What is Protected Health Information

What is Protected Health Information

Medical-Office-Protected-Health-InformationThe Health Insurance Portability and Accountability Act (HIPAA) defines protected health information (PHI) as any data that contains a patient’s name or could be combined with other information to determine the patient’s identity.

The PHI category includes most direct patient records, but also includes other records related to demographic information and general patient data, even when that data has been anonymized. The original HIPAA legislation has been amended by multiple regulations issued in subsequent years, and your office must adhere to each requirement outlined in the Combined Regulation Text. Let TriHaz Solutions walk you through protected health information. 

What is Protected Health Information

Protected Health Information (PHI) encompasses any data within medical records or associated with health services that can identify an individual. This definition extends beyond medical histories to include any form of information obtained during healthcare provision, such as diagnoses, treatment information, medical test results, and personal identifiers like names, addresses, and social security numbers. Governed by the Health Insurance Portability and Accountability Act (HIPAA) in the U.S., PHI is safeguarded to uphold patient privacy and confidentiality.

Protected Health Information

HIPAA mandates that healthcare providers, insurers, and their business associates implement comprehensive security measures to protect PHI, strictly regulate its disclosure and use, and empower patients with certain rights over their health information. This legal framework ensures the sensitive nature of health data is respected, preventing unauthorized access and maintaining the integrity of patient confidentiality in the healthcare system.

What is Considered Protected Health Information?

Protected Health Information (PHI) includes a wide array of information that relates to an individual’s past, present, or future physical or mental health condition, the provision of health care to the individual, or payment for the provision of health care to the individual, which can be used to identify the person. This information can be in any form or medium—electronic, paper, or oral. Here are the key categories and examples of what is considered PHI under HIPAA regulations:

Personal Identifiers

Any piece of information that can directly or indirectly identify an individual, such as:

    • Names
    • All geographical identifiers smaller than a state, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of the Census, the geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people
    • Dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older
    • Phone numbers
    • Fax numbers
    • Email addresses
    • Social Security numbers
    • Medical record numbers
    • Health insurance beneficiary numbers
    • Account numbers
    • Certificate/license numbers
    • Vehicle identifiers and serial numbers, including license plate numbers
    • Device identifiers and serial numbers
    • Web Universal Resource Locators (URLs)
    • Internet Protocol (IP) address numbers
    • Biometric identifiers, including finger and voice prints
    • Full face photographic images and any comparable images
    • Any other unique identifying number, characteristic, or code except the unique code assigned by the investigator to code the data

Health Information

This includes any information related to the individual’s health condition, medical history, medical treatments, and test results:

    • Diagnoses
    • Treatment information
    • Medical test results
    • Prescription information

Payment Information

Information about insurance coverage, billing details, and any payment records linked to healthcare.

Why Should PHI Be Protected?

Your medical office is required to maintain the confidentiality of your patient’s PHI, and failing to do so could lead to steep penalties. Avoiding HIPAA violations is a core component of operations for any medical facility, and regulators view the situation accordingly. Government agencies have investigated nearly 200,000 HIPAA complaints over the last decade, and violations can range from large fines to loss of license and ability to practice.

Best Practices for Protected Health Information (PHI)

While PHI and HIPAA concerns are vast and complex, meeting their requirements in your medical office is best achieved with an organized, measured approach that includes these five key steps:

1. Designate a Security Administrator

Every primary department in your office should have a designated lead for maintaining knowledge of, and compliance with, HIPAA and PHI requirements. You should also have a Security Administrator to coordinate related operations across your entire facility, with a particular focus on identifying PHI generated by your activities, then protecting the data accordingly.

Along with daily monitoring, your Security Administrator should conduct regular audits of PHI activity and carefully review all technical and partnership aspects of your operations to maintain compliance.

2. Conduct Proper Training

Your training activities should prioritize efforts tied to regulatory requirements and violation risks. For most medical offices, that means instituting full training programs for concerns related to OSHA, HIPAA, and Department of Transportation regulations. In each case, both course material and required attendee categories are strictly defined, so it’s important to ensure you maintain compliance throughout your office.

3. Use Business Associate Agreements

HIPAA carefully defines “covered entities” that are required to maintain compliance. It includes all healthcare providers and attendant offices. This also includes any activity performed by outside partnerships or contractors, which are defined by regulations as “business associates.”

To protect your office, you should always use a Business Associate Agreement with any qualifying partner. These agreements clearly define the legal and regulatory parameters of the work being done, along with the associate’s responsibilities and methods for complying with such requirements.

Business Associate Agreements can be tailored to each situation, but should always include key legal language to meet the standards set by regulators.

4. Maintain Secure Document Destruction

Your office is responsible for all PHI it generates or comes into contact with, even once that data has been sent for disposal. If a document or data file is not properly destroyed—leaving the information open to theft or even simple exposure— your office is on the line for violations and penalties.

For that reason, it’s critical to maintain thorough, documented procedures for storing and destroying all records in your office, both paper and digital. If you use an outside partner to handle those activities, the related Business Associate Agreement should clearly define the same scope of requirements and liabilities.

5. Take IT Seriously

In modern healthcare your electronic and digital infrastructure is the most important part of your PHI and general data landscape. Safeguarding that activity and protecting its data should be your top priority. That requires a robust, well-managed technical and Health Information Technology regime.

Because your office operates under such extensive regulatory requirements, it’s not enough to find a general IT provider or administrator. Any employee or outside partner who manages your digital infrastructure needs to be fluent in the requirements of Health IT and its compliance concerns.

With robust procedures, smart decisions, and highly qualified partnerships, you can ensure your medical office meets all of its requirements for protecting PHI under the law.

What is Protected Health Information PHI vs PII?

Protected Health Information (PHI) and Personally Identifiable Information (PII) are both crucial in the context of data privacy, but they cater to different aspects of information security and privacy laws, particularly in the United States.

Scope and Application

PHI is a subset of PII that specifically relates to health information and is regulated under HIPAA in the U.S. PII encompasses a broader range of information that can identify an individual and is not limited to the healthcare sector.

Regulatory Framework

PHI is governed by HIPAA, which imposes strict rules on how health-related information must be handled, protected, and disclosed. PII’s protection, while also subject to laws and regulations, varies more widely depending on the industry and type of information.

Types of Information Covered

PHI includes health-related information that can identify an individual. PII includes any information that can be used to identify an individual, not just health-related.

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