What is PHI and What Does it Stand For?

If you’re in the healthcare field, you know that some patient information is protected under HIPAA, but do you know exactly what?

In this blog, we will help you gain a better understanding of PHI, including the best practices for protecting PHI in healthcare organizations and what happens if PHI is not handled properly. 

What Is PHI?

PHI stands for protected health information. It’s a term defined by the Health Information Portability and Accountability Act (HIPAA) to distinguish what kind of information needs to be handled according to its Privacy and Security Rules.

So, what is considered PHI? It’s important to understand what counts if you work in healthcare because you need to know which pieces of information can only be disclosed under certain circumstances and what records need to be accessed, stored, and transmitted according to strict HIPAA guidelines.

Below, we’ll break down a few categories of PHI examples, but the general rule of thumb is that any information that can be used to link a specific individual with their confidential health information (including health history, genetic information, diagnoses, treatments, medications, test results, and similar details) can be considered PHI.

Personal Information

Personal information, as the name suggests, pertains to data that identifies an individual patient. Examples of personal information that fall under the umbrella of patient PHI: 

• Names
• Phone numbers
• Email addresses
• Fax numbers
• Date information (except year) related to birth, death, admission, or discharge
• Geographic subdivisions smaller than a state
• Social Security numbers
• Vehicle identifiers like license plates
• Full-face photos and comparable images

Ensuring the confidentiality of personal information is essential for upholding patient privacy, but this is not your only concern. Personal information also plays a vital role in distinguishing between similar cases, enabling appropriate care. When interacting with patients or reviewing files, ensuring accurate personal information is just as important as securing it. By doing so, you can prevent confusion between different files and cases, facilitating efficient and effective healthcare delivery. 

Medical Records

HIPAA’s protected health information also includes medical records. Medical records contain crucial information about a patient's previous healthcare, which healthcare providers can leverage to make informed decisions about future care.

Here are a few PHI examples related to medical records: 

• Medical record numbers
• Account numbers
• Health plan beneficiary numbers
• Certificate or license numbers
• Biometric identifiers

Digital Records

In the era of digitalization, HIPAA recognizes that some pieces of digital data can be used to link health information to an individual.

Not only are electronic copies of personal information or medical records considered PHI, but there are a few more types of digital information that must be protected, including:

• Internet protocol (IP) addresses
• Web URLs and social media handles
• Device identifiers and serial numbers

Other Information

HIPAA doesn’t try to conceptualize every possible type of identifying information that must be protected. In addition to the examples above, they add the catchall category of “any other unique identifying number, characteristic, or code.” This can include everything from driver’s license information to unique birthmarks.

Additionally, HIPAA forbids any anonymizing codes used to protect individuals from re-identification to be derived from PHI. For example, the subject’s initials are derived from their name and therefore off-limits.

PHI vs. ePHI

In your search to understand the meaning of PHI, you may encounter the term ePHI, which stands for electronic protected health information. This term refers to any information that is electronically stored or transmitted by HIPAA-covered entities. It encompasses various records, such as electronic patient records or digital invoices for care. 

HIPAA makes a distinction because safeguarding ePHI necessitates distinct methods from regular PHI. All ePHI must be protected by adhering to the HIPAA Security Rule. A security breach involving ePHI can result in significant penalties.

It is essential to employ a combination of physical and technical safeguards to protect both ePHI and PHI.

What Is Not PHI?

It’s important to note that not all records within a healthcare facility are inherently confidential. Healthcare organizations are responsible for maintaining records that may not necessarily qualify as PHI.

A few non-PHI examples include:

• Education records
• Employee information
• Pay stubs
• Accounting records

In cases of uncertainty, it is best to treat any information with caution and assume it falls under PHI. If you are unsure about the classification of certain information, consult with your colleagues to avoid inadvertently disclosing confidential data and to better understand what falls outside the scope of HIPAA. 

Are There Other PHI Meanings in Healthcare?

Although "protected health information" is the most common usage of “PHI,” the acronym can have other meanings within the healthcare field.

Here are a few other healthcare terms that can be shorthanded to PHI: 

• Private health insurance
• Permanent health insurance
• Public health institute
• Public health information
• Patient health information
• Personal health information

It’s important to avoid any potential confusion or ambiguity when discussing PHI, so you should be clear when using an alternate meaning. 

Who Uses Protected Health Information?

Who is allowed to use and have access to PHI? Who is required to protect it?

While healthcare professionals are the primary users of protected health information, there are several categories of related entities who need access to PHI as part of our healthcare system.

Healthcare Providers

Healthcare providers encompass a wide range of professionals, including: 

• Doctors 
• Nurses 
• Nurse practitioners 
• Physician assistants 
• Nursing aides 
• Administrative staff

As part of their daily work, these people frequently interact with PHI. They must know how to safeguard protected health information as they go about their responsibilities. That’s why it’s important that all healthcare provider employees have the necessary level of understanding in regard to PHI and HIPAA.

Health Insurance Plans

Health insurance companies are also considered HIPAA-covered entities. These companies need to handle PHI for matters such as claims approvals and healthcare costs.

Government healthcare programs such as Medicaid and Medicare are also included in this category, as are military and veterans’ health programs.

Healthcare Clearinghouses

Healthcare clearinghouses collaborate with healthcare providers and insurance payers to ensure the accuracy and proper processing of medical claims. Their role involves verifying the accuracy of claims and converting non-standard data into a standard format that can be seamlessly integrated into the payers' system.

How Common Are PHI Breaches?

At the end of 2024, the HIPAA Journal reported a 15.3% month-over-moth increase in healthcare data breaches. Between December 2023 and November 2024, there were 745 healthcare data breaches that included 500 or more patient records.

Most data breaches were reported by healthcare providers or business associates rather than health plans or clearinghouses. Large breaches often involve a ransomware attack, hacking of a network server, or compromised email account(s).

How to Protect PHI and ePHI

When handling PHI, there are several measures you must take to ensure information security, with specific considerations for both PHI and ePHI. 

Use Locks

To enhance the security of physical patient records, using locks on records rooms and individual filing cabinets can be effective. This maintains privacy and restricts access to specific staff members. 

Additionally, you should avoid removing PHI and computers with access to ePHI from a locked or access-restricted environment. Bringing computers or paper files home or to a public place represents a PHI security risk.

Implement Encryption 

Just as locks and other physical barriers should be used to protect PHI, encryption should be used to protect ePHI.

HIPAA requires electronic files to be encrypted during their creation, storage, and transfer. Before sending files to other HIPAA-covered entities, verify that they also have encryption in place to avoid potential breaches. Ensure that your office maintains a secure Wi-Fi network to prevent unauthorized access by hackers or visitors.

Implement passwords and other electronic safeguards on the devices that store these files. Passwords allowing access should be complex, unique, and kept secure to minimize the likelihood of unauthorized access.

Enforce Policies for Patient Privacy

Aside from safeguarding data where it’s stored, it’s essential to prioritize patient privacy during the course of patient interactions. This includes:

• Ensuring that doors are fully closed before discussing patient information
• Obtaining patient consent before sharing their case details with others in the room
• Verifying someone’s identity when contacting patients by phone
• Restricting PHI access to only the individuals who genuinely require it for their responsibilities

Other best practices for protecting PHI in healthcare organizations include: 

• Regularly scanning for viruses 
• Addressing security issues promptly 
• Being vigilant in preventing fraudulent activities 

Educate Staff

Employees can only protect PHI to the extent of what they understand. That’s why it’s crucial to provide quality HIPAA compliance training as well as cybersecurity training to arm them with the knowledge they need.

HIPAA compliance training is mandatory, as are annual refreshers.

What Happens If PHI Is Not Handled Properly?

The penalties for a HIPAA violation will depend on the extent of the breach and the intent behind it. The penalties for violations committed for personal gain are much harsher than those for accidental violations, for example.

The potential consequences for improperly handling PHI include:

• Civil penalties of $100 to $50,000
• Criminal penalties of up to $250,000 or ten years in jail
• Termination of employment
• Medical license suspension or revocation
• Personal lawsuits
• Damage to your reputation

Learn More About PHI Protection

By being knowledgeable about PHI enables you to avoid unintentionally disclosing sensitive healthcare information and allows you to protect yourself from HIPAA violations.

Online HIPAA training is a great way to get an in-depth introduction to PHI and HIPAA. We offer role-specific courses that outline the best practices for your job, including HIPAA for Healthcare Workers, HIPAA for Medical Office Staff, HIPAA for Dental Offices, and HIPAA for Business Associates.

Enroll today to get started!