PHI vs PII
Protected Health Information, commonly known as PHI, has become a ubiquitous term in the healthcare lexicon. What PHI stands for can be traced back to the Privacy Rule, which was proposed in 1999 and came to fruition in 2002. This development occurred in the wake of the Health Insurance Portability and Accountability Act (HIPAA), enacted by Congress in 1996. HIPAA was a legislative response to a previously unsuccessful healthcare reform effort and aimed to safeguard employees with pre-existing conditions from losing their insurance coverage during job transitions. A significant aspect of HIPAA was its initiative to modernize and enhance the flow of information between healthcare providers, marking a pivotal step toward the digital transformation of health information exchange.
Title II of HIPAA, known as the Administrative Simplification Act, was instrumental in setting transaction standards to facilitate the exchange of data among healthcare entities. Moreover, it introduced privacy and security measures to safeguard these data exchanges. The Privacy Rule, finalized in 2002, outlines the framework for what constitutes PHI, underpinning the legislative efforts to protect patient privacy in an era increasingly dominated by electronic information exchange. The anticipation of Congress that the advent of electronic methods would exponentially increase the volume of patient information exchanges necessitated a robust regulatory framework.
What is PII and PHI?
The distinction between PHI and Personally Identifiable Information (PII) often leads to confusion. Both PII or PHI are critical in healthcare but serve different purposes. PHI refers to any information in a medical record or other health-related information that can be used to identify an individual and that was created, used, or disclosed in the course of providing a healthcare service, such as diagnosis or treatment. This includes a wide range of identifiers, such as name, address, birth date, and Social Security Number, when they are linked with health information.
PII, on the other hand, encompasses a broader range of information that can be used on its own or with other information to identify, contact, or locate a single person, or to identify an individual in context. While all PHI is considered PII, not all PII is PHI. The primary difference between PII and PHI lies in the latter's specific association with health information. Understanding the phi medical definition and what phi stands for is crucial in grasping the broader implications of healthcare privacy.
The enactment of HIPAA and the subsequent addition of the Privacy and Security Rules in 2002 and 2004, respectively, underscored the importance of PHI in the healthcare sector. These regulatory measures were designed to protect the privacy of individuals' health information while also facilitating the secure exchange of this information between healthcare providers, insurers, and other entities. The phi and pii meaning becomes particularly significant in this context, highlighting the necessity of distinguishing between general personal information and that which pertains to an individual's health status or treatment.
Why is PHI Important?
The importance of PHI extends beyond the realm of privacy concerns. In the healthcare setting, the secure and efficient handling of PHI is fundamental to delivering quality care. It enables healthcare providers to access a patient's medical history, make informed treatment decisions, and communicate effectively with other healthcare professionals involved in a patient's care. Additionally, the protection of PHI is not just a legal obligation but also a critical aspect of maintaining patient trust. Patients are more likely to share sensitive health information with their healthcare providers if they are confident that their data will be handled securely and with respect for their privacy.
The differences between PII and PHI, and the nuances of each, are exemplified in scenarios where healthcare data is used or shared. For instance, a hospital sharing patient health information with an insurance company for billing purposes involves PHI because it includes health information linked with identifiers. Conversely, a medical research study that uses anonymized patient data may handle PII but not PHI, as the health information cannot be linked back to specific individuals.
The concepts of PHI and PII are foundational to understanding privacy and security in the healthcare domain. The legislative framework established by HIPAA, including the Privacy and Security Rules, provides a structured approach to protecting patient information in an increasingly digital world. As healthcare continues to evolve with technological advancements, the significance of distinguishing between PHI and PII, understanding their definitions, and implementing measures to protect such information becomes ever more critical. The ongoing challenge for healthcare providers, insurers, and other stakeholders is to balance the need for information sharing with the imperative to safeguard patient privacy and trust.
PHI vs PII Examples
PHI Examples
Patient names
Geographical elements (such as a street address, city, county, or zip code)
Dates related to the health or identity of individuals (including birthdates, date of admission, date of discharge, date of death, or exact age of a patient older than 89)
Telephone numbers
Fax numbers
Email addresses
Social security numbers
Medical record numbers
Health insurance beneficiary numbers
Account numbers
Certificate/license numbers
Vehicle identifiers
Device attributes or serial numbers
Digital identifiers, such as website URLs
IP addresses
Biometric elements, including finger, retinal, and voiceprints
Full face photographic images
Other identifying numbers or codes
PHI Examples
Mother’s maiden name
Driver’s license number
Bank account information
Credit card information
Relatives’ names
Biometric information
Home or cellular telephone number
Personal characteristics
Passport information
Social Security Number (SSN)
Date or place of birth
Other information that would make the individual’s personal identity easily traceable
PHI and PII Exclusions
An individual’s name and other work related information because it is considered professional identifiable information. In 2010, NIST (an agency of the Department of Commerce) created a publication “Guide to Protecting the Confidentiality of Personally Identifiable Information. In the report NIST made the following recommendations:
Organizations should identify all PII residing in their environment
Organizations should minimize the use, collection, and retention of PII to what is strictly necessary to accomplish their business purpose
Organizations should classify their PII by their impact level
Organizations should apply the appropriate safeguards for PII based on their impact level
Most organizations have PII but PHI and occasionally PII healthcare info is limited to healthcare and healthcare related organizations. However, the best practices for protecting these high risk data sets are similar. Protecting PII and PHI include the following procedures and tactics:
Maintaining policies and procedures and training employees, contractors and vendors on these policies
De-identifying whenever possible
Implement access controls
Providing transmission safeguards like encryption and securing networks
Monitoring system activity
Breach response procedures
PHI and PII Penalties and Compliance
Another area that is important in understanding PII and PHI are the penalties for noncompliance with current federal, state and local regulations. When considering security and creating safeguards there is not much of a difference between how an organization handles its PII and its PHI. Most organizations have contractual obligations for PHI security in addition to government regulations. Business associate agreements must be in place for two parties to exchange PHI per the Privacy Rule under HIPAA.
Compliance with HIPAA is governed by the Department of Health and Human Services’ Office of Civil Rights (OCR) and state attorneys general. PII/PHI penalties are mostly financial and can be applied to healthcare providers, health plans, healthcare clearinghouses and all other covered entities, as well as business associates that have been found to have violated HIPAA rules.
The penalty is structured into tiers and is based upon the seriousness of the violation. Ignorance is never an excuse for failing to comply with the rules and PHI security. For willful violations of personal identifiable information and PHI the maximum fines will be applied.
In some cases if a healthcare professional knowingly obtains or uses PHI for reasons that are not permitted by the HIPAA Privacy Rule that person may be criminally liable for the violation. Criminal violations of HIPAA rules are prosecuted by the Department of Justice. These violations may include the sale or the theft of patient information for financial gain or wrongful disclosures with the intent to cause harm.
Similar misdemeanor criminal penalties are in place for individuals and/or companies that violate privacy laws like the Federal Privacy Act of 1974. The FTC and DOJ are becoming more aggressive about pursuing consumer and privacy protection. Facebook paid a $5 Billion penalty in 2019 for misleading users about how their private information was being shared with third party application developers. Congress is looking at additional regulatory changes to help increase consumer protection.
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