Telehealth Security for Small Clinics: HIPAA-Compliant Setup

Telehealth has evolved from a pandemic-era necessity into a permanent fixture of modern healthcare delivery. As of 2025, more than 80 percent of healthcare organizations offer some form of virtual care. But telehealth introduces unique security challenges that traditional in-office visits do not. Patient data traverses public networks, providers may use personal devices, and patients connect from home environments with varying levels of security. Securing telehealth is not just a compliance exercise; it is essential to maintaining patient trust and the integrity of the care relationship.

HIPAA Compliance for Virtual Visits

The HIPAA enforcement flexibilities that were introduced during the COVID-19 public health emergency have expired. Healthcare providers must now ensure that all telehealth activities fully comply with HIPAA Privacy, Security, and Breach Notification Rules. Key compliance requirements for telehealth include:

• Use only HIPAA-compliant platforms. Consumer-grade video tools such as standard Zoom, FaceTime, or Google Meet do not meet HIPAA requirements unless specifically configured with a BAA in place. Use telehealth platforms that sign a BAA and provide appropriate encryption and access controls.

• Encryption in transit. All audio and video communications must be encrypted end-to-end or at minimum use TLS 1.2+ encryption in transit. Verify that your platform encrypts data streams and does not store unencrypted recordings.

• Access controls. Require authentication for both providers and patients to join telehealth sessions. Implement waiting rooms or host-admitted access to prevent unauthorized individuals from joining sessions.

• Audit logging. Your telehealth platform must maintain logs of session access, including who joined, when, and from what device or location.

• Minimum necessary standard. Only share the minimum amount of PHI necessary during virtual visits. Be aware that screen sharing during telehealth sessions may inadvertently expose other patients' information.

Securing the Provider Environment

The security of the provider's environment during telehealth sessions is critical. Whether providers are conducting virtual visits from a clinic or from home, the following measures should be in place:

• Dedicated devices or secure profiles. Providers should use organization-managed devices whenever possible. If personal devices are used, implement mobile device management (MDM) or containerized work profiles that separate clinical applications from personal use.

• Secure network connections. Require providers to use encrypted VPN connections when conducting telehealth sessions from outside the organization's network. Home Wi-Fi networks should use WPA3 encryption with strong passwords.

• Physical privacy. Providers must conduct telehealth sessions in private spaces where conversations cannot be overheard by unauthorized individuals. This applies whether they are in a clinic, office, or home setting.

• Screen lock and session management. Devices should lock automatically after brief inactivity. Telehealth sessions should be closed promptly when complete rather than left open in the background.

• Updated software. Maintain current operating systems, browsers, and telehealth applications on all devices used for virtual care. Outdated software introduces exploitable vulnerabilities.

Patient-Side Security Considerations

Patients share responsibility for telehealth security, but most need guidance from their providers. Include the following recommendations in your patient telehealth instructions:

• Use a private space for telehealth visits where conversations will not be overheard.

• Connect via a secure, password-protected Wi-Fi network rather than public Wi-Fi.

• Use the latest version of the telehealth application or a supported web browser.

• Do not share telehealth session links or access codes with anyone.

• Log out of the telehealth platform after each visit.

Recognize that some patients may have limited technology resources or digital literacy. Provide clear, simple instructions and offer technical support to help patients connect securely.

Platform Selection Criteria

Choosing a telehealth platform is a security decision as much as a clinical one. Evaluate potential platforms against these criteria:

• BAA availability. The vendor must sign a HIPAA Business Associate Agreement. If they refuse, move on immediately.

• Encryption standards. Look for end-to-end encryption for video and audio. At minimum, the platform must use AES-256 encryption for data at rest and TLS 1.2+ for data in transit.

• Access controls. The platform should support multi-factor authentication for providers, unique session links per appointment, waiting room functionality, and host controls to remove unauthorized participants.

• Audit and compliance features. Comprehensive access logging, session recording controls (with appropriate consent mechanisms), and compliance reporting capabilities.

• Integration with existing systems. Secure integration with your EHR, scheduling system, and patient portal reduces data re-entry and associated error risks.

• Uptime and reliability. Review the vendor's service level agreements, uptime history, and incident response capabilities. Platform outages during scheduled patient visits create clinical and reputational risks.

• Data residency and retention. Understand where patient data is stored, how long it is retained, and how it is disposed of. Ensure these practices align with your HIPAA policies.

Telehealth-Specific Threat Awareness

Several threats are particularly relevant to telehealth environments:

• Session hijacking: Attackers who obtain telehealth session links or codes can join visits and access PHI. Use unique, time-limited session links and authenticated access to mitigate this risk.

• Man-in-the-middle attacks: On unsecured networks, attackers can intercept telehealth communications. End-to-end encryption is the primary defense.

• Recording and screenshot capture: Unauthorized recording of telehealth sessions by any party creates breach risk. Establish and communicate policies about session recording and obtain appropriate consent where recording is clinically necessary.

• Phishing for telehealth credentials: Attackers send fraudulent telehealth invitations to harvest provider or patient credentials. Train staff and patients to verify the source of telehealth invitations.

Building a Secure Telehealth Program

Telehealth security should be embedded into your broader organizational security and compliance programs rather than treated as a standalone initiative. Develop telehealth-specific policies, include telehealth scenarios in your risk assessments, train providers on secure virtual care practices, and audit telehealth activities just as you would in-person clinical operations.

Bellator Cyber Guard helps healthcare organizations build secure, compliant telehealth programs from the ground up. We evaluate platforms, configure security controls, develop telehealth policies, train your clinical staff, and monitor for emerging threats. Contact us at guard@bellatorit.com to ensure your virtual care delivery is as secure as it is convenient.