Protected Health Information (PHI) is individually identifiable health information created, received, maintained, or transmitted by covered entities (healthcare providers, health plans, or clearinghouses). This broad category of data includes medical records, demographic details, and billing information that relates to a patient’s past, present, or future health condition. The communication and disclosure of this sensitive information are strictly governed by the Health Insurance Portability and Accountability Act (HIPAA). HIPAA establishes federal standards requiring covered entities and their partners to implement rigorous safeguards to ensure PHI remains confidential, secure, and available only to authorized individuals. This regulatory framework is essential given the high volume of health data communicated daily and the need for patient trust.
Electronic Communication Methods
Electronic communication is the most common pathway for PHI transmission today and requires stringent technical safeguards to prevent unauthorized access. Methods such as email, text messaging, and telehealth platforms must secure data both during transmission and while stored. The primary protection mechanism is encryption, which scrambles electronic PHI (ePHI) using an algorithm, making it unreadable without the proper decryption key.
Encryption is a highly recommended measure for ePHI, especially for data traveling across public networks. This security measure must be applied to data “in transit,” such as emails sent between providers, and to data “at rest,” which is information stored on servers or local devices. Healthcare organizations often use secure, dedicated platforms for messaging and video conferencing to meet compliance obligations.
Using standard, non-secure messaging apps or personal email accounts for PHI presents a significant risk because they typically lack necessary technical controls, such as end-to-end encryption. The implementation of these technical safeguards, which include access controls and audit logs, is dictated by federal regulations governing the security of electronic health information.
Verbal and Physical Communication Guidelines
Communicating PHI through verbal and physical means requires strict administrative and physical safeguards. The “Minimum Necessary Rule” applies to all forms of PHI, including oral communications. This rule requires covered entities to limit the use, disclosure, or request of PHI to the smallest amount needed for a specific purpose. This means providers should use concise summaries and avoid sharing irrelevant personal details when discussing a case with a colleague for treatment or payment purposes.
Administrative policies must govern verbal exchanges, requiring staff to employ reasonable safeguards to minimize the chance of accidental disclosure. Examples include speaking quietly when discussing a patient’s condition, moving sensitive conversations to private areas away from public waiting rooms, and verifying a caller’s identity before discussing PHI over the phone. These actions help ensure that any “incidental disclosure,” such as a name being briefly overheard, is unavoidable and limited.
Physical PHI, such as paper records and X-rays, is protected through physical access controls and administrative procedures. Documents must be stored in locked cabinets or secure areas with limited access to prevent unauthorized viewing. When physical records are no longer needed, they must be securely destroyed, typically through cross-shredding, to ensure the information cannot be reconstructed. Secure communication via fax or mail also requires dedicated practices, such as using secure fax machines and handling physical mail with care to prevent loss or misdirection.
Direct Patient Communication and Authorization
Communication rules change substantially when a covered entity transmits PHI directly to the patient who is the subject of that information. Patients have a defined right to request communication by alternative means or at an alternative location to ensure their privacy, and providers must accommodate all reasonable requests. For instance, a patient may request that all appointment reminders be sent to a specific phone number or an alternate mailing address.
A unique provision allows patients to request that their PHI be sent using non-secure methods, such as unencrypted email or text message. Before honoring such a request, the healthcare provider must inform the patient of the potential risks associated with the unsecured communication method, which include the possibility of unauthorized interception. If the patient still prefers the unencrypted method after being informed of the risks, the provider may proceed, acknowledging the patient’s autonomy in choosing their communication preference.
When communicating verbally with a patient over the phone, staff must follow a procedure to verify the individual’s identity before releasing any PHI. This often involves asking for identifying information that only the patient or their authorized representative would know, providing a mechanism to prevent accidental disclosure to an unauthorized party. This patient-directed flexibility is distinct from the mandatory security measures required for communication between healthcare professionals or entities.
Communication via Business Associates
Secure PHI communication often involves external vendors, contractors, and service providers known as Business Associates (BAs), who perform functions on behalf of a covered entity. Examples of BAs include billing companies, IT service providers who manage electronic health records, and external lawyers who require access to PHI to perform their duties. The relationship between a covered entity and a BA is governed by the legally mandated Business Associate Agreement (BAA).
The BAA is a contract that dictates exactly how the BA must handle, safeguard, and disclose the PHI they receive. This agreement must be in place before any PHI is shared and contractually mirrors the security and privacy obligations of the covered entity, requiring the BA to implement appropriate administrative, physical, and technical safeguards.
The BAA must explicitly define the permitted uses and disclosures of PHI, ensuring the BA only accesses the minimum necessary information to perform contracted services. Furthermore, the BAA includes specific requirements for reporting security incidents or breaches to the covered entity without unreasonable delay. If a BA hires a subcontractor who will also have access to PHI, that subcontractor must, in turn, have a BAA that enforces the same level of protection, creating a chain of responsibility.