However, it could be reported in a de-identified data set as 2009. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics. Consequently, compliance experts refer to the safe harbor standard for the de-identification of PHI (164.514) to determine what is consider PHI. Author: Steve Alder is the editor-in-chief of HIPAA Journal. Further information about data use agreements can be found on the OCR website.36 Covered entities may make their own assessments whether such additional oversight is appropriate. By contrast, a health plan report that only noted the average age of health plan members was 45 years would not be PHI because that information, although developed by aggregating information from individual plan member records, does not identify any individual plan members and there is no reasonable basis to believe that it could be used to identify an individual. For example, a health diagnosis Asthma for example becomes PII when it includes an identifier that links the information to a specific patient, or when there is a reasonable basis to believe the information could be used to identify a patient. What is manifold pressure on an airplane? 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. In this case, the expert may determine that public records, such as birth, death, and marriage registries, are the most likely data sources to be leveraged for identification. Usually a patient will have to give their consent for a medical professional to discuss their treatment with an employer; and unless the discussion concerns payment for treatment or the employer is acting as an intermediary between the patient and a health plan, it is not a HIPAA-covered transaction. When sufficient documentation is provided, it is straightforward to redact the appropriate fields. A verbal conversation that includes any identifying information is also considered PHI. Thus, it could be challenging . Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. KSAT 12 6 O'Clock News : Dec 06, 2021 Watch on Answer (1 of 10): There are a lot of "it depends" required to answer your question. Relationship between uniques in the data set and the broader population, as well as the degree to which linkage can be achieved. Identifying Code Individually identifiable health information: Withholding information in selected records from release. 3.4 Can dates associated with test measures for a patient be reported in accordance with Safe Harbor? 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. 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. Violate any of the provisions in the HIPAA Privacy, Security, or Breach Notification Rules and you could be financially penalized. The workshop was open to the public and each panel was followed by a question and answer period. Third, the expert will determine if the specific information to be disclosed is distinguishable. A code corresponds to a value that is derived from a non-secure encoding mechanism. Author: Steve Alder is the editor-in-chief of HIPAA Journal. As summarized in Figure 1, the Privacy Rule provides two methods by which health information can be designated as de-identified. There is no explicit numerical level of identification risk that is deemed to universally meet the very small level indicated by the method. The computation of population uniques can be achieved in numerous ways, such as through the approaches outlined in published literature.14,15 For instance, if an expert is attempting to assess if the combination of a patients race, age, and geographic region of residence is unique, the expert may use population statistics published by the U.S. Census Bureau to assist in this estimation. Much has been written about the capabilities of researchers with certain analytic and quantitative capacities to combine information in particular ways to identify health information.32,33,34,35 A covered entity may be aware of studies about methods to identify remaining information or using de-identified information alone or in combination with other information to identify an individual. Experts may design multiple solutions, each of which is tailored to the covered entitys expectations regarding information reasonably available to the anticipated recipient of the data set. Disclosure of a code or other means of record identification designed to enable coded or otherwise de-identified information to be re-identified is also considered a disclosure of PHI. In response to questions sent to HIPAA Journal, we have written a series of posts explaining some of the basic elements of HIPAA, the latest being what is considered PHI? 2.7 What are the approaches by which an expert assesses the risk that health information can be identified? He is a specialist on healthcare industry legal and regulatory affairs, and has several years of experience writing about HIPAA and other related legal topics. For this reason, future health information must be protected in the same way as past or present health information. 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. Second, the expert will determine which data sources that contain the individuals identification also contain the demographics in question. Are initials protected health information? All rights reserved. Thus, by relying on the statistics derived from the data set, the expert will make a conservative estimate regarding the uniqueness of records. If such information was listed with health condition, health care provision or payment data, such as an indication that the individual was treated at a certain clinic, then this information would be PHI. "ePHI". Two methods to achieve de-identification in accordance with the HIPAA Privacy Rule. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. ZCTAs are generalized area representations of U.S. Section 164.514(a) of the HIPAA Privacy Rule provides the standard for de-identification of protected health information. What are the approaches by which an expert mitigates the risk of identification of an individual in health information? A higher risk feature is one that is found in many places and is publicly available. (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.) Initials _____ HIPAA Checklist for a Valid Authorization 164.508(c) (1) defines the following core elements for an authorization to disclose . Information that had previously been de-identified may still be adequately de-identified when the certification limit has been reached. For example, when ESPN reported on a football player losing fingers in a fireworks incident people thought they violated HIPAA. Must a covered entity remove protected health information from free text fields to satisfy the Safe Harbor Method? All rights reserved. For instance, one example of a data protection model that has been applied to health information is the k-anonymity principle.18,19 In this model, k refers to the number of people to which each disclosed record must correspond. If the data set contains any limited identifiers, but none of the direct identifiers, it is considered a limited data set under HIPAA. In those cases, the first three digits must be listed as 000. Are initials alone considered PHI? In doing so, the expert has made a conservative decision with respect to the uniqueness of the record. However, nothing prevents a covered entity from asking a recipient of de-identified information to enter into a data use agreement, such as is required for release of a limited data set under the Privacy Rule. 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. Sending a PHI-encrypted email to an incorrect recipient would be both an unauthorized and a HIPAA violation. HIPAA Journal is the leading provider of news, updates, and independent advice for HIPAA compliance. No. 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. This category corresponds to any unique features that are not explicitly enumerated in the Safe Harbor list (A-Q), but could be used to identify a particular individual. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics. Providertechs CareMessenger is a HIPAA-compliant text messaging platform that allows providers and healthcare practices to securely message patients and other health professionals by sending HIPAA-compliant texts, photos, and documents. In the context of the Safe Harbor method, actual knowledge means clear and direct 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. Notice, however, that the first record in the covered entitys table is not linked because the patient is not yet old enough to vote. 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. Are initials protected health information? 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. This means making sure you have appropriate notices visible, both online and in the real world, warning patients about the potential security risks of transmitting protected health information (PHI) using non-secure email over the Internet. Is it always considered PHI? There are even criminal penalties for HIPAA violations; and claiming ignorance of the Rules is not a valid defense if you are found to have failed to protect health information under HIPAA law. The data must be either created, collected, stored, or transmitted by a covered entity. Can dates associated with test measures for a patient be reported in accordance with Safe Harbor? The covered entity, in other words, is aware that the information is not actually de-identified information. Further information about when consent or authorization is required, and the permissible disclosures for public benefit activities can be found in HHS Summary of the HIPAA Privacy Rule. Receive weekly HIPAA news directly via email, HIPAA News The key word here is "identify": If a snippet of data or a data set . This standard consists of 18 specific identifiers: Names All geographic subdivisions smaller than a State All elements of dates (except year) for dates directly related to an individual. OCR also thanks the 2010 workshop panelists for generously providing their expertise and recommendations to the Department. The code, algorithm, or pseudonym should not be derived from other related information* about the individual, and the means of re-identification should only be known by authorized parties and not disclosed to anyone without the authority to re-identify records. Information could be classified as high-risk features was last updated in 2000 be exploited by anyone receives! Physical records and electronic devices containing PHI to an incorrect recipient would be both an unauthorized disclosure and HIPAA. 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