FAQs: Disclosing PHI

Disclosing protected health information (PHI) is governed by strict regulations to ensure patient privacy and confidentiality. Under the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers and entities must follow specific guidelines to protect PHI, whether shared for treatment, payment, legal purposes, or emergencies. 

This FAQ will cover the most common questions related to disclosing PHI, providing clarity on when and how this sensitive information can be shared.

What is protected health information (PHI)?

PHI refers to any information that can be used to identify an individual and relates to their health condition, provision of healthcare, or payment for healthcare services. It includes medical records, patient names, addresses, and health insurance information.

See also: FAQs: Protected health information (PHI)

Who can access and disclose PHI?

PHI can be accessed and disclosed by:

• Healthcare providers: For treatment, payment, and healthcare operations.
• Healthcare entities: For purposes such as billing, insurance claims, and quality assessment.
• Individuals: With proper authorization or in situations where they are allowed by law.
• Researchers: With appropriate approvals and compliance with regulations.

What are the requirements for disclosing PHI without patient consent?

PHI can be disclosed without patient consent in certain situations, including:

• Public health activities: Reporting diseases or injuries.
• Legal requirements: Compliance with court orders or legal investigations.
• Law enforcement: For specific legal purposes, such as reporting abuse.
• Emergencies: To prevent or lessen a serious threat to health or safety.

What are the patient’s rights regarding their PHI?

Patients have several rights concerning their PHI, including:

• Right to access: Request copies of their medical records.
• Right to amend: Request corrections to their health information.
• Right to restrict: Request restrictions on how their PHI is used or disclosed.
• Right to confidential communications: Request communication in a certain manner or location.

According to the HHS, “Individuals with access to their health information are better able to monitor chronic conditions, adhere to treatment plans, find and fix errors in their health records, track progress in wellness or disease management programs, and directly contribute their information to research.”

What is the HIPAA Privacy Rule?

The HIPAA Privacy Rule establishes national standards for protecting the privacy of PHI and provides patients with certain rights over their health information. It governs how healthcare providers and other entities handle PHI.

How should PHI be disclosed via email?

When disclosing PHI via email:

• Ensure encryption: Use HIPAA compliant email services that offer encryption.
• Verify recipient: Confirm that the recipient is authorized to receive the information.
• Include disclaimers: Use disclaimers to indicate that the information is confidential and intended only for the recipient.

See also: HIPAA Compliant Email: The Definitive Guide

What are the penalties for improper disclosure of PHI?

The penalties for improper disclosure of PHI under HIPAA can be severe and vary depending on the nature and severity of the violation. Civil penalties range from $100 to $50,000 per violation, with annual maximum fines reaching $1.5 million for repeat offenses. Criminal penalties also apply for intentional disclosure or misuse of PHI, with fines ranging from $50,000 to $250,000 and imprisonment for up to 10 years, depending on the intent and harm caused. 

How can healthcare organizations ensure compliance with PHI disclosure regulations?

To ensure compliance, healthcare organizations should:

• Implement policies and procedures: Establish and maintain clear policies for handling and disclosing PHI.
• Train staff: Provide regular training on HIPAA regulations and privacy practices.
• Conduct audits: Regularly review and audit practices to ensure compliance.
• Use secure communication channels: Employ encrypted communication methods for transmitting PHI.

Can a healthcare provider disclose PHI to family members or friends?

Yes, healthcare providers can disclose PHI to family members, friends, or other individuals involved in a patient's care, but only if:

• The patient has agreed or had the opportunity to object to the disclosure.
• The disclosure is relevant to the person's involvement in the patient’s care or payment for care. In emergencies, if the patient is incapacitated, providers may share information if it's in the patient's best interest.

When can PHI be disclosed for research purposes?

PHI can be disclosed for research purposes without individual authorization under certain conditions:

• The research has been approved by an Institutional Review Board (IRB) or a Privacy Board.
• The research falls under the “preparatory to research” provision, such as identifying eligible participants.
• The information is de-identified or part of a limited data set, with identifiers removed.

See also: HIPAA compliance when conducting research

What is the minimum necessary standard for disclosing PHI?

The minimum necessary standard requires that any disclosure of PHI includes only the information needed to accomplish the intended purpose. Healthcare providers must limit the information they disclose to what is essential. Exceptions to this rule include disclosures to the patient, healthcare providers for treatment, and situations required by law.

Read more: How to determine the minimum necessary information

Can PHI be disclosed to third-party vendors?

Yes, PHI can be disclosed to third-party vendors, known as business associates, who provide services on behalf of a covered entity, such as billing, data storage, or IT support. However, these vendors must sign a business associate agreement (BAA), which legally binds them to comply with HIPAA standards for protecting PHI.

Learn more: What does a HIPAA compliant BAA look like?