Introduction to Protected Health Information
Protected health information PHI refers to any information about an individual’s health status provision of healthcare or payment for healthcare that is created collected transmitted or maintained by a healthcare provider health plan employer or healthcare clearinghouse. PHI is protected under the Health Insurance Portability and Accountability Act HIPAA to ensure individuals’ medical information remains private and secure. Understanding what constitutes PHI and how it must be safeguarded is critical for anyone working in the healthcare industry today.
Protected health information encompasses a wide range of data relating to an individual’s physical or mental health. Some examples of PHI include
- Name address birthdate and Social Security number
- Medical record number and health insurance details
- Test results diagnoses medications and medical procedures
- Conversations with doctors and nurses
- Billing information and payment data
Essentially any information that can be linked back to identify an individual and relates to their healthcare is considered protected. This applies to information transmitted or maintained in oral written or electronic formats.
There are several key facts organizations and individuals should understand about PHI
- PHI can be created or received by healthcare providers health insurance companies employers healthcare clearinghouses and business associates of these entities.
- PHI relates to past present or future physical or mental health conditions of an individual. It also pertains to healthcare services provided and payment for those services.
- There are strict laws and regulations about who can access PHI and under what circumstances. HIPAA establishes national standards for protecting medical information.
- Individuals have rights over their PHI. They can request copies of records ask for corrections and request restrictions on certain uses and disclosures.
- Safeguards must be in place to prevent unauthorized access use or disclosure of PHI. Administrative physical and technical security controls should protect PHI stored or transmitted electronically or on paper.
- Unauthorized use or disclosure of PHI can result in civil and criminal penalties enforced by the Department of Health and Human Services’ Office for Civil Rights.
what are 9 examples of protected health information?
To understand what is encompassed under PHI it helps to consider specific examples
- Medical records documenting health status medical conditions tests procedures images doctor’s notes and conversations. This applies to records from hospitals clinics dentists optometrists psychiatrists and other providers.
- Insurance claims/billing records containing payment information dates of service diagnoses codes procedures and supplier information.
- Prescriptions and pharmacy records that indicate medications prescribed and taken.
- Laboratory test results including blood work pathology reports and genetic testing results.
- Immunization records listing vaccines received.
- Insurance enrollment and eligibility paperwork showing coverage status and policy details.
- Explanation of benefits paperwork sent by insurers explaining payments made.
- Appointment reminder calls and messages referencing upcoming provider visits.
- Registration forms collecting demographic and insurance information from patients.
Essentially if information relates to an individual’s health or healthcare it requires HIPAA protections.
Protected health information cannot be used or disclosed freely. There are rules regarding when and how PHI may be released without an individual’s explicit authorization
- Treatment PHI can be shared between healthcare providers for coordinating care and treatment.
- Payment PHI can be given to insurance companies Medicaid Medicare and other payers to obtain payment for treatment.
- Healthcare operations Providers can use and disclose PHI to support core business activities like quality assurance audits and administrative functions.
- Public health activities PHI may be disclosed to public health authorities for reasons such as adverse event reporting product recalls and disease surveillance.
- Judicial and administrative proceedings PHI may be disclosed in response to court orders subpoenas discovery requests and other lawful processes.
- Law enforcement purposes PHI may be disclosed to police or other authorities to support investigations or identify suspects victims or witnesses.
- Research PHI may be used or disclosed for research purposes if protocols are followed to protect privacy and security.
- Serious threats to health or safety PHI may be shared to prevent or lessen imminent threats to a person or the public.
Any use or disclosure of PHI beyond these allowed purposes requires explicit written authorization from the individual. Authorization can be revoked at any time to halt future disclosures. Tight controls must surround all uses and disclosures of protected health information.
Various parties play a role in properly managing and protecting PHI
- Healthcare providers and business associates must implement safeguards to prevent unauthorized access and strictly limit uses and disclosures of PHI beyond allowed purposes. Policies training and audits should support HIPAA compliance.
- Health plans must have controls to protect PHI they create receive or maintain. This includes claims data enrollment information payment details and other member information.
- Individuals should understand their rights under HIPAA to access their own PHI request amendments view disclosures logs and restrict certain disclosures. They share responsibility to protect their information.
- Employers sponsoring group health plans must ensure all policies contracts and administrative processes protect workers’ PHI in accordance with HIPAA regulations.
- The Office for Civil Rights under Health and Human Services oversees and enforces HIPAA privacy and security regulations.
Protecting confidentiality and integrity of protected health information is imperative given the sensitivity of the data. Following HIPAA rules and implementing appropriate safeguards helps maintain individuals’ trust and privacy.
In summary protected health information encompasses a wide array of data related to an individual’s health status medical care and insurance coverage. Strict laws govern use and disclosure of PHI to prevent unauthorized or inappropriate access. All individuals and organizations that create maintain transmit or use PHI must have comprehensive safeguards in place to protect confidentiality. Understanding the scope of PHI and responsibilities for security and privacy is essential for HIPAA compliance. Appropriate management of PHI is critical given the extremely sensitive nature of the information.