What Is PHI, And Why Is It Important For Your Healthcare Business?
Health information is perhaps the most valuable kind of data in the world. It can reveal so much about an individual and is often the target of hackers and cybercriminals. Hence, it is no wonder that various rules and regulations protect healthcare data.
Today, we will explain what Protected Health Information or PHI is. You will learn everything about PHI, its examples, the laws that protect PHI, and more as you read on.
What is PHI or Protected Health Information?
PHI or Protected Health Information is any healthcare data or information that can reveal a patient’s identity. It is sometimes referred to as personal health information or patient health information, and it can include information such as:
- Demographic Information
- Medical History
- Laboratory/Test Results
- Mental Health Conditions
- Insurance Information
But that’s not all. Even the conversations between healthcare professionals about the treatment are protected as PHI. And yes, PHI Patient Health Information also includes any data processed for medical billing and health insurance.
The Health Insurance Portability and Accountability Act (HIPAA) defined PHI. HIPAA oversees the use, access, and disclosure of PHI in the United States. It is similar to data protection laws we have here in the UK, such as General Data Protection Regulation (GDPR) and the Data Protection Act 2018.
In general, you could say that the purpose of these laws is to protect the public’s privacy. However, this protection only applies to a niche when it comes to HIPAA. Because while GDPR deals with public data in general, PHI Protected Health Information focuses explicitly on healthcare data.
ePHI
During its inception, PHI health data was limited to hard copies because there were no digital alternatives available. But eventually, digitisation hit the healthcare industry just like every other industry. It became necessary to protect PHI in digital form.
As you can guess, ePHI is short for Electronic Protected Health Information. Any PHI data you create, maintain, or process electronically can be termed ePHI. Remember the PHI data you keep and access securely on your desktop, mobile, website, or other electronic devices?
Yes, all of that is also protected as ePHI, and it would be advisable for you to keep them safe and secure. Like the regular PHI, ePHI also receives all the data protection from HIPAA. Any breach could lead to a lot of legal problems and hefty fines.
What Are Some Examples of Protected Health Information?
Unlike you may think, not all information identifiers are classified as PHI. HIPAA provides a list of 18 identifiers that become PHI only when paired with health information. It is also possible some of these identifiers can be used to identify an individual even when they are not paired with health information.
Here are some examples of PHI health data.
- Name
- Address
- Dates such as birthday, admission date, etc. (excluding years)
- Phone number
- Email address
- Social Security number
- Certificate or licence number
- Full-face photographs
- Fax number
- Account number
- Medical record number
- Vehicle identifies such a licence plate number
- Medical record number
- Health plan beneficiary number
- Device identifiers
- Website URL
- IP address
- Biometric IDs such as fingerprints
- Any unique identifying number/code
What Are The Uses of PHI Health Data, And Who Uses It?
Have you ever wondered what happens when a new baby is born in a hospital? The PHI health data is also created almost simultaneously with the newborn baby. A health record is made for the baby where they record everything from its weight to temperature.
So, now you have a comprehensive record of that baby’s health data from the moment the baby was born. PHI enables the tracking of an individual’s health data throughout their life. As a result, healthcare professionals can easily understand and assess a person’s health conditions.
Clinical And Research Scientists
Studying health and healthcare trends is much easier with the help of PHI health data. Hence, clinical and research scientists benefit tremendously from PHI data. However, even researchers can’t access PHI data unless they are anonymised.
What does that mean? The PHI data is stripped of any identifying features, and they are pooled together in a massive database. Such databases are perfect for population health management efforts and creating value-based care programs.
Hacker And Cybercriminals
Another group of people interested in PHI are hackers and cybercriminals. One of the main reasons why PHI was created was this group of people. Many people and even some healthcare organisations don’t understand the actual value of PHI Patient Health Information.
Hackers and cybercriminals may sell PHI data for a high price. And suppose your organisation is responsible for the leak of PHI data to these groups. In that case, the authorities may subject you to legal actions. Additionally, cybercriminals may also use PHI data that they hacked to get ransom from healthcare providers and other organisations.
Marketers
Marketers can also use PHI data for marketing products and services relevant to the patient. But, it only applies to cases where the patient expressly allows an organisation to use their PHI data. The HIPAA regulations strictly limit how an organisation can share PHI or use it for marketing purposes.
What is a Covered Entity?
HIPAA classifies a covered entity as any organisation or individual that handles PHI health data regularly. All covered entities must ensure they follow HIPAA’s privacy and security rules. Several organisations deal with PHI regularly. However, you can classify covered entities under HIPAA into three categories, and they are:
- Healthcare Providers
- Health Plans
- Healthcare Clearinghouses
Healthcare Provider
Healthcare providers are perhaps the source of all PHI health data. And yes, healthcare providers are precisely the people and organisations you are thinking of right now. But, to make it clear, let us list out the healthcare providers for you.
- Hospitals
- Doctors
- Clinics
- Psychologists
- Dentists
- Chiropractors
- Nursing Homes
- Pharmacies
Are you or your organisation on the list above? If yes, you are a covered entity under HIPAA. However, we are just getting started, and there are still two more categories of covered entities for us to cover.
Health Plans
The next category of covered entities is health plans. It includes government programs that pay for health care, such as Medicare and Medicaid. In addition to that, military and veterans’ health care programs are also considered health plans.
Health Insurance Providers
Health insurance providers are also subject to HIPAA regulations because they often deal with sensitive Protected Health Information. Even the monthly billing statements they send out must be HIPAA compliant.
HMOs or Health Maintenance Organisations
A Health Maintenance Organisation or HMO is similar to a healthcare insurance provider. However, unlike regular insurance providers, it limits the coverage to care from doctors in a contractual relationship with the HMO.
Company/Organisation Health Plans
You should also note that employers and schools that deal with PHI Patient Health Information are also classified as health plans. In the above case, the employer or school uses PHI to enrol new members. The data they collect must be secured as per HIPAA standards.
Healthcare Clearinghouses
Healthcare clearinghouses include organisations which process nonstandard health information to a standard one or vice versa. It usually uses standard electronic format or data content. In other words, a healthcare clearinghouse takes PHI from an entity, standardises it, and then provides the output to another entity or organisation. Even this standardisation process requires the entity to be HIPAA compliant.
What is a Business Associate?
Covered entities are not the only individuals or organisations that use PHI Patient Health Information. Think about it, who prints and delivers documents like patient statements for healthcare organisations? The chances are that healthcare organisations use a Managed Print Service like PostGrid for printing and sending PHI documents.
However, having access to PHI does not make direct mail services like PostGrid a covered entity. By definition, a business associate is an entity that can access, use, or disclose PHI on behalf of a covered entity. You could also say that they are subcontractors or vendors of a covered entity with access to PHI data.
What Does a Business Associate Do With PHI Health Data?
Covered entities use business associates to perform a function or activity that involves using PHI health data. Let’s retake the example of PostGrid. Covered entities like hospitals do not have a specialised printing system.
However, they can use a HIPAA compliant direct mail provider like PostGrid for printing and mailing PHI documents like patient billing statements. Similarly, healthcare insurance providers can use PostGrid for sending their monthly billing statements.
But remember, PostGrid is just one example of a business associate. Healthcare organisations can use vendors for streamlining all kinds of operations like:
- Data storage or document storage services
- Data transmission services
- Communication services
- Portals/interfaces for sharing patient details via ePHI
Listed above are just some of the ways business associates deal with PHI health data. A healthcare organisation can use numerous types of vendors to streamline its business operations.
Subcontractors
Sometimes the vendor or business associate may delegate its covered function to someone else. These entities to which the vendor delegates its responsibilities are considered subcontractors.
Do HIPAA Regulations Apply To Business Associates?
Yes, every business associate that deals with PHI Patient Health Information need to comply with HIPAA regulations. It is not uncommon for HIPAA compliant service providers to still avoid the use of PHI data because they are concerned about data security.
Let’s say that a covered entity sends its PHI to a vendor, and the vendor stores the data in its servers. As soon as the vendor receives the PHI data, they automatically come under the definition of a business associate. It also means that the vendor is now subject to HIPAA security rules.
PostGrid is a perfect example of a HIPAA compliant business associate. It offers a fully automated direct mail solution that helps covered entities like hospitals and health insurance providers. PostGrid even provides specialised direct mail services for the healthcare and insurance industries.
HIPAA Privacy Rule And PHI Health Data
We can not talk about PHI Patient Health Information without discussing HIPAA because both go hand-in-hand with each other. HIPAA privacy rule clearly defines or specifies how healthcare providers access, use, and process PHI data, including hospitals and clinics.
Another way of looking at HIPAA is that it provides federal protection to PHI data. Apart from this protection to the PHI data, it also gives the patient a specific set of rights regarding their PHI data. For instance, the patient can allow some marketers to use the PHI to suggest relevant health products and services.
When Can Organisations Sell PHI Health Data?
The strict nature of the HIPAA privacy rule might give you the impression that selling PHI health data is impossible. However, that is not the case. Even though HIPAA strongly regulates the use of PHI data, it does not isolate it completely. Following are the circumstances where your organisation is allowed to sell PHI data.
- In the case of a public health emergency such as an epidemic
- For medical research purposes (but only for reimbursing the cost)
- For the treatment and payment as allowed by HIPAA
- In the case of a merger or acquisition of a HIPAA-covered entity
In addition to this, HIPAA also gives individuals the right to amend their personal PHI maintained by a covered entity. For making such a change to their PHI health data, the patient or individual must give a written request.
HIPAA Audits
Partners of healthcare providers and insurers that use, access, or process PHI data are required to sign a
HIPAA business associate agreement. Upon signing this agreement, the service provider becomes legally bound to handle PHI Patient Health Information as HIPAA rules.
You were already aware or at least guessed about the agreement part. But, what you might not know is that both covered entities and business associates are subject to HIPAA audits. The audits are conducted by the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR).
HIPAA violations are a serious matter, and they are dealt with the same seriousness. A PHI health data leak can lead to hefty fines, especially if you are a repeat offender. It can ruin your business reputation. We don’t have to tell you how crucial importance is in the healthcare industry.
HIPAA Privacy Rule And Access To Patient’s PHI
As we mentioned before, HIPAA regulations were originally for paper records. Initially, covered entities could take up to 30 days to respond to a PHI data access request from a patient. However, since the passage of the HITECH Act, the old paper records got replaced with EHRs.
Today, HIPAA deals primarily with electronically stored patient data or ePHI. However, HIPAA regulations apply to regular PHI on paper and ePHI equally. But, with healthcare organisations that use health IT technology, the patient may be able to access their PHI health data faster.
It is also worth remembering that the disposal method of electronic and paper PHI is also different. With the paper form, you can shred it or make it unreadable in any other way. Whereas ePHI needs to be purged from the system and made sure no trace of it is left.
HIPAA Compliance and Security
We know that the covered entities have to safeguard themselves against threats to the PHI data. These safeguards can protect your healthcare or insurance organisation against credible threats to the PHI health data.
As per HIPAA guidelines, three safeguards can protect the PHI data of a covered entity, and they are:
Technical Safeguards: Firewalls, encryption, etc.
Physical Safeguards: Lockers for physical records and electronic devices containing PHI.
Administrative Safeguards: People-based approaches to security, policies limiting PHI access, safety training, etc.
HIPAA vs GDPR
As we briefly mentioned before, HIPAA and GDPR are both privacy laws that protect the personal data of individuals. However, they are not the same, and it doesn’t take a close examination to see that they are different either.
Perhaps, the main difference between the two is that the GDPR applies to all personal data of individuals within its scope. The scope is much more narrow when it comes to HIPAA, and it only applies to PHI Patient Health Information. Below we discuss the significant differences between HIPAA and GDPR.
Protected data
The protected data under HIPAA is the PHI. Or in other words, any healthcare data such as their health status, care, or payment collected by a covered entity. At the same time, GDPR applies to any data that can reveal an individual’s identity.
Scope
HIPAA compliance only applies to covered entities and their business associates. In contrast, the compliance standards of GDPR apply to all entities within its scope.
Consent
HIPAA allows the use and disclosure of some PHI health data for treatment purposes without the individual’s consent. When it comes to GDPR, you need the individual’s explicit consent for processing personal health data. However, there are certain exceptions in GDPR where you can process the data without permission.
Right To Delete Data
HIPAA does not allow individuals to delete their PHI Patient Health Information. However, individuals can amend PHI data with a written request. In GDPR, individuals have the right to delete their data upon request.
Why Is It Important To Use HIPAA And GDPR Compliant Tools For Your Business?
As you can see, HIPAA and GDPR are two significant privacy laws every healthcare and insurance provider must follow. Healthcare is already a global industry. It is high time to set up your healthcare business for a worldwide audience.
To ensure streamlined communication with your patients inside and outside the UK, you need advanced solutions like PostGrid. Solutions like PostGrid come equipped with HIPAA and GDPR compliances. It enables you to communicate with your national and international audience seamlessly.
PostGrid fully automated direct mail system ensures the security of your PHI Protected Health Information at all times. It is compliant with HIPAA and GDPR, and you need not waste money on two different solutions. And as a result, your direct mail communication becomes a whole lot easier.
Conclusion
Healthcare organisations and insurance providers deal with a significant amount of PHI health data. Yet many of them are not fully aware of how crucial these data are or the stringent regulations surrounding them. Misusing PHI data could have serious consequences, including hefty fines.
Hence, healthcare organisations and insurance providers must use HIPAA and GDPR compliant solutions like PostGrid. Using tools like PostGrid enables you to ensure that your patient’s sensitive information remains secure at all times.
By doing so, you are also able to ensure that your business remains compliant with the complex rules and regulations. More importantly, it protects your organisation’s reputation, which is the crux of everything in the healthcare industry.
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