PHI - What does it mean?

PHI stands for Protected Health Information. It can be formally defined as:

"Any information about health status, provision of healthcare, or payment for healthcare that can be linked to a specific individual."

Informally, it includes any part of a patient's medical record or payment history.

Under the US Health Insurance Portability and Accountability Act (HIPAA), PHI that is linked based on the following list of 18 identifiers, must be treated with special care:

1.Names

2.All geographical identifiers smaller than a state, except for the initial three digits of a zip code if, according to the current publicly available data from the Bureau of the Census: the geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and [t]he initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000

3.Dates (other than year) directly related to an individual

4.Phone numbers

5.Fax numbers

6.Email addresses

7.Social Security numbers

8.Medical record numbers

9.Health insurance beneficiary numbers

10.Account numbers

11.Certificate/license numbers

12.Vehicle identifiers and serial numbers, including license plate numbers;

13.Device identifiers and serial numbers;

14.Web Uniform Resource Locators (URLs)

15.Internet Protocol (IP) address numbers

16.Biometric identifiers, including finger, retinal and voice prints

17.Full face photographic images and any comparable images

18.Any other unique identifying number, characteristic, or code except the unique code assigned by the investigator to code the data

By removing certain pieces of information *based on the above listed 18 items), health information can be de-identified and, hence, can be used and shared publically , but still governed by the Common Rule, which is specifically applicable to biomedical and behavioral research involving human subjects in SUA. Removing these 18 elements is also known as the "Safe Harbor Method".

HIPAA Privacy Rule covers PHI in any medium, while HIPAA Security rule covers Electronic PHI or ePHI.

De-Identifying PHI:

The de-identification standard is covered under HIPAA Privacy Rule [45 CFR 164.514]. Some basic information regarding this rule is stated below:

(a) Standard:  de-identification of protected health information.  Health information [defined above] that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual is not individually identifiable health information.

(b) Implementation specifications:  requirements for de-identification of protected health information.  A covered entity may determine that health information is not individually identifiable health information only if:

(1) A person with appropriate knowledge of and experience with generally accepted statistical and scientific principles and methods for rendering information not individually identifiable:

(i)   Applying such principles and methods, determines that the risk is very small that the information could be used, alone or in combination with other reasonably available information, by an anticipated recipient to identify an individual who is subject of the information; and

(ii) Documents the methods and results of the analysis that justify such determination; or

(2)

(i) The following identifiers of the individual or of relatives, employers, or household members of the individual, are removed:

(A) Names;

(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 a zip code if, according to the current publicly available data from the Bureau of the Censue:

(1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and

(2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.

(C) All elements of dates (except year) for dates directly related to an individual, including birth date, admission date,, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;

(D) Telephone numbers;

(E) Fax numbers;

(F) Electronic mail addresses;

(G) Social security numbers;

(H) Medical record numbers;

(I) Health plan beneficiary numbers;

(J) Account numbers;

(K) Certificate/license numbers;

(L) Vehicle identifiers and serial numbers, including license plate numbers;

(M) Device identifiers and serial numbers;

(N) Web Universal Resource Locators (URLs);

(O) Internet Protocol (IP) address numbers;

(P) Biometric identifiers, including finger and voice prints;

(Q) Full face photographic images and any comparable images; and

(R) Any other unique identifying number, characteristic, or code, except as permitted by paragraph (c) of this section; and

(ii) The covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information.

(c) Implementation specifications:  re-identification.  A covered entity may assign a code or other means of record identification to allow information de-identified under this section to be re-identified by the covered entity, provided that:

(1) Derivation.  The code or other means of record identification is not derived from or related to information about the individual and is not otherwise capable of being translated so as to identify the individual; and

(2) Security.  The covered entity does not use or disclose the code or other means of record identification for any other purpose, and does not disclose the mechanism for re-identification.”

© 2012 Health Compliance Consultants

HIPAA /HITECH Acts - New Final Rule 2013 - What changed?

DISCLAIMER: This article should not be taken as legal advice, instead it is a basic introduction to some changes that have been promulgated to the HIPAA/HITECH Acts final rules.

A Significant modification to the existing HIPAA/HITECH Rules was made which came into effect on March 26, 2013. The Covered Entities have until September 23, 2013 to become compliant with the revised rules. Let's start with some changes that are going to make the heaviest impact:

Business Associates are now considered Covered Entities and full force of HIPAA/HITECH Act have been enforced on them as well. This requires the Business Associates Agreements to be updated to reflect this change. The BAA's that had been implemented prior to this final rule became effective can be revised within the next 18 months as opposed to all new BAAs have to be in place for new Business Associates after the effective date to be updated within 6 months (the Sept. 23, 2013 cut off date).

Breach Notification standards have been revised. The Harm Standard, as it was commonly known, has been redefined with a new name or title "adverse to the individual". Each potential breach needs to be evaluated or assessed based on four factors: 1. what information was breached? 2.to whom the information was released? 3. was it actually accessed, used, or disclosed, and 4. what mitigating steps were taken on the incidence. This standard does not only provide some guidance regarding if a breach is reportable, but also enforces CEs to establish a process to establish a risk for every potential breach. The law does require proper assessment for each breach incident and does not allow the process to be automatic.

Patients Right to Access Their PHI has been modified as well. The patients have the same rights as before but they can ask their PHI (Protected Health Information) to be transmitted to them in an unsecured way, and the CE after informing the individual of the risk of privacy breach can transmit it based on the individuals demand. CE's do need to document this discussion for future reference and for their defense in case of an audit or litigation. The important point to note here is that this applies to individual whose PHI is being transmitted and not to professional exchange of PHI, in which case it should be properly encrypted.

We will continue posting further updates to this article to highlight more significant and not so significant modifications to the HIPAA/HITECH laws.

© 2012 Health Compliance Consultants

Whats Wrong With America's Healthcare System?

The US Healthcare industry sits at number 2 just below the Defense in the worldwide industry rankings. It also belongs to a select group of three or four industries that are considered recession proof, again defense being one of them. The cost of healthcare for a common person has escalated exponentially over the last decade and any number of reasons may be quoted for this increase, and primarily depends on who is asked the question. The provider will almost always point to the liability factor, which results in not only them ask for higher reimbursements, but also them practicing what may be termed as defensive treatments. If insurance companies are asked the same question, they would blame it on the providers who charge too much and who also do not manage  their patients properly thereby incurring extra costs in the long run. Patients simply make it look like the physicians bilking them out of their skins to maintain their luxurious lifestyles. Outsiders would blame lobbyists and pharmaceutical companies. Hence, there is no clear cut explanation and as a result no definite solution can be generated. Lets try and gather as many views fro as many diverse audience as possible and try to narrow down the issue at hand. Having spent almost a decade in this field and with significant experience on all fronts, i.e. provider, health plan, and patient, I have my own unique perspective, but will hold back for a while so as not to start a debate in support or against what I perceive as the problems in this industry. Lets try to be very objective in our analysis, and avoid negating or supporting views of others and instead present our own independent views.