What Is Protected Health Information

Protected Health Information (PHI) is a formal and regulated term under the Health Insurance Portability and Accountability Act (HIPAA) in the United States. It encompasses any data—whether written, digital, or spoken—that relates to an individual's health status, healthcare services received, or healthcare payments, and
which can identify the individual directly or indirectly.

• “Relates to the individual's past, present or future physical or mental health, the provision of health care, or payment for health care**,
   
• Is created, received, maintained, or transmitted by a covered entity or its business associate,
   
• And identifies (or could be used to easily identify) a specific person
   

Key PHI Identifiers

HIPAA details 18 identifiers that, when paired with health data, make it PHI:

1. Name
    
2. Street address, city, county, ZIP (below state level)
    
3. All dates (except year)—birth, admission, discharge, death
    
4. Telephone & fax numbers
    
5. Email addresses
    
6. Social Security numbers
    
7. Medical record & account numbers
    
8. Health plan beneficiary numbers
    
9. Certificate/license numbers
    
10. Vehicle identifiers (serial, license plate)
     
11. Device identifiers/serials
     
12. URLs, IP addresses
     
13. Biometric IDs (fingerprints, voiceprints)
     
14. Full‑face photos and comparable
     
15. Any unique identifying code, number, or characteristic
     

Who Must Protect PHI?

PHI protection applies only to:

• Covered entities: health care providers, health plans, health care clearinghouses.
   
• Business associates: third‑party vendors working on behalf of covered entities, handling PHI
   

Entities not under HIPAA include employers, schools (unless transmitting PHI), general consumer apps, or the deceased (beyond 50 years).

Why Is PHI So Important?

1. Legal Compliance & Penalties

Violating PHI rules can result in civil fines from $100–$50,000 per violation (up to $1.5 million annually), and for willful neglect, criminal charges up to $250,000 & 10 years in prison

2. Patient Privacy & Trust

Unauthorized disclosure can lead to identity theft, discrimination, distress, and breach of trust. Patients have rights to access, amend, and control their PHI

3. Integrity of Healthcare

PHI plays a vital role in delivering accurate and secure healthcare, maintaining continuity of care, and enabling medical research and public health efforts—all while safeguarding patient privacy.

Legal Framework

HIPAA Privacy Rule (2003)

It defines when and how PHI can be used or shared—such as for treatment, billing, and healthcare operations—while enforcing the ‘minimum necessary’ standard and giving patients the right to view and amend their health records.

HIPAA Security Rule

Applies to electronic PHI (ePHI): covers administrative, physical, technical safeguards—training, access controls, encryption, audit logs, facility protections

HITECH Act (2009)

Enhanced HIPAA via breach notifications and extended rules to business associates

Identifying PHI vs. Non‑PHI

• Individually identifiable health information handled by covered entities = PHI.
   
• IIHI not transmitted/handled by covered entity (e.g., home blood pressure records) = not PHI
   

Real‑World Examples of PHI

PHI includes (but isn’t limited to):

• Clinical data: diagnoses, lab test results, treatment plans
   
• Administrative data: billing, insurance claims
   
• Contact & demographic info: names, addresses, DOBs, phone numbers, emails
   
• Identifiers: SSNs, MRNs, IP addresses, fingerprints, facial photos
   

Authorized Uses and Disclosures of PHI

Under HIPAA, the use or sharing of Protected Health Information (PHI) is permitted in the following scenarios:

• For essential healthcare functions such as diagnosis, treatment, billing, and other operational purposes
   
• With the patient’s explicit consent for specific disclosures
   
• In the public interest, including disease control reporting or law enforcement needs
   
• For medical research, provided there's Institutional Review Board (IRB) approval or the use of a limited data set
   

All such disclosures must strictly adhere to the “minimum necessary” principle, ensuring only relevant information is accessed or shared.

PHI Safeguards: Administrative, Physical, Technical

1. Administrative
    
   • Policies, training, risk assessments, access management, BAAs
      
2. Physical
    
   • Secure physical records, locked storage, ID badges, device access control
      
3. Technical
    
   • Encryption (at rest/in transit), access controls, audit logging, antivirus.
      

De‑Identification of PHI

Removing 18 identifiers via:

• Safe Harbor: remove all listed identifiers
   
• Expert Determination: statistical method confirming low re‑identification risk
   

Once de‑identified, data is no longer PHI and falls outside of HIPAA 

Breaches & Notifications

A breach = unauthorized PHI exposure. HIPAA/HITECH mandate:

• Notify affected individuals, HHS, and sometimes media
   
• Breach notification rules triggered for unsecured PHI
   

PHI in the Digital Age

Emerging challenges:

• PHI in apps, wearables, telehealth, and cloud storage
   
• Many consumer health apps fall outside HIPAA, but state laws (e.g., California, Nevada, Washington) may apply
   
• Recent US rules also protect reproductive health PHI
   

Best Practices to Secure PHI

1. Comprehensive risk assessments
    
2. Robust policies & employee training
    
3. Technical controls: encryption, firewalls, access limits
    
4. Secure physical storage
    
5. BAAs with all third-party vendors
    
6. Incident response plans for breach notification
    
7. Regular audits & updates for ongoing compliance.
    

PHI Beyond U.S.

Globally, data protection is covered under laws like GDPR (EU) and PDPA (Asia). While specifics vary, the principle of PHI and data privacy is global.

Conclusion

PHI is the cornerstone of healthcare privacy. It includes any identifiable health-related information handled by covered entities. HIPAA provides strict rules through Privacy and Security rules, with strong penalties for violations. As healthcare continues digital transformation, it’s crucial to strengthen PHI protection through policies, safeguards, and compliance.

By deeply understanding what PHI is, how it’s regulated, and how to protect it, Inspire Webapp can offer authoritative, globally-relevant guidance and establish international reputational leadership.