The adoption of VoIP technology and its implications for HIPAA compliance have evolved significantly since the federal government first issued guidance regarding traditional analog phone systems. Today, VoIP phone systems that process or store electronic Protected Health Information (ePHI) are subject to the provisions of the HIPAA Security Rule.

Business VoIP use continues to grow rapidly, with the global VoIP market projected to reach $508.7 billion by 2030. As of 2024, approximately 70% of businesses had integrated VoIP into their communications strategies, with small and medium-sized enterprises driving much of this growth.

VoIP converts analog audio signals into digital data transmitted over the Internet. In healthcare settings, this data often includes patient information that constitutes ePHI, falling squarely within HIPAA’s scope. Healthcare providers utilizing VoIP systems must ensure HIPAA compliance to protect patient data during transmission, storage, and access.

What Constitutes ePHI Transmission in VoIP?

Under HIPAA, electronic media include storage devices (e.g., computer hard drives) and transmission media (e.g., the internet). The 2013 Omnibus Rule clarified that certain transmissions, such as paper faxes and traditional telephone voice calls, are not considered electronic transmissions if the information did not exist in electronic form before transmission. However, VoIP calls, particularly when involving voicemail, call recording, or any form of data retention, are treated as ePHI transmissions under HIPAA. Providers of VoIP services that handle stored or recorded data are generally considered Business Associates and must comply with HIPAA’s requirements.

HIPAA-Compliant VoIP Features

Key implementation specifications under the HIPAA Security Rule that apply to VoIP phone systems include:

• Unique User Identification & Authentication: Each phone or user account must be uniquely identifiable (e.g., by phone number, serial number, or user ID) and protected by appropriate authentication methods.
• Access Controls: Systems must support role-based access to restrict functions (e.g., administrative control, voicemail access) based on user privileges.
• Audit Logs: Systems should generate detailed logs of call metadata, user access, and administrative activities to enable auditing and incident investigation.
• Encryption: VoIP systems should implement strong encryption (such as TLS or VPN) for data in transit between IP phones and communications servers. Additional encryption technologies should be applied to data at rest (e.g., voicemails or call recordings). HIPAA considers encryption an “addressable” standard, meaning it should be implemented unless an alternative, equivalent safeguard is documented and justified.
• Business Associate Agreement (BAA): Cloud-based VoIP providers that handle ePHI must execute a valid BAA with covered entities. This agreement confirms the provider’s obligation to implement the required physical, technical, and administrative safeguards.

Important Note on the “Mere Conduit” Exception

The HIPAA Final Omnibus Rule provides limited exceptions for services that act as a “mere conduit” of information, such as traditional telephony providers that only transmit data without storing it. However, HHS has made clear that VoIP services offering features like voicemail and call recording do not qualify as mere conduits. Persistent data storage establishes the provider’s role as a Business Associate, making HIPAA compliance mandatory. Covered entities and their business partners should exercise caution and avoid engaging VoIP providers that claim “mere conduit” status while storing or handling ePHI.

Carolina Digital Phone’s HIPAA Compliance & Business Associate Agreement (BAA)

Carolina Digital Phone’s hosted VoIP solution is designed with HIPAA compliance in mind. Customers are responsible for conducting risk assessments, security evaluations, and compliance documentation to meet HIPAA requirements. Carolina Digital takes robust measures to secure the data you store on our servers, ensuring it is accessible only to you and your authorized representatives.

Carolina Digital offers a Sample BAA for review for covered entities and business associates requiring a Business Associate Agreement. This document is a starting template only and is not a binding agreement. After your legal team reviews the sample, Carolina Digital’s management and legal counsel will work with you to tailor a finalized BAA that meets your specific compliance requirements. No PHI should be shared with Carolina Digital until a fully executed BAA is in place. 

Additional Compliance Commitments

Carolina Digital Phone complies with all applicable FCC regulations, including 911/E911 service requirements, robocall mitigation protocols, and STIR/SHAKEN call authentication standards, to enhance call security, identity protection, and public safety.

Revised: May 7, 2025