HIPAA Alert: Google Tag Manager’s Critical Update for Healthcare Marketers

Google recently announced a significant update to Google Tag Manager (GTM), set to take effect on April 10th, 2025. While this change may appear minor to the average marketer, it represents a potentially serious compliance concern for healthcare organizations and medical device companies that must maintain HIPAA compliance while still leveraging digital marketing tools.

This update doesn’t just affect technical implementation—it fundamentally changes how data flows between your website and Google’s platforms, it potentially exposes sensitive information in ways that could violate privacy regulations. For healthcare marketers, understanding these changes is crucial to maintaining both effective marketing campaigns and regulatory compliance.

Understanding the Google Tag Manager Update

Google Tag Manager is a tag management system that allows marketers to implement tracking codes and conversion pixels without requiring extensive technical knowledge or developer resources. At the heart of Google’s tracking infrastructure is what they call the “global script tag,” commonly known as the Google Tag, GTAG or gtag.js, which is responsible for running various Google libraries.

This GTAG helps set cookies for Google Analytics and Google Ads, monitoring user sessions and helping with conversion tracking. It essentially manages the lifecycle of cookies across Google’s various marketing and analytics products.

The announced change is significant: whenever a Google Ads tag or Floodlight tag fires, GTM will automatically load the gtag.js script first, if your GTM is not already doing this. Importantly, GTM has already been doing this for some time, but beginning April 10th, the automatically loaded gtag.js script will have all of your GTAG’s configuration settings enabled, including automatic event detection and user provided data, rather than the previously limited implementation.

The purpose of this change is to provide advertisers with accurate data – user data and session data – to accompany the conversion data that gets sent back to these platforms.

Impact on Data Collection and HIPAA-Compliant Marketing

From an advertising perspective, this change offers clear benefits. It ensures more accurate conversion tracking by guaranteeing that the proper cookies are set before conversion data is sent back to Google’s platforms. This means better attribution and potentially more precise targeting capabilities.

For most marketers, this automatic implementation simplifies technical setup and improves data accuracy without requiring additional work. Google is essentially ensuring that the correct prerequisites are in place when sending events to their services, even if they weren’t properly configured initially.

However, there’s a critical trade-off happening here that especially affects healthcare organizations: improved data collection often comes at the expense of privacy protections.

Privacy Implications and HIPAA Compliance Concerns

Interestingly, this update runs counter to Google’s previously announced privacy-focused initiatives, such as the deprecation of third-party cookies, which they are no longer phasing out. In certain cases, you may want to track conversion actions without sending all that user data back to Google Ads. Now, this update essentially forces your hand to do just that.

For healthcare marketers operating under HIPAA regulations, this automatic data collection presents serious compliance risks. When the GTAG fires, they can potentially send sensitive data that, when combined with user identifiers, could constitute a violation of HIPAA rules.

The specific risks include:

• Mixing PHI with PII: If a URL contains condition-specific information (which many healthcare websites do), this information could be sent along with user data to Google, potentially constituting a violation. Any PII associated with a disease state is considered a violation under HIPAA.
• Google’s Refusal to Sign BAAs: Google won’t sign Business Associate Agreements, meaning they cannot legally receive PHI from covered entities.

Solutions for Healthcare Marketers: Server-Side GTM Implementation

The most comprehensive solution for healthcare marketers is implementing server-side GTM. This approach places a server between your website and Google’s platforms, allowing you to control exactly what data is sent to third parties.

Server-side GTM allows you to:

• Collect necessary marketing data for campaign optimization
• Filter out any PHI or sensitive health information before it reaches Google
• Maintain HIPAA compliance while still leveraging digital marketing tools

However, server-side implementation does come with challenges:

• Cost considerations: Setting up and maintaining servers on AWS, Azure, or other cloud platforms represents an additional expense.
• Technical complexity: Implementation requires developer resources and specialized knowledge outside the typical marketing skillset.

For organizations with budget constraints, newer solutions like Stape offer a more accessible path to server-side implementation. Stape provides a simpler setup process with lower costs, though it may not scale as effectively for larger organizations.

Strategic Recommendations and Next Steps for HIPAA Compliant GTM

As the April 10th implementation date approaches, healthcare marketers should take the following steps:

Immediate Actions

• Review your live GTM containers to understand current implementation
• Set manual GTAG to avoid auto load behavior, making testing and troubleshooting easier. This will also allow you to control which GTAG settings load
• Assess what data is currently being collected and sent to Google
• Document your current setup to identify potential compliance vulnerabilities

Determine Your Urgency Level

• High urgency: If you’re a healthcare organization using client-side GTM for conversion tracking
• Medium urgency: If you have mixed implementation with some server-side components
• Lower urgency: If you already have comprehensive server-side implementation

Long-term Strategy

• Evaluate server-side GTM implementation options and associated costs
• Prepare stakeholder communications about compliance requirements and necessary changes
• Consider consulting with marketing technology specialists who understand both HIPAA compliance and digital marketing needs

Safeguarding Patient Privacy While Maintaining Marketing Effectiveness

While Google’s GTM update improves data accuracy and simplifies implementation for most marketers, it presents significant compliance challenges for healthcare organizations. The automatic loading of Google’s tracking libraries means more data being sent to platforms that won’t sign BAAs, creating potential HIPAA violations.

Server-side GTM implementation represents the most comprehensive solution, allowing healthcare marketers to maintain both effective campaigns and regulatory compliance. The upcoming April 10th deadline gives you an opportunity to review your current implementation and consider upgrades to your marketing technology stack. If you’re looking to implement server-side GTM or would like assistance navigating these compliance challenges, we’re here to help you chart a clear path forward while protecting your patients’ privacy. Reach out today to start the conversation.

Resources

• How To Implement Google Tag Manager For HIPAA-Compliance – Our detailed webinar on the technical requirements for HIPAA-compliant GTM and the step-by-step instructions for implementation.
• Guides for Deploying GTM in AWS and Azure – Submit your information below to receive exclusive and downloadable “how to” documents for implementing GTM in AWS and Azure.

FAQ About Google Tag Manager and HIPAA Compliance

Is Google Tag Manager HIPAA-compliant?

Google Tag Manager itself isn’t inherently HIPAA compliant or non-compliant. The compliance issue arises from how it’s implemented and what data it collects and transmits. With proper configuration, especially using server-side GTM, it can be used in a HIPAA-compliant manner.

Can healthcare organizations use Google Analytics?

Healthcare organizations can use Google Analytics, but they must ensure no Protected Health Information (PHI) is sent to Google. This typically requires server-side implementation to filter sensitive data before it reaches Google’s servers.

What is server-side GTM and why is it important for healthcare?

Server-side GTM processes data on your own server before sending it to third parties like Google. This gives you control over what information is shared, allowing you to filter out PHI and maintain HIPAA compliance while still collecting marketing data.

What happens if my healthcare organization violates HIPAA through marketing tools?

HIPAA violations can result in significant financial penalties, ranging from $100 to $50,000 per violation (per record) with a maximum penalty of $1.5 million per year for violations of an identical provision. Beyond financial penalties, organizations may face reputational damage and loss of patient trust.