HIPAA and PHI: A practical guide for healthcare providers

The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy and security of sensitive patient information. It’s designed to support healthcare professionals in accessing information necessary for healthcare delivery while safeguarding patients against unauthorized access and abuse of their private information.

When independent practices covered under HIPAA fail to comply, they can face significant risks, such as litigation and reputational damage. Federal consequences may include corrective actions, steep fines or penalties, and increased regulatory scrutiny. Issues stemming from the mishandling of patient information can affect your practice’s bottom line and potentially lead to customer loss, seriously impacting business health.

Fortunately, practices can achieve HIPAA compliance with a targeted strategy. Here's what you should know to get started.

HIPAA is a federal law that protects patient privacy and secures health information. Its primary focus is ensuring the confidentiality, integrity, and availability of protected health information (PHI).

PHI refers to patient demographics and other information that could reveal an individual’s identity. HIPAA-covered entities and their business associates must safeguard all PHI, including electronic health records (EHR) data, paper records, and information shared in person during healthcare visits. 

Examples of PHI include:

HIPAA allows the use and disclosure of PHI without patient consent only during activities classified as TPO. According to HIPAA, TPO stands for treatment, payment, and healthcare operations, referring to activities like care provision, billing, and other actions necessary for effective, timely care delivery.

“Covered entities” must comply with the standards outlined in the HIPAA Privacy and Security Rules. HIPAA defines a covered entity as:

Business associates are those that handle PHI on behalf of a covered entity — such as 3rd-party claims processors, consultants, and accounting firms — and they must also adhere to HIPAA and PHI requirements.

The HIPAA Privacy Rule outlines administrative, physical, and technical protocols that protect PHI, including paper, oral, and electronic data. These standards limit the use and disclosure of PHI while ensuring it can be shared between professionals when appropriate. 

Under the Privacy Rule, patients are guaranteed access to their own records and can limit who can use them without their explicit consent.

The HIPAA Security Rule establishes administrative, technical, and physical security protocols that specifically address electronic protected health information (ePHI). Its goal is to ensure the confidentiality and integrity of ePHI while also maintaining its accessibility for the purpose of quality care delivery. 

The HIPAA Breach Notification Rule's goal is to establish a clear framework for responding to breach incidents that ensures both transparency and accountability. 

The rule outlines specific steps for notifying stakeholders after a breach — such as affected individuals and the United States Department of Health & Human Services (HHS). It also provides guidelines on when to notify the media after a breach based on the number of affected individuals.

Following are key actions small practices can take to address all HIPAA and PHI requirements without compromising operations or efficiency. 

Establish comprehensive policies in writing regarding PHI handling within your practice. Begin by conducting a risk assessment to identify potential vulnerabilities. 

This risk analysis process should involve the following:

Once you've identified risks and their likelihood, implement security features to mitigate them. You can develop clear protocols on how to manage PHI properly and address specific issues like access controls, transmission security, encryption, and incident response — as well as the issues raised in your risk analysis. Outline breach notification procedures and a contingency plan in case of emergencies.

Tailor procedures to integrate with existing, practice-specific workflows. Always document compliance, including patient rights procedures, EHR processes, and technical safeguards and upgrades. 

Also, remember to conduct routine audits to identify any new threats or vulnerabilities and ensure the implemented security measures are functioning correctly. Review and update these policies routinely and whenever significant changes occur to guarantee that your program maintains PHI and HIPAA compliance. 

Your staff plays a crucial role in protecting privacy and security in daily operations. HIPAA regulations mandate that all members of the workforce (including volunteers and trainees) receive training on PHI policies and procedures. This training should be part of your team's onboarding process and periodically afterward.

Human error is among the most common causes of PHI and HIPAA violations. Proper training reduces errors and helps optimize the overall compliance program.

HIPAA requires you to protect ePHI throughout its lifecycle at your practice. Recommended safeguards include:

Whether intentional or unintentional, failure to comply with any aspect of HIPAA constitutes a violation. Any violation could lead to an Office for Civil Rights (OCR) investigation and potentially result in penalties or fines. 

OCR issues penalties on a 4-tier scale: 

Common HIPAA violations include improperly disposing of PHI, denying patients access to their data, and not having business associate agreements in place — and they can come with hefty fines. For example, in 2024, the OCR announced a $100,000 penalty against a mental health center for failing to provide a patient with timely access to their records.

Another example of a HIPAA violation and a possible breach of unsecured PHI would be allowing practice-wide access to patient data . This could lead to a potential unauthorized employee viewing or downloading PHI. The HIPAA Security Rule requires practices to use unique login information for employees that provides access only to the PHI necessary to perform their work roles. 

Maintaining PHI and HIPAA compliance is fundamental to providing ethical healthcare. Keeping sensitive information secure and private is also essential to cultivating trusting provider-patient relationships. 

Keep abreast of changes in HIPAA laws, regularly assess and update security measures, and educate staff about the importance of privacy protection to take the first steps toward a more vigorous compliance program.

Start enhancing data security today with Tebra’s HIPAA-compliant, all-in-one solution.