Understanding Protected Health Information and Its Exclusions

Understanding Protected Health Information and Its Exclusions

Organizations collect and store various types of information to meet their operational requirements and provide better services to customers. Among the different types exists protected health information or PHI. PHI is a specific category of personal medical information and also includes identifying information.

In this article, we will take a closer look at the definition of PHI, how it is protected under the law, and its exclusions. We will examine why PHI is so important and the potential risks of non-compliance with the law.

What is Protected Health Information?

PHI is defined as any information related to a person’s health status, treatment, or payment. This type of information is typically obtained through medical records, individual or group health plans, healthcare clearinghouses, and healthcare providers to diagnose or treat patients.

PHI includes data such as:

– name
– address
– email address
– phone number
– Social Security number
– medical history
– test results
– diagnoses
– prescriptions
– health insurance information
– payment, billing, and claims information

How PHI is Protected

HIPAA, or the Health Insurance Portability and Accountability Act, is a federal law that protects PHI. It mandates how healthcare institutions, providers, and their associated business entities must comply with the law to safeguard PHI.

HIPAA specifies standards for the creation, maintenance, storage, and transmission of PHI. It applies only to “covered entities,” including healthcare providers, insurers, and clearinghouses that transmit information electronically for healthcare operations. It also covers business associates who provide services to covered entities and have access to PHI.

HIPAA regulates the privacy and security of PHI through several means:

– Privacy Rule: defines how PHI should be used, disclosed, and safeguarded, among other things
– Security Rule: establishes administrative, physical and technical safeguards to protect PHI
– Breach Notification Rule: mandates that covered entities inform individuals whose PHI is breached

HIPAA ensures that individuals have access to their own PHI, can correct PHI that is inaccurate, and restrict the use of their PHI.

Exclusions from PHI

HIPAA excludes several categories of information from the definition of PHI. Excluded information may not be subject to HIPAA regulation, protecting the privacy and confidentiality of individuals.

The categories of excluded information include:

– Employment records: health information included in records about an individual’s employment created and maintained by a covered entity
– Public health data: health information reported to federal, state, tribal, or local public health agencies
– De-identified information: health information stripped of any identifying information making it impossible to identify an individual
– Research data: information collected for research and compliance with governing privacy laws
– Educational records: health information excluded from FERPA, the Family Educational Rights and Privacy Act, which covers student data

The Importance of PHI and Compliance Risks

PHI is vital because it helps with patient care, research, public health initiatives, and insurance billing. Protecting PHI is essential to prevent breaches, identity theft, and other forms of unauthorized access.

When the PHI breaches, healthcare providers and business associates face regulatory fines, legal penalties, reputational damages, and financial losses. It often leads to patient mistrust and loss of reputation. Data breaches not only harm individuals’ privacy but also affect an organization’s HIPAA compliance status.

According to HIPAA Journal, the number of reported healthcare data breaches increased more than ten times between 2009 and 2020. By the end of 2020, over 33 million individuals were affected by healthcare data breaches.

Conclusion

In summary, PHI is any information that identifies or relates to an individual’s health status, treatment, or payment. HIPAA mandates that covered entities and their business associates maintain the privacy, security, and confidentiality of PHI. PHI is not only vital for patient care but also a lucrative target for cybercriminals.

Remember that compliance is essential to protect PHI and avoid negative consequences. Educating your employees, implementing HIPAA policies and procedures, and continually monitoring risks are all vital components of maintaining PHI compliance.