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Communicating with caregivers is an essential part of patient care, particularly when patients require assistance with medications, appointments, or recovery.
However, texting patient information requires providers to assess both the basis for disclosure and the security of the communication.
Indeed, HIPAA permits providers to share certain information with caregivers under defined circumstances. A caregiver's involvement, however, does not warrant unrestricted access to a patient's medical information.
Therefore, before sending a text, providers must determine what the recipient is entitled to receive and apply appropriate safeguards.
In this article, we discuss these requirements and explain how practices can establish appropriate procedures for caregiver texting.
Table of Contents
1. When does HIPAA allow providers to share information with caregivers?
2. What patient information can you text a caregiver?
3. So, how can you text caregivers without violating HIPAA rules
4. Texting caregivers about patients: frequently asked questions
5. Give caregivers a secure connection to your practice with iPlum
When does HIPAA allow providers to share information with caregivers?
HIPAA allows providers to share patient information with family members, friends, and other caregivers involved in the patient's care or payment for care.
However, the disclosure must relate to that involvement.
Under 45 CFR § 164.510(b), providers can share relevant information in the following circumstances:
- When the patient agrees: A patient can permit a provider to discuss medication instructions, treatment updates, or other relevant information with a caregiver.
- When the patient has the opportunity to object but doesn’t: A provider can explain the proposed disclosure and offer the patient an opportunity to decline.
- When the provider reasonably infers that the patient does not object: For example, a patient who invites a caregiver into a treatment discussion can indicate agreement through those circumstances.
- When the patient is unavailable or unable to participate: A provider can use professional judgment to determine whether sharing information serves the patient’s best interests.
Nevertheless, these circumstances do not authorize disclosure of the patient’s entire medical history. For example, a caregiver who manages medications could receive relevant dosage instructions. Their involvement would not, on its own, justify sharing unrelated diagnoses.
Therefore, providers must assess both the circumstances permitting disclosure and the information appropriate to the caregiver’s responsibilities.
What patient information can you text a caregiver?
Providers can text information relevant to a caregiver’s involvement in the patient’s care or payment for care, provided the disclosure is permitted, and the practice applies appropriate safeguards.
The caregiver’s responsibilities, therefore, determine which details are appropriate to share. For example:
- When the caregiver arranges transportation: Appointment dates, arrival times, and collection instructions can be appropriate. However, providing transportation does not automatically entitle the caregiver to receive test results.
- When the caregiver manages medications: Providers can share relevant dosage instructions, medication changes, and administration precautions.
- When the caregiver assists with recovery: Wound care instructions, mobility restrictions, and symptoms requiring medical attention can relate to their responsibilities.
- When the caregiver manages payments: Providers can discuss relevant charges, outstanding balances, and payment arrangements. However, involvement in billing does not justify sharing unrelated clinical information.
According to HHS, disclosures must relate to the recipient’s involvement in care or payment. Thus, permission to receive one type of update should not be treated as permission to receive all patient information.
For example, a daughter who administers her father’s medication could receive revised dosage instructions. An unrelated diagnosis would require a separate basis for disclosure.
That said, before sending the message, providers should confirm that its contents align with the caregiver’s responsibilities and any limits the patient has established.
So, how can you text caregivers without violating HIPAA rules
HIPAA requires providers to establish a permitted basis for disclosure and protect the patient information they exchange.
Permission to involve a caregiver addresses the first requirement.
In addition, practices must assess their messaging systems, employee access, and communication procedures.
The measures below help translate those obligations into a process your practice can use before, during, and after caregiver conversations.
Record who can receive updates and for what purpose
Start by identifying the caregiver’s responsibilities and the information the patient agrees to share. More importantly, your employees should be able to check those details before responding to a message.
While the HHS does not require written documentation of the patient’s agreement under this caregiver disclosure provision, recording the decision gives employees a reference when another provider takes over the conversation.
Your practice can document:
- The recipient: The caregiver’s name, relationship, and verified contact details.
- Their responsibilities: The care or payment activities they participate in.
- The patient’s preferences: Which updates the caregiver can receive, and any restrictions.
- Changes to the arrangement: Revised permissions, contact details, or caregiver responsibilities.
For disclosures based on professional judgment, record the relevant circumstances according to your practice’s procedures. Avoid treating a previous conversation as permanent permission for future disclosures.
Assess the messaging channel before sending patient information
The HIPAA Security Rule requires administrative, physical, and technical safeguards for electronic protected health information.
Your practice must therefore evaluate how its texting channel helps protect information during transmission and storage.
Here, you need to assess more than the phones the employees use. You also need to consider the messaging application, linked computers, backups, and account access.
For example, a medication discussion could remain accessible through an employee’s personal messaging account after they leave the practice. Meanwhile, a shared device could expose messages to unauthorized users.
A secure messaging solution provides your practice with a dedicated channel for clinical exchanges.
Review your secure messaging service's responsibilities and Business Associate Agreement
A secure messaging provider that creates, receives, maintains, or transmits protected health information on your practice’s behalf generally acts as a business associate.
Where that relationship applies, HIPAA requires an appropriate agreement.
The Business Associate Agreement establishes permitted uses and disclosures, safeguards, and other obligations concerning patient information.
Restrict employee access and establish response procedures
Employees should access caregiver conversations according to their assigned duties.
Here, you’ll need to use individual accounts where available, assign appropriate permissions, and revoke access promptly when employment or responsibilities change.
Your communication policy should also explain how employees respond to requests that exceed an approved caregiver’s involvement. For example, a request for an unrelated test result should prompt a permission review before disclosure.
In addition, establish procedures for:
- Unexpected recipients: Check the circumstances before adding another relative to a conversation.
- Personal-number messages: Redirect clinical exchanges to the approved channel.
- Urgent concerns: Explain which issues require a call or emergency assistance.
- Misdirected texts: Report the incident promptly for assessment under the practice’s privacy procedures.
Training should address these situations using examples that employees encounter in their work.
Get a phone service that allows secure caregiver texting
Your phone service should provide caregivers with an accessible channel to receive patient updates and give your practice the security features needed to protect those exchanges.
It should provide encrypted messaging, account access controls, and a Business Associate Agreement as part of the setup.
On top of that, the service should accommodate communication from the devices your employees already use. In addition, it should include a separate business number that allows providers to contact caregivers through the practice rather than sharing their personal contact details.
iPlum, for instance, provides a HIPAA-compliant phone service with business calling, secure texting, and voicemail on existing smartphones.
With iPlum, your practice can exchange approved care instructions, medication updates, and recovery information with caregivers.
Some of the features that make iPlum an ideal, secure texting service for caregivers include:
- Encrypted texting: Providers can initiate a secure texting channel with an approved caregiver and exchange messages through that encrypted connection.
- Free caregiver accounts: Recipients can create a free account and communicate through the iPlum app or web portal. Consequently, caregivers who prefer browser access do not have to download the app.
- Business Associate Agreement: iPlum provides a BAA for its HIPAA service, establishing its responsibilities concerning protected health information.
- Separate business communication: A dedicated number gives caregivers a professional contact for calls and messages while preserving the provider's personal number.
iPlum, for example, allows a nurse to send approved discharge instructions through secure messaging. The caregiver can then refer to those instructions and reply with questions about the care they provide.
Furthermore, iPlum offers business hours and an advanced phone tree with unlimited extensions to meet the practice's broader communication needs. Caregivers can contact the appropriate department when a conversation requires a call.
Your practice, therefore, gains a service for ongoing caregiver communication, from written instructions to follow-up discussions, with encrypted texting and business calling available through the same provider on employees' existing mobile devices.
Texting caregivers about patients: frequently asked questions
Does HIPAA require written permission before texting a caregiver?
HIPAA does not require a written agreement for disclosures permitted under its caregiver provision. However, documenting the patient's preferences gives employees a reference for future communication.
Can providers text caregivers when a patient is unconscious?
Yes. Providers can use professional judgment to share relevant information when disclosure serves the patient's best interests. However, appropriate messaging safeguards still apply.
Does a caregiver’s text authorize the provider to share patient information?
No. Receiving a text does not establish permission to disclose patient information. Providers must first determine whether HIPAA permits the requested disclosure.
Can providers send patient updates in a group text?
Only when disclosure is permitted to all recipients, and appropriate safeguards apply. Providers should assess the information shared and avoid adding relatives solely at another caregiver's request.
Can a patient stop a caregiver from receiving updates?
A patient with decision-making capacity can object to further disclosures by caregivers. Providers should update communication records and stop those updates unless another legal basis permits or requires disclosure.
Does an emergency contact automatically qualify to receive treatment updates?
No. Emergency contact status alone does not authorize ongoing treatment updates. Providers must assess the recipient’s involvement, the patient’s preferences, and the applicable basis for disclosure.
Do caregivers need a paid iPlum subscription for secure texting?
No. Caregivers can create a free account after receiving the practice’s invitation. They can then exchange secure messages through the iPlum app or web portal.
Give caregivers a secure connection to your practice with iPlum
Caregiver communication should give families the information they need to participate in care while protecting the patient’s privacy.
Your practice, therefore, needs a dedicated channel for these exchanges.
With iPlum, you can give providers a business number on their existing smartphones, establish encrypted caregiver conversations, and obtain a Business Associate Agreement. Caregivers can participate through free accounts using the app or web portal.
Make secure caregiver texting part of your practice's daily communication.
Give your providers a professional service to share approved updates, answer care questions, and communicate with caregivers through a dedicated business channel.
