How Does the HIPAA Law Define Protected Health Information?

The HIPAA law defines protected health information as any individually identifiable health information held or transmitted by a covered entity or business associate, including demographic data, medical history, test results, insurance information, and any other data that relates to an individual’s past, present, or future physical or mental health or condition, the provision of health care to the individual, or the payment for the provision of health care, with limited exceptions and subject to specific privacy and security regulations.

What is PHI?

PHI refers to any individually identifiable health-related data that is collected, transmitted, or maintained by a covered entity or its business associate. This information involves a broad range of data points, ranging from basic demographic details, such as a patient’s name, address, and contact information, to medical records, such as diagnoses, treatment plans, laboratory results, and imaging studies. PHI also includes data elements such as social security numbers, insurance identifiers, and any other information that could potentially link an individual to their health data. PHI extends beyond the traditional paper-based records and covers data in electronic formats as well, including emails, digital images, electronic health records (EHRs), and even spoken or recorded conversations about a patient’s health condition. HIPAA emphasizes the importance of protecting PHI regardless of its medium, heightening the necessity for strong security measures across all channels of data storage and transmission.

Entities Covered by HIPAA

The primary entities subject to HIPAA regulations are known as covered entities, which include healthcare providers, health plans, and healthcare clearinghouses. Business associates of covered entities, who have access to PHI as part of their services, are also held accountable under HIPAA. Business associates could include third-party billing companies, IT service providers, and consultants, amongst others. A covered entity must enter into a business associate agreement with these entities to ensure PHI is handled securely and in compliance with HIPAA.

To preserve the confidentiality and integrity of PHI, HIPAA imposes a set of HIPAA Privacy Rule and Security Rule requirements on covered entities and their business associates. The HIPAA Privacy Rule sets regulations governing the use, disclosure, and patient rights related to PHI, while the HIPAA Security Rule outlines the standards for safeguarding electronic PHI (ePHI). These rules establish a framework that obligates healthcare entities to implement administrative, physical, and technical safeguards, involving procedures, policies, and technologies to protect PHI from unauthorized access, use, or disclosure.

Uses and Disclosure of PHI

When considering permissible uses and disclosures of PHI, HIPAA allows for specific exceptions. Covered entities can disclose PHI for treatment, payment, and healthcare operations without obtaining explicit patient authorization. Treatment includes sharing patient information among healthcare providers to facilitate coordinated care, while payment involves transmitting PHI to billing and insurance entities for reimbursement purposes. Healthcare operations include activities like quality assessments, research, and legal compliance. In most other circumstances, HIPAA mandates that PHI may only be shared with patient authorization. This requirement emphasizes the importance of obtaining written consent from patients before disclosing their health information for purposes such as marketing, fundraising, or sharing with third parties not involved in treatment, payment, or healthcare operations. HIPAA grants patients certain rights concerning their PHI, allowing them to access, amend, and obtain an accounting of disclosures of their health information. Covered entities must give individuals a Notice of Privacy Practices (NPP), outlining their rights and how their PHI will be used, shared, and protected.

Understanding PHI under HIPAA is necessary for healthcare professionals. PHI involves individually identifiable health information held or transmitted by covered entities and their business associates. This information ranges from basic demographics to medical records and includes electronic data as well. HIPAA enforces strict rules and safeguards to protect PHI, obligating covered entities and business associates to implement measures to secure sensitive patient information. Permissible uses and disclosures of PHI are limited, with patient authorization typically required for non-treatment, non-payment, and non-healthcare operation purposes. By adhering to HIPAA regulations, healthcare professionals can maintain patient privacy and uphold high standards of confidentiality in the healthcare industry.

About Christine Garcia 1299 Articles
Christine Garcia is the staff writer on Calculated HIPAA. Christine has several years experience in writing about healthcare sector issues with a focus on the compliance and cybersecurity issues. Christine has developed in-depth knowledge of HIPAA regulations. You can contact Christine at [email protected]. You can follow Christine on Twitter at