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The way that the data is maintained.
Both ways
I thought email isnt allowed. Ous EMR provided a patient logon portal for them to download their ePHI. Its my understanding that anything medical (diagnosis, treatment) plus anything that can indentify someone (PII) makes it ePHI regardless of what form that data is in (ie paper, zipfile, pdf, jpg...). Someone please correct me if im wrong.
Email isnt good because it isnt encrypted - fails security rule. Additionally, its easy to email the wrong person and get a violation.