For instance, the details of a complicated series of procedures, such as a primary surgery followed by a set of follow-up surgeries and examinations, for a person of a certain age and gender, might permit the recipient to comprehend that the data pertains to his or her relatives case. For instance, many practices include a page for submitting questions to the office via email. A code corresponds to a value that is derived from a non-secure encoding mechanism. HIPAA Advice, Email Never Shared The Privacy Rule calls this information protected health information (PHI).. HIPAA Journal is the leading provider of news, updates, and independent advice for HIPAA compliance. Avail of a complimentary session with a HIPAA compliance risk assessment expert. HIPAA Advice, Email Never Shared Read more on the Workshop on the HIPAA Privacy Rule's De-Identification Standard. 3 Answers. Beyond this data, there exists a voter registration data source, which contains personal names, as well as demographics (i.e., Birthdate, ZIP Code, and Gender), which are also distinguishing. The expert will then execute such methods as deemed acceptable by the covered entity or business associate data managers, i.e., the officials responsible for the design and operations of the covered entitys information systems. Although PHI can be shared without authorization for the provision of treatment, when medical professionals discuss a patients healthcare, it must be done in private (i.e. Table 3 illustrates this last type of suppression by showing how specific values of features in Table 2 might be suppressed (i.e., black shaded cells). To best explain what is considered PHI under HIPAA Rules, it is necessary to review the definitions section of the Administrative Simplification Regulations (160.103) starting with health information. HITECH News In this case, the risk of identification is of a nature and degree that the covered entity must have concluded that the individual subject of the information could be identified by a recipient of the data. HIPAA does not prohibit the electronic transmission of PHI. Your Privacy Respected Please see HIPAA Journal privacy policy. SMS texting is a violation of HIPAA Rules and many healthcare organizations are allowing HIPAA Rules to be violated. They freak out about the possibility of a HIPAA violation. Figure 3. No, she cannot be prosecuted for it. The expert may consider different measures of risk, depending on the concern of the organization looking to disclose information. An incidental disclosure is a secondary, accidental disclosure that cannot reasonably be prevented, is limited in nature, and that occurs as a result of another disclosure permitted by the Privacy Rule for example, if a physician invites a health plan employee to his office to discuss payments, and the health plan employee passes a patient he or she recognizes in the waiting room. > Special Topics Any information that can be used to establish the identity of an individual either individually or together with other information is a PHI identifier; and it is important to be aware that there are more PHI identifiers than those listed under 164.514 relating to the deidentification of PHI. (ii) With respect to which there is a reasonable basis to believe the information can be used to identify the individual. Of course, de-identification leads to information loss which may limit the usefulness of the resulting health information in certain circumstances. Yet, it may also be stored in a wide range of documents with less structure and written in natural language, such as discharge summaries, progress notes, and laboratory test interpretations. Here are some recommendations to consider when implementing HIPAA regulations and requirements in your office and establishing your patient electronic communication protocol: Patient identifiers to avoid when communicating with patients via email and SMS. > Methods for De-identification of PHI. To sign up for updates or to access your subscriber preferences, please enter your contact information below. KSAT 12 6 O'Clock News : Dec 06, 2021 Watch on How do experts assess the risk of identification of information? There are many potential identifying numbers. Stakeholder input suggests that a process may require several iterations until the expert and data managers agree upon an acceptable solution. Learn the rules and HIPAA exceptions now. However, employers that administer a self-funded health plan do have to meet certain requirements with regards to keeping employment records separate from health plan records in order to avoid impermissible disclosures of PHI. The field of statistical disclosure limitation, for instance, has been developed within government statistical agencies, such as the Bureau of the Census, and applied to protect numerous types of data.5. As described in the forthcoming sections, covered entities may wish to select de-identification strategies that minimize such loss. HIPAA Journal is the leading provider of news, updates, and independent advice for HIPAA compliance. To safeguard against this, any device containing PHI should be password protected. HIPAA Journal provides the most comprehensive coverage of HIPAA news anywhere online, in addition to independent advice about HIPAA compliance and the best practices to adopt to avoid data breaches, HIPAA violations and regulatory fines. What Is Markov Chain Monte Carlo And Why It Matters? (1) The geographic unit formed by combining all ZIP codes with the same three initial digits contains more than 20,000 people; and Therefore, PHI includes health records, health histories, lab test results, and medical bills. Although the risk is very small, it is not zero, and there is a possibility that de-identified data could be linked back to the identity of the patient to which it corresponds. This information can be used to identify, contact, or locate a single person or can be used with other sources to identify a single individual. 3.6 What is actual knowledge that the remaining information could be used either alone or in combination with other information to identify an individual who is a subject of the information? A hash function that is designed to achieve certain security properties. Get our HIPAA Compliance Checklist to see everything you need to be compliant. FACT: HIPAA applies to any and all healthcare providers who transmit, store or handle protected health information. The geographic designations the Census Bureau uses to tabulate data are relatively stable over time. But the fear that is struck in many of their hearts is really unneeded. It notes that derivations of one of the 18 data elements, such as a patient's initials or last four digits of a Social Security number, are considered PHI. However, a covered entitys mere knowledge of these studies and methods, by itself, does not mean it has actual knowledge that these methods would be used with the data it is disclosing. : Madhu Gupta should be written as MG. PHI is health information in any form, including physical records, electronic records, or spoken information. HIPAA Journal's goal is to assist HIPAA-covered entities achieve and maintain compliance with state and federal regulations governing the use, storage and disclosure of PHI and PII. > Privacy For example, any HIPAA form a patient signs needs to have a Right to Revoke clause. 2.10 Must a covered entity use a data use agreement when sharing de-identified data to satisfy the Expert Determination Method? In a small town, where most everyone knows each other, calling patient names in a waiting room is not releasing PHI and is not a violation of HIPAA. Therefore, the data would not have satisfied the de-identification standards Safe Harbor method unless the covered entity made a sufficient good faith effort to remove the occupation field from the patient record. In this situation, the covered entity has actual knowledge because it was informed outright that the recipient can identify a patient, unless it subsequently received information confirming that the recipient does not in fact have a means to identify a patient. 3.9 Must a covered entity use a data use agreement when sharing de-identified data to satisfy the Safe Harbor Method? For instance, imagine the information in a patient record revealed that a patient gave birth to an unusually large number of children at the same time. Must a covered entity use a data use agreement when sharing de-identified data to satisfy the Safe Harbor Method? not within earshot of the general public) and the Minimum Necessary Standard applies the rule that limits the sharing of PHI to the minimum necessary to accomplish the intended purpose. All elements of dates (except year) for dates directly related to an individual. However, it should be noted that there is no particular method that is universally the best option for every covered entity and health information set. Data managers and administrators working with an expert to consider the risk of identification of a particular set of health information can look to the principles summarized in Table 1 for assistance.6 These principles build on those defined by the Federal Committee on Statistical Methodology (which was referenced in the original publication of the Privacy Rule).7 The table describes principles for considering the identification risk of health information. It can also consist of a single item under the definition of a designated record set in 164.501. The greater the replicability, availability, and distinguishability of the health information, the greater the risk for identification. If a covered entity knows of specific studies about methods to re-identify health information or use de-identified health information alone or in combination with other information to identify an individual, does this necessarily mean a covered entity has actual knowledge under the Safe Harbor method? No. They represent the majority USPS five-digit ZIP code found in a given area. PHI is an acronym of Protected Health Information, while PII is an acronym of Personally Identifiable Information. Thus, it could be challenging . Rare clinical events may facilitate identification in a clear and direct manner. 3.2 May parts or derivatives of any of the listed identifiers be disclosed consistent with the Safe Harbor Method? A client's initials are considered to be identifying for the purposes of determining if a given piece of information is PHI under HIPAA, because they are derived from names. A mathematical function which takes binary data, called the message, and produces a condensed representation, called the message digest. U.S. Department of Health & Human Services Get our HIPAA Compliance Checklist to see everything you need to be compliant. Googles G Suite includes email and is covered by its business associate agreement. A disclosure of Protected Health Information (PHI) is the sharing of that PHI outside of a covered entity. The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. Figure 4. In this situation, the risk of identification is of a nature and degree that the covered entity must have concluded that the recipient could clearly and directly identify the individual in the data. The following are examples of such features: Identifying Number The re-identification provision in 164.514(c) does not preclude the transformation of PHI into values derived by cryptographic hash functions using the expert determination method, provided the keys associated with such functions are not disclosed, including to the recipients of the de-identified information. What is not considered protected health information? A covered entity may determine that health information is not individually identifiable health information only if: Impermissible disclosure of patient health information. Personally identifiable information (PII) or individually identifiable health information (IIHI) is any health information that allows the patient to be identified. the past, present, or future payment for the provision of health care to the individual, and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual. What Is Considered Protected Health Information Under HIPAA? I have heard from some folks that if you send client communications referencing them in email as their first two and last two initials that it is permissible. So, yes, the MRN is PHI, but sharing it in this context is not a violation. Therefore: As well as covered entities having to understand what is considered PHI under HIPAA, it is also important that business associates are aware of how PHI is defined. Are initials considered PHI? HIPAA-covered entities must disclose PHI on demand to an individual who is the subject of the PHI and to inspectors from HHS Office for Civil Rights when they are conducting an audit or other compliance activity. The other woman training me says never use their last name in public, use their first name (ie: calling out for Jill or Jim). In this example, we refer to columns as features about patients (e.g., Age and Gender) and rows as records of patients (e.g., the first and second rows correspond to records on two different patients). In an effort to make this guidance a useful tool for HIPAA covered entities and business associates, we welcome and appreciate your sending us any feedback or suggestions to improve this guidance. A: Yes, because an individuals name is an identifier and initials are derived from the individuals name, initials are considered identifiers under the Privacy Rule. Author: Steve Alder is the editor-in-chief of HIPAA Journal. Finally, as noted in the preamble to the Privacy Rule, the expert may also consider the technique of limiting distribution of records through a data use agreement or restricted access agreement in which the recipient agrees to limits on who can use or receive the data, or agrees not to attempt identification of the subjects. However, it could be reported in a de-identified data set as 2009. For example, the preamble to the Privacy Rule at 65 FR 82462, 82712 (Dec. 28, 2000) noted that Clinical trial record numbers are included in the general category of any other unique identifying number, characteristic, or code.. First, are you covered by HIPAA in some way to protect patient information? When the certification timeframe reaches its conclusion, it does not imply that the data which has already been disseminated is no longer sufficiently protected in accordance with the de-identification standard. As it would be impractical for HIPAA to stipulate there has to be fewer than so many Mr. Xs in a population of Y before the two identifiers are considered to be PHI, all combinations of identifiers are consider PHI under HIPAA even Mr. No single universal solution addresses all privacy and identifiability issues. In the past, there has been no correlation between ZIP codes and Census Bureau geography. When can ZIP codes be included in de-identified information? these provisions allow the entity to use and disclose information that neither identifies nor provides a reasonable basis to identify an individual. HITECH News In practice, an expert may provide the covered entity with multiple alternative strategies, based on scientific or statistical principles, to mitigate risk. The first two rows (i.e., shaded light gray) and last two rows (i.e., shaded dark gray) correspond to patient records with the same combination of generalized and suppressed values for Age, Gender, and ZIP Code. Any data that is created, collected or disclosed during interaction with healthcare services and that can be used to uniquely identify an individual is defined as Protected Health Information (PHI) under HIPAA. Sending an email containing PHI to an incorrect recipient would be an unauthorized disclosure and a violation of HIPAA. . Names; 2. The different between PHI and ePHI is that ePHI refers to Protected Health Information that is created, used, shared, or stored electronically for example on an Electronic Health Record, in the content of an email, or in a cloud database. A verbal conversation that includes any identifying information is also considered PHI. Finally, for the third condition, we need a mechanism to relate the de-identified and identified data sources. 3.5 What constitutes any other unique identifying number, characteristic, or code with respect to the Safe Harbor method of the Privacy Rule? PII is Personally Identifiable Information that is used outside a healthcare context, while PHI (Protected Health Information) and IIHA (Individually Identifiable Health Information) is the same information used within a healthcare context. TTD Number: 1-800-537-7697, Guidance Regarding Methods for De-identification of Protected Health Information in Accordance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, Content created by Office for Civil Rights (OCR), U.S. Department of Health & Human Services, has sub items, about Compliance & Enforcement, has sub items, about Covered Entities & Business Associates, Other Administrative Simplification Rules, Covered Entities, Business Associates, and PHI. Can an expert derive multiple solutions from the same data set for a recipient? names (this includes parts of names, such as initials) geographic subdivisions smaller than a state For instance, clinical features, such as blood pressure, or temporal dependencies between events within a hospital (e.g., minutes between dispensation of pharmaceuticals) may uniquely characterize a patient in a hospital population, but the data sources to which such information could be linked to identify a patient are accessible to a much smaller set of people. You can see patients' lab test results with their names and dates of birth. This means that electronic records, written records, lab results, x-rays, and bills make up PHI. Suppression of an entire feature may be performed if a substantial quantity of records is considered as too risky (e.g., removal of the ZIP Code feature). It notes that derivations of one of the 18 data elements, such as a patients initials or last four digits of a Social Security number, are considered PHI. Though G Suite, email can be made HIPAA compliant provided the service is used alongside a business domain. The information must be individually-identifiable (i.e. This guidance will be updated when the Census makes new information available. Stakeholder input suggests that the determination of identification risk can be a process that consists of a series of steps. Additionally, other laws or confidentiality concerns may support the suppression of this information. Have expert determinations been applied outside of the health field? Delivered via email so please ensure you enter your email address correctly. Cancel Any Time. PHI exists in the context of HIPAA, whereas PII is not necessarily . Based on this observation, the expert recommends removing this record from the data set. All rights reserved. However, many researchers have observed that identifiers in medical information are not always clearly labeled.37.38 As such, in some electronic health record systems it may be difficult to discern what a particular term or phrase corresponds to (e.g., is 5/97 a date or a ratio?). This guidance is intended to assist covered entities to understand what is de-identification, the general process by which de-identified information is created, and the options available for performing de-identification. (Of course, the expert must also reduce the risk that the data sets could be combined with prior versions of the de-identified dataset or with other publically available datasets to identify an individual.) The protected health information can be in any form i.e., electronic, paper, or oral and includes images, charts, and any other characteristic including characteristics of family members maintained in the same data set that could be used either individually or together identify a patient or health plan member. Consequently, compliance experts refer to the "safe harbor" standard for the de-identification of PHI ( 164.514) to determine what is consider PHI. HHS Publishes Guidance on How to De-Identify Protected Health Information. OCR also thanks the 2010 workshop panelists for generously providing their expertise and recommendations to the Department. However, even without mentioning names one must keep in mind if a patient can identify themselves in what you write about this may be a violation of HIPAA. So what is considered PHI by HIPAA? Dates associated with test measures, such as those derived from a laboratory report, are directly related to a specific individual and relate to the provision of health care. See section 3.10 for a more complete discussion. No. One of the 18 protected health information (PHI) identifiers in the HIPAA Privacy Rule is patient names (first and last name, or last name and initial). Table 5 illustrates how perturbation (i.e., gray shaded cells) might be applied to Table 2. As summarized in Figure 1, the Privacy Rule provides two methods by which health information can be designated as de-identified. Vehicle identifiers and serial numbers, including license plate numbers, Biometric identifiers, including finger and voice prints, Full face photographic images and any comparable images, Any other unique identifying number, characteristic, or code. (2)(i) The following identifiers of the individual or of relatives, employers, or household members of the individual, are removed: (B) All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP code, and their equivalent geocodes, except for the initial three digits of the ZIP code if, according to the current publicly available data from the Bureau of the Census: Some of the methods described below have been reviewed by the Federal Committee on Statistical Methodology16, which was referenced in the original preamble guidance to the Privacy Rule de-identification standard and recently revised. Further information about individuals rights under HIPAA can be found in our HIPAA Rights article. The identifiers that make health information PHI are: Patient Name (full or last name and initial) Date of birth Yes, HIPAA applies only to healthcare providers; however, fiduciaries owe a duty of confidentiality. 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