Twelve things to have in place before your practice uses AI with patient information.
Answer each item yes, no or not sure. You get your list of open items straight away, each with the reason and the source it comes from. Your answers stay in your browser: none of them is sent or saved. If you choose to write to us afterwards, the only thing the checklist adds to your message is the count.
Not sure is a fine answer. It puts the item on your list to check.
Know what you use
- A list of the AI tools in use. We keep a written list of every AI tool anyone on our team uses for practice work, including personal accounts used for work tasks.
Why it matters, and what to do
Why it matters: The Security Rule requires “an accurate and thorough assessment of the potential risks and vulnerabilities” to the electronic patient information a practice holds. A tool nobody has listed cannot be part of one.
What to do: Ask each person on the team, in writing, which tools they use for work. Include browser extensions, phone apps and free accounts.
Sources: 45 CFR 164.308(a), Security Rule administrative safeguards
- No patient information in consumer plans. No one on our team puts patient information into a free or personal plan of a chat assistant, or into ChatGPT Business.
Why it matters, and what to do
Why it matters: OpenAI’s HIPAA guide says: “ChatGPT services for consumers (e.g., Free, Plus, Pro) and ChatGPT Business are not Eligible Services.” Check any other vendor’s consumer plan against that vendor’s own documents.
What to do: Tell staff plainly which plans are off limits, and name what they may use instead. Removing a patient’s name does not de-identify a note: HIPAA lists eighteen kinds of identifier, including dates.
Sources: OpenAI, HIPAA Implementation and Configuration Guide (posted July 9, 2026); 45 CFR 164.514(b), de-identification
- A written rule on AI tools. We have a short written rule that says which AI tools may be used with patient information, which may not, and who to ask.
Why it matters, and what to do
Why it matters: The Privacy Rule requires a covered entity to “implement policies and procedures with respect to protected health information” that are designed to comply with it. Putting your rules for AI tools in writing applies that requirement to a new kind of tool, and it gives staff something to follow and your counsel something to review.
What to do: Write half a page: the approved tools, the forbidden uses and the person to ask. Have your counsel read it.
Sources: 45 CFR 164.530, Privacy Rule administrative requirements
Agreements
- An agreement that names the product. For every vendor that handles patient information for us, we hold a signed business associate agreement that names the exact product and plan we use.
Why it matters, and what to do
Why it matters: A practice may let a business associate handle patient information if it obtains “satisfactory assurance” of safeguards, documented in a written contract or other written agreement (45 CFR 164.502(e)). OpenAI’s guide adds that if the agreement “does not expressly specify OpenAI API Services are Eligible Services,” the customer may not process patient information through them.
What to do: List each vendor beside the product, the plan and the date of its agreement. Treat a product with no row as not covered until you have checked.
Sources: 45 CFR 164.502(e), disclosures to business associates; OpenAI, HIPAA Implementation and Configuration Guide (posted July 9, 2026)
- What the agreement leaves out. We have read what each agreement leaves out, how soon the vendor must report a breach to us, and what happens to our data when the contract ends.
Why it matters, and what to do
Why it matters: Google’s Workspace page says: “Third-party applications including add-ons are not included in the Included Functionality covered by the BAA.” The Privacy Rule also expects the contract to require the vendor to report any use or disclosure it does not provide for, including breaches, and at termination, if feasible, to return or destroy the information (45 CFR 164.504(e)).
What to do: Read the exclusions, the breach-notice terms and the end-of-contract terms. Write down any feature you use that the agreement does not name.
Sources: Google, HIPAA compliance with Google Workspace and Cloud Identity; 45 CFR 164.504(e), business associate contracts
- Installers, support firms and subcontractors. We know whether any firm that installs or supports our AI tool can see or handle patient information, and what written agreement covers it. We have asked each vendor which subcontractors handle our data.
Why it matters, and what to do
Why it matters: The federal definition of a business associate reaches a person who creates, receives, maintains or transmits patient information for a covered entity, and a person who provides consulting, management or administrative services where the service involves disclosure of patient information to that person (45 CFR 160.103). A vendor’s own subcontractors that handle the information need satisfactory assurances too (45 CFR 164.502(e)(1)(ii)).
What to do: Ask every vendor and every installer: can you see or handle our patient information, and which other companies handle it? Get the answer in writing.
Sources: 45 CFR 160.103, definitions (business associate); 45 CFR 164.502(e), disclosures to business associates
Safeguards
- Individual sign-ins, ended when someone leaves. Each person signs in to an AI tool with their own account, and we can end that access the day someone leaves.
Why it matters, and what to do
Why it matters: The Security Rule requires “a unique name and/or number for identifying and tracking user identity” (45 CFR 164.312(a)(2)(i)) and, as an addressable specification, procedures for ending access to electronic patient information when a workforce member’s employment or other arrangement ends (45 CFR 164.308(a)(3)(ii)(C)). OpenAI’s guide also makes the customer responsible for configuring single sign-on to manage access.
What to do: No shared logins. Add each AI tool to your checklist for staff who leave.
Sources: 45 CFR 164.312(a), Security Rule technical safeguards; 45 CFR 164.308(a), Security Rule administrative safeguards; OpenAI, HIPAA Implementation and Configuration Guide (posted July 9, 2026)
- Retention and logging settings. We know how long each tool keeps what we type in and what it writes back, and who at the vendor can read it, and we have set the options that limit it.
Why it matters, and what to do
Why it matters: Retention is a setting, not a given. OpenAI’s guide says use of its API under a BAA “currently requires Customer’s account being provisioned for a Modified Retention feature,” and Google’s page says a customer with a BAA should not opt in to data logging for Speech-to-Text.
What to do: Ask each vendor for its retention terms in writing, then check the setting in your own account.
Sources: OpenAI, HIPAA Implementation and Configuration Guide (posted July 9, 2026); Google, HIPAA compliance on Google Cloud and Google Workspace
- A regular look at who used what. Someone looks at who used each tool and for what, on a schedule we have written down.
Why it matters, and what to do
Why it matters: The Security Rule requires procedures “to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports” (45 CFR 164.308(a)(1)(ii)(D)). OpenAI’s guide puts monitoring of staff use on the customer: “Customer is responsible for implementing its own tools and processes for monitoring End Users’ use of the Services.”
What to do: Pick an owner and a day each month. Look at the vendor’s usage or audit records and note what you checked.
Sources: 45 CFR 164.308(a), Security Rule administrative safeguards; OpenAI, HIPAA Implementation and Configuration Guide (posted July 9, 2026)
People and process
- Staff training on AI. Everyone who uses AI at work has been trained on what may and may not go into it.
Why it matters, and what to do
Why it matters: The Privacy Rule requires a covered entity to “train all members of its workforce on the policies and procedures with respect to protected health information,” as necessary and appropriate for their functions (45 CFR 164.530(b)(1)), and the Security Rule requires a security awareness and training program for all members of the workforce (45 CFR 164.308(a)(5)(i)). Training on what may go into an AI tool applies those duties to a new kind of tool. OpenAI’s addendum also requires its customers to train their personnel on the obligations it sets out (section 3.4).
What to do: Run a 30-minute session on your written rule, using examples your staff really face. Note the date and who attended.
Sources: 45 CFR 164.530, Privacy Rule administrative requirements; 45 CFR 164.308(a), Security Rule administrative safeguards; OpenAI, Healthcare Addendum and BAA (version 111124)
- A licensed person checks the output. A licensed person reviews AI output before it is used in care, billing or a patient record, and we have tested the tool on our own kind of work.
Why it matters, and what to do
Why it matters: OpenAI’s Healthcare Addendum puts related duties on its customers: test the service “for accuracy in Customer’s use cases,” and ensure that “only duly trained and qualified individuals who maintain licenses, certifications or other authorizations required to perform such Healthcare Activities” use the service or its output in connection with healthcare activities.
What to do: Name who checks the output for each use, and keep a few sample checks on file.
Sources: OpenAI, Healthcare Addendum and BAA (version 111124)
- A procedure for when information goes to the wrong place. We have a written procedure for what staff do if patient information goes somewhere it should not, such as a paste into the wrong tool.
Why it matters, and what to do
Why it matters: The Security Rule requires policies and procedures to address security incidents, including to “document security incidents and their outcomes” (45 CFR 164.308(a)(6)). Vendor agreements must require the vendor to report to you any use or disclosure the contract does not provide for (45 CFR 164.504(e)); your procedure should say what you do when they do.
What to do: Write the first three steps: who to tell, what to stop using, and how to record it.
Sources: 45 CFR 164.308(a), Security Rule administrative safeguards; 45 CFR 164.504(e), business associate contracts
0 of 12 answered. Anything you skip goes on your list as not sure.
This is general information, not legal advice or a compliance assessment. The list covers what changes when a practice starts using an AI tool; it is not everything HIPAA requires, and it assumes your practice is a covered entity, which your counsel can confirm. Having all twelve in place does not make a practice compliant with HIPAA: Google’s HIPAA guide notes that the Department of Health and Human Services “doesn’t offer a certification program for HIPAA compliance.” Ask your own counsel about your practice.