · see citing works
A Review of Medical Ethics in Orthopaedic Surgery
Lam, R., He, Z. M. S., Thapar, R., Wang, M., Birhiray, D. G., Milad, M., Ouellette, L., Ghilzai, U. M., Cushing, T. J., Price, M. B., et al. (2025) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.24.01137
Alotaibi, H. A., Alahazmi, K. N., Alsaad, Y. M. H., Alsharif, F. H., Hagawe, S. M., Sinan, S. H. D. A., Hamedhi, H. A. H., Kulaibi, A. M. Y., Faqihi, A. H. M., Asseri, K. Y. A., et al. (2025) · Saudi Journal of Medicine and Public Health · doi:10.64483/202522540
Understanding clinician deviance: A systematic review of text messaging practices
Heath, M. L., Porter, T. H., & Allgood, A. M. (2026) · Health Care Management Review · doi:10.1097/hmr.0000000000000466
Empowering IoT with Federated Learning: A Cross-Domain Survey from Healthcare to Industry
Aggarwal, S., Purkayastha, A. A., & Tharwani, J. (2026) · IEEE International Conference on Interdisciplinary Approaches in Technology and Management for Social Innovation (IATMSI) · doi:10.1109/iatmsi68868.2026.11465303
Yılan, F. C., & Saygılı, M. (2026) · Hacettepe sağlık idaresi dergisi · doi:10.61859/hacettepesid.1778377
- Authors
- Drolet, B. C., Marwaha, J. S., Hyatt, B., Blazar, P. E., & Lifchez, S. D.
- Affiliations
- Vanderbilt University Medical Center (US)
- Brown University (US)
- Brooke Army Medical Center (US)
- Johns Hopkins University (US)
- Corresponding author
- Drolet, Brian C.
- Venue
- The Journal of Hand Surgery
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 42
- Issue
- 6
- Pages
- 411-416
- ISSN
- 0363-5023 (ISSN-L)
- OpenAlex
- W2620670582
- Cited by
- 46
- References
- 16
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 3 · 2023: 7 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 7 · 2018: 5 · 2017: 1
- FWCI
- 8.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal Of Hand Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Computer Science › Information Systems › Thoreau and American Literature
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- protected health information, text messaging, HIPAA compliance, health information privacy, health information security, hand surgeons, digital communication, data breaches
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