How do you secure telemedicine APIs that carry patient data?

Securing a telemedicine API means making sure each request is tied to a verified person, is allowed to touch the specific patient record it names, travels encrypted, and leaves an audit trail. Most real failures are not broken encryption. They are missing authorization checks on individual records.

What does the law ask for?

The HIPAA Security Rule's technical safeguards, in 45 CFR 164.312, read like an API checklist:

• Access control, with unique user identification (required): assign a unique name or number to track each user.
• Audit controls: mechanisms that record and examine activity in systems containing electronic protected health information (ePHI).
• Integrity: protect ePHI from improper alteration or destruction.
• Person or entity authentication: verify that whoever seeks access is the one claimed.
• Transmission security: guard against unauthorized access to ePHI sent over a network, with integrity controls and encryption as addressable specifications.

Addressable does not mean optional. It means you must assess whether the measure is reasonable for your situation, and document your decision. The administrative safeguards in 164.308 add a risk analysis and risk management requirement on top.

What are the common API failures in a telehealth app?

The OWASP API Security Top 10 (2023) puts Broken Object Level Authorization (BOLA) at number one. It happens when an endpoint takes an object identifier and acts on the object without checking that the signed-in user may access that specific object. OWASP says the issue is extremely common in API-based applications, because the server relies on IDs sent by the client.

A constructed example. A telehealth app has an endpoint that returns a visit summary by visit number. Doctors and patients both sign in. The server confirms the caller is signed in, but not that the visit belongs to that patient or that the doctor is on the care team. A patient who changes the number in the request sees another patient's summary. Encryption in transit, a valid login and a firewall were all in place. None of them stop this.

Other likely gaps:

• Tokens that never expire, or that stay valid after a clinician leaves.
• Video session links that anyone with the URL can join.
• File upload endpoints, for scans and photos, with no limits on type or who can fetch the file later.
• Verbose errors or debug endpoints left on in production.
• Logs that store full request bodies, including patient notes.

What controls should be in place?

1. Check authorization on every object access, in server code, using the relationship between user and record: patient to own data, clinician to assigned patients.
2. Use strong authentication, with multi-factor authentication for staff and short-lived tokens for all.
3. Use random, unpredictable identifiers, as OWASP recommends, but treat this as a second layer and not a replacement for authorization checks.
4. Encrypt in transit with current TLS and encrypt stored files and databases.
5. Protect real-time sessions: one-time or signed join links, tied to the participants, with expiry.
6. Log who accessed which record and when, without writing patient content into the logs.
7. Write automated tests where user A tries to read, change and delete user B's records, and make the build fail if any succeed.

How to check or apply this

1. List every endpoint that takes a record identifier. Mark each with how authorization is checked.
2. Test two accounts with different roles against each endpoint. Try swapping identifiers.
3. Check token lifetime, revocation on staff exit, and join link expiry.
4. Review log samples for patient names, notes or tokens.
5. Run your risk analysis again whenever you add a vendor, a video provider or a new device integration.
6. Record decisions about addressable items such as encryption in your security documentation.

Quick check

Sources

• 45 CFR 164.312, Technical safeguards (eCFR)
• 45 CFR 164.306, Security standards general rules (eCFR)
• 45 CFR 164.308, Administrative safeguards (eCFR)
• OWASP API Security Top 10 2023, API1 Broken Object Level Authorization

Last reviewed: 18 October 2026.