Jonah Patel
PHI stands for Protected Health Information. It is a term defined by the Health Insurance Portability and Accountability Act (HIPAA) to distinguish what kind of information needs to be handled according to its Privacy and Security Rules. PHI is any information in the medical record or designated record set that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment. It is important to understand what counts as PHI and who is allowed to use and have access to it to avoid impermissible uses and disclosures.
| Characteristics | Values |
|---|---|
| Full Form | Protected Health Information |
| Regulated By | Health Insurance Portability and Accountability Act (HIPAA) |
| Covered Entities | Health plans, health care clearinghouses, and qualifying healthcare providers |
| Business Associates | Multiple business associates |
| Protected Information | Individually identifiable health information |
| Examples of Protected Information | Enrollment, medical, and billing records |
| ePHI | Electronic protected health information |
| ePHI Examples | Electronic patient records, digital invoices for care |
| De-identification | A patient name alone is not considered PHI |
| 18 PHI Identifiers | Date of birth, phone numbers, fax numbers, email addresses, Social Security numbers, medical record numbers, health plan beneficiary numbers, account numbers, certificate/license numbers, vehicle identifiers, device identifiers, web URLs, IP addresses, biometric identifiers, full-face photographic images, and other unique identifiers |
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What You'll Learn
Protected Health Information
PHI stands for Protected Health Information. This term was first used in 1999 with the publication of the proposed Privacy Rule, to distinguish between individually identifiable health information maintained or transmitted by covered entities and health information maintained or transmitted by non-covered entities.
Covered entities include health plans, health care clearinghouses, and qualifying healthcare providers that conduct electronic transactions for which the Department of Health and Human Services (HHS) has published standards. Health insurance companies are also considered covered entities. The Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information.
Business associates of covered entities are also required to comply with the HIPAA Security and Breach Notification Rules when providing a service to or on behalf of a covered entity, and any other applicable standard(s) of HIPAA. This means that business associates may also need to comply with parts of the HIPAA Administrative Requirements and the HIPAA Privacy Rule.
PHI also encompasses electronic protected health information (ePHI), which refers to any information that is electronically stored or transmitted by covered entities. All ePHI must be protected by adhering to the HIPAA Security Rule, and a security breach involving ePHI can result in significant penalties.
PHI includes all elements of dates (except the year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89. It also includes phone numbers, fax numbers, email addresses, Social Security numbers, medical record numbers, health plan beneficiary numbers, account numbers, certificate/license numbers, vehicle identifiers and serial numbers, device identifiers and serial numbers, Web Universal Resource Locators (URLs), Internet Protocol (IP) address numbers, biometric identifiers, full-face photographic images, and any other unique identifying number, characteristic, or code.
PHI does not include a patient name alone, as this does not reveal any medical, treatment, or payment information. It also does not include the year of birth, as this does not reveal sufficient information about an individual to identify them.
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Individually identifiable health information
PHI stands for Protected Health Information. It is a term defined by the Health Insurance Portability and Accountability Act (HIPAA) to distinguish what kind of information needs to be handled according to its Privacy and Security Rules.
Protected Health Information consists of individually identifiable health information. This includes identifiers such as an individual's enrollment, medical, and billing records, as well as any information that can be used to identify the patient, for example, medical record numbers, insurance identifiers, Social Security numbers, or other unique identifiers.
HIPAA-covered entities include health plans, health care clearinghouses, and qualifying healthcare providers that conduct electronic transactions for which the Department of Health and Human Services (HHS) has published standards. Health insurance companies are also considered covered entities and need to handle PHI for matters such as claims approvals and healthcare costs. Government healthcare programs such as Medicaid and Medicare are included in this category, as are military and veterans’ health programs.
HIPAA regulations allow researchers to access and use PHI when necessary to conduct research. Sponsored clinical trials that submit data to the U.S. Food and Drug Administration involve PHI and are therefore subject to HIPAA regulations. However, it is important to note that not all records within a healthcare facility are inherently confidential. Healthcare organizations are responsible for maintaining records that may not necessarily qualify as PHI.
Healthcare providers, including doctors, nurses, and other professionals, are the primary users of PHI. However, there are several categories of related entities who need access to PHI as part of the healthcare system. It is important for employees of covered entities and business associates to understand what is considered PHI to prevent impermissible uses and disclosures of PHI and to ensure compliance with regulatory standards.
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ePHI (electronic Protected Health Information)
The acronym PHI stands for Protected Health Information. It is a term defined by the Health Information Portability and Accountability Act (HIPAA) to distinguish what kind of information needs to be handled according to its Privacy and Security Rules.
PHI consists of individually identifiable health information such as enrollment, medical, and billing records that are maintained in designated record sets and used by covered entities to make diagnosis, treatment, and/or payment decisions. A designated record set is defined in 45 CFR §164.501 as "a group of records maintained by or for a covered entity that is the medical records and billing records about individuals [...], used, in whole or in part, by or for the covered entity to make decisions about individuals".
HIPAA-covered entities include health plans, health care clearinghouses, and qualifying healthcare providers that conduct electronic transactions for which the Department of Health and Human Services (HHS) has published standards. Health insurance companies are also considered HIPAA-covered entities.
EPHI, or electronic Protected Health Information, refers to any information that is electronically stored or transmitted by HIPAA-covered entities. This includes various records, such as electronic patient records or digital invoices for care. All ePHI must be protected by adhering to the HIPAA Security Rule, and a security breach can result in significant penalties.
It is important to note that not all records within a healthcare facility are inherently confidential. Healthcare organizations are responsible for maintaining records that may not necessarily qualify as PHI. For example, a patient name alone is not considered PHI under HIPAA as it does not reveal any medical, treatment, or payment information. However, a phone number maintained in a designated record set with other identifying information is considered PHI.
Healthcare providers, business associates, and workforce members must understand what is considered PHI under HIPAA to prevent impermissible uses and disclosures of PHI, as well as to prevent information that is not considered PHI from being secured unnecessarily. Employees should be well-versed in the intricacies of HIPAA, including recognizing potential vulnerabilities and knowing how to respond to breaches or incidents.
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HIPAA Privacy Rule
PHI stands for Protected Health Information. The term was adopted in 1999 to distinguish between individually identifiable health information maintained or transmitted by covered entities and health information maintained or transmitted by non-covered entities.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) introduced the HIPAA Privacy Rule, which provides a federal floor of privacy standards that protect individuals' health information and other identifying information. The Privacy Rule was published in 2000, with final modifications released in 2002.
The Privacy Rule standards address the use and disclosure of individuals' health information by covered entities, as well as standards for individuals' privacy rights to understand and control how their health information is used and disclosed. The rule is designed to be flexible and comprehensive to cover the variety of uses and disclosures that need to be addressed.
Covered entities include health plans, health care clearinghouses, and qualifying healthcare providers that conduct electronic transactions for which the Department of Health and Human Services (HHS) has published standards. Health insurance companies are also considered HIPAA-covered entities, as are government healthcare programs such as Medicaid and Medicare. Business associates of covered entities are also required to comply with the HIPAA Privacy Rule, depending on the nature of the service being provided.
The HIPAA Privacy Rule gives individuals the rights to access, amend, or transfer their Protected Health Information, and to request copies of their health information and request corrections. If organizations violate the HIPAA Rules, individuals have the right to complain to the organization or HHS' Office for Civil Rights, which has the authority to impose corrective action plans or financial penalties on non-compliant organizations.
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Compliance and repercussions
Protected Health Information (PHI) is a term defined by the Health Insurance Portability and Accountability Act (HIPAA) to distinguish what kind of information needs to be handled according to its Privacy and Security Rules. The Privacy Rule provides federal protections for personal health information held by covered entities and gives patients a range of rights concerning that information. The Rules require covered entities to put various administrative, physical, and technical safeguards in place to protect the privacy, integrity, and availability of any identifiable data they deal with.
Covered entities include health plans, health care clearinghouses, and qualifying healthcare providers that conduct electronic transactions for which the Department of Health and Human Services (HHS) has published standards. Business associates of covered entities are also considered covered entities and must comply with the HIPAA Security and Breach Notification Rules.
PHI encompasses any information in the medical record or designated record set that can be used to identify an individual and was created, used, or disclosed in the course of providing a health care service such as diagnosis or treatment. This includes but is not limited to medical history, diagnoses, test results, prescribed medications, and demographic information. It also includes payment information for medical services and any information that can be used to identify the patient, such as medical record numbers, insurance identifiers, and Social Security numbers.
Healthcare organizations can face severe legal and financial repercussions for failing to adequately protect PHI. Entities that mishandle PHI can face substantial penalties, ranging from thousands to millions of dollars, depending on the severity of the breach and the organization's response. Legal actions from affected patients or regulatory authorities can lead to additional financial strain, and the damage to an organization's reputation and credibility can result in patient attrition.
To ensure compliance, organizations should foster an environment of education and awareness, empowering their employees to be proactive guardians of PHI. This includes providing regular training on data security and regulatory compliance and implementing advanced encryption, stringent access controls, and secure transmission methods.
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Frequently asked questions
PHI stands for Protected Health Information.
PHI constitutes any information that can be used to identify an individual, including their health history, genetic information, diagnoses, treatments, and payment information.
Healthcare professionals are the primary users of PHI, but there are several categories of related entities who need access, including healthcare providers, health insurance plans, and healthcare clearinghouses, as well as their business associates.
Healthcare organizations can face severe legal and financial repercussions for mishandling PHI, including penalties ranging from thousands to millions of dollars, legal actions from patients or regulatory authorities, and damage to their reputation and credibility.
