June 15, 2024
PPT HIPAA Training for Pharmaceutical Industry Representatives

Protected Health Information (PHI) Explained

What is Protected Health Information (PHI)?

Protected Health Information (PHI) refers to any individually identifiable health information that is collected, stored, transmitted, or maintained by healthcare providers, health plans, or healthcare clearinghouses. This includes information about a person’s past, present, or future physical or mental health condition, as well as any related healthcare services.

Examples of PHI

Examples of PHI include medical records, lab results, health insurance claims, billing information, prescription history, and any other information that can be used to identify an individual in relation to their health.

Why is PHI Protected?

PHI is protected to ensure the privacy and security of individuals’ health information. The Health Insurance Portability and Accountability Act (HIPAA) sets standards for the protection of PHI and imposes penalties for non-compliance. The main goal is to prevent unauthorized access, use, or disclosure of PHI, while allowing appropriate access for healthcare providers to provide quality care.

Who Has Access to PHI?

Access to PHI is strictly limited to individuals who have a legitimate need for it to perform their job duties. This includes healthcare professionals involved in a patient’s care, health plan employees, and business associates who provide services on behalf of covered entities. Each person with access must abide by HIPAA regulations and follow the principle of “minimum necessary” – accessing only the minimum amount of PHI required to perform their tasks.

HIPAA Rules and Compliance

HIPAA requires covered entities to establish policies and procedures to protect PHI and to train their workforce on privacy and security practices. This includes implementing physical, technical, and administrative safeguards to prevent unauthorized access or disclosure of PHI. Non-compliance with HIPAA regulations can result in severe penalties and reputational damage.

How Is PHI Used and Disclosed?

PHI can be used and disclosed for treatment, payment, and healthcare operations without explicit patient authorization. Treatment refers to the provision, coordination, or management of healthcare and related services. Payment involves activities such as billing, claims processing, and collection. Healthcare operations include activities to ensure quality care, such as conducting audits, improving healthcare services, and training staff.

Authorization for Other Uses and Disclosures

For uses and disclosures outside of treatment, payment, and healthcare operations, patient authorization is required. This includes situations such as research, marketing, or sharing PHI with family members or friends. Patients have the right to request restrictions on the use and disclosure of their PHI, and covered entities must comply with these requests, unless required by law.

Securing PHI

Protecting PHI requires a multi-faceted approach. Covered entities must implement administrative safeguards (such as workforce training), physical safeguards (such as access controls), and technical safeguards (such as encryption and secure transmission). Regular risk assessments and audits are necessary to identify and address any vulnerabilities in the protection of PHI.

Breach Notification

If there is a breach of unsecured PHI, covered entities are required to notify affected individuals, the Secretary of Health and Human Services, and, in some cases, the media. Breach notification must be provided without unreasonable delay, typically within 60 days of discovering the breach.


Protected Health Information (PHI) is vital to providing quality healthcare while ensuring the privacy and security of individuals’ health information. Understanding the rules and regulations surrounding PHI is crucial for healthcare providers, health plans, and their business associates to comply with HIPAA and protect sensitive information.