Phi vs Pii: Understanding Their Influence on HIPAA Compliance

Both types of information are confidential, but they play different roles in ensuring compliance with the Health Insurance Portability and Accountability Act – one of the most strict but essential for protecting health data regulations.

Key Takeaways

• What’s the difference? Learn the distinction between PII (Personally Identifiable Information) and PHI (Protected Health Information) and why it matters for HIPAA.
• PII and PHI in healthcare. How are these types of information treated differently, and why does PHI need extra protection in medical settings?
• Compliance is key. How mishandling PII or PHI can cost you big time and HIPAA violations and how to avoid them?
• Security tips. How to create the top strategies using encryption, access control, and regular security testing to protect sensitive healthcare data?
• Real-life examples. Get examples and real cases where HIPAA violations led to big breaches. Learn how to avoid the same mistakes/

So in this article, we'll take a look at what is hidden behind these acronyms, how to differentiate them and why the context is important, break down PHI vs PII examples, and discuss how the right approach to security testing can make regulatory compliance easier for you. Let’s go!

PII vs. PHI: Definition

What is Personally Identifiable Information (PII)?

Personally Identifiable Information, or PII, is basically any piece of information that you can use to identify a person, either directly or indirectly. This may include details like your name, street address, birth date, phone number, or even full-face photographic images. In essence, PII refers to any data that is unique to somebody and can help recognize them.

What is Protected Health Information (PHI)?

Protected Health Information, or PHI, is a special type of personal information that relates to a person's health and is protected by the Health Insurance Portability and Accountability Act (HIPAA). In other words, this category includes any health-related data that can identify a person. This may be, for instance, medical records, health plan beneficiary numbers, lab results, and so on.

The important point is that healthcare providers and other organizations handle such data, which must be covered by HIPAA. This act requires strict safeguards to protect health-related information, making sure that this sensitive health information stays secure. So, if you’re a health care service provider, you have to be very serious about HIPAA compliance.

And, by the way, PHI is protected for 50 years after a person's death.

In short, PHI covers:

• person's past, present, or future physical or mental health conditions;
• healthcare services provided to an individual;
• payment information for healthcare services.

PHI vs. PII: Key Differences

Both PHI and PII are types of confidential information, but they are used in different contexts and are subject to different regulatory requirements. In addition, it is worth understanding that Protected Health Information (PHI) is a type of personally identifiable information (PII).

Both groups can contain the same identifiers, such as name, address, or social security number. However, PHI goes beyond that, including medical records, treatment details, and billing information for medical services.

It is very important to pay attention to the context of data use. For example, let's take the difference between PII vs PHI vs PCI. The last one is payment card information such as credit card number, CVV, etc. However, if the healthcare application has a payment system and stores this data for medical or insurance services, this information becomes PHI and is subject to HIPAA regulation.

Compliance Implications

In 2023, more than 1100 health data breaches were reported in the United States, compromising the personal data of millions of patients. Since 2016, the number of reported violations in the US healthcare system has been gradually increasing, which is why regulatory restrictions are becoming more stringent.

HIPAA is all about protecting personal data (health information specifically). As a subset of PII, PHI is health-related data tied to a patient’s identity and medical records.

The difference between PHI and PII is key to HIPAA compliance. PHI is subject to the HIPAA Privacy Rule, which lists 18 identifiers that make information tied to health data. So if a person’s name, address, or other piece of PII appears in a medical context, it becomes PHI and is protected under HIPAA. In a non-medical context, that same information would be PII but would not trigger the same level of protection unless other privacy laws, state laws, etc. apply.

The implications are large because mishandling PHI can result in big penalties under HIPAA. Healthcare organizations and their business associates must have physical and digital safeguards for PHI, access controls, and encryption. PII protections vary by context and law but are generally less strict than PHI.

PHI vs. PII: HIPAA Implications

Violations of HIPAA can be either unintentional or deliberate. In both cases, violations can have serious legal and financial consequences. Knowing how violations occur and the penalties involved is key for organizations that handle Protected Health Information and Personally Identifiable Information.

Unintentional Violations

An example of an unintentional violation is when more PHI is disclosed than necessary, breaching the “minimum necessary” standard. HIPAA requires that any disclosure of PHI must be limited to the information needed to accomplish the purpose. Even though unintentional, these violations still have financial penalties, although the fines are generally lower than intentional violations.

Example: A hospital discloses more medical info than necessary in a treatment verification request. Unintentional violation of the minimum necessary rule results in penalties, depending on the extent of the violation.

Deliberate Violations

A deliberate violation is willful neglect, like not sending breach notification letters. HIPAA’s Breach Notification Rule requires you to notify people within 60 days of a breach. Going past that timeframe is a violation that can get you in big trouble.

Example: A healthcare provider doesn’t notify patients of a breach of stolen medical records within the 60-day timeframe. That’s a deliberate violation of HIPAA and will cost you big time.

Most HIPAA violations are due to negligence, like not doing a risk assessment. You are required to identify risks to PHI and mitigate them. In this case, Security Testing Services may be the canary in the coal mine, alerting you to potential vulnerabilities before they become costly breaches.

Penalty Tiers for Violations

When determining penalties, the Office for Civil Rights (OCR) considers several factors, including:

• The duration of the violation.
• The number of affected individuals.
• The nature of the compromised data.
• The organization's cooperation with the investigation.
• Prior history and financial condition of the organization.
• The level of harm caused by the breach​.

For example, larger breaches affecting thousands of patients, particularly when sensitive medical conditions are involved, will lead to higher penalties compared to breaches affecting a smaller number of people.

Strategies for Safeguarding PHI and PII in Compliance with HIPAA Regulations

In 2023, the Office for Civil Rights reported a huge jump in data breaches. Between 2018 and 2023, there was a 239% increase in hacking breaches and a 278% increase in ransomware attacks. But the severity of those breaches has gotten worse. In 2021, 45.9 million healthcare records were compromised; in 2022, 51.9 million; and in 2023, 133 million records were exposed, stolen, or improperly disclosed.

That included 26 breaches of over 1 million records and 4 breaches of over 8 million records. The biggest breach of 2023 was 11.27 million records, making it the second largest healthcare breach ever.

What's the point of all this? Regulatory requirements are specifically designed to systematize and improve data protection measures, and HIPAA is no exception. The best strategies for safeguarding PHI and PII in compliance with HIPAA regulations involve adhering to specific rules designed to secure data. You can read more about them here, but we will discuss them briefly in the context of safeguarding strategies.

HIPAA requires you to protect both Protected Health Information (PHI) and Personally Identifiable Information (PII) so data is confidential and intact. The HIPAA Security Rule and related guidelines help you implement defenses against data breaches as we rely more and more on electronic systems.

HIPAA Security Rule

The HIPAA Security Rule sets standards for defending electronically protected health information (ePHI) throughout its lifecycle – production, storage, and disposal.

You must have three types of safeguards:

• Administrative safeguards – policies and procedures for how employees access and handle PHI.
• Physical safeguards – securing physical devices and workstations that store or access ePHI
• Technical safeguards – access control, encryption, antivirus software, etc.

Example

A health insurer, Premera Blue Cross, was fined $6.85 million when hackers used a phishing email to get to PHI. This went undetected for 9 (!) months. And what is really sad is that professional penetration testing services and continuous monitoring may prevent this situation.

HIPAA Omnibus Rule

The Omnibus Rule expanded HIPAA to business associates and subcontractors and holds them liable for breaches of PHI. It requires healthcare organizations to make sure their partners are HIPAA compliant.

Examples

Here is the illustration of the Omnibus Rule in action. In 2020, the New Haven Health Department, CT, was fined $202,400 by OCR for HIPAA violation. The investigation began in May 2017 after New Haven reported a breach.

It occurred that a terminated employee, during her probationary period, used her work key to get into her old office, logged into her old computer with her credentials, and downloaded 498 patient’s PHI onto a USB drive.

This included names, addresses, dates of birth, race/ethnicity, gender, and STD test results. The breach could have been avoided if the Health Department had deactivated the employee’s login credentials when she was terminated. Also, if they had assigned unique login credentials to all users, they could have tracked system activity and interactions with the PHI better.

HIPAA Breach Notification Rule

The Breach Notification Rule outlines the steps you must take if you have a data breach, acknowledging that no system is 100% secure. This rule requires you to notify affected individuals, the media (for large breaches), and the Secretary of Health and Human Services. Notification must be made within 60 days.

Examples

In 2011, the Office for Civil Rights (OCR) fined APDerm, a Concord, Massachusetts-based practice, $150,000. An unencrypted thumb drive was taken from an employee’s car.

OCR’s investigation found that the dermatology practice had not done a risk analysis of the confidentiality of electronic protected health information (ePHI). They also didn’t have policies and procedures in place to meet the breach notification rule and had not trained staff on those procedures. Lack of preparedness led to the breach and the settlement.

The fine is part of a larger settlement, which includes a corrective action plan to develop a risk analysis and management plan to address security vulnerabilities and report them to OCR.

More ways to safeguard PHI and PII

• Encrypt sensitive data so it can’t be read if accessed by unauthorized individuals.
• Limit access to PHI and PII so only employees with the right authority can access sensitive information.
• Do regular audits and risk assessments to find and fix vulnerabilities.
• Train employees on data protection best practices and the risks of breaches.
• Develop incident response plans so you can act fast and effectively in the event of a breach and minimize damage.​

Ultimately, ensuring compliance with HIPAA involves continuous monitoring, risk assessments, and prompt corrective actions. Organizations must take these steps seriously to avoid heavy financial penalties and ensure patient data remains secure.

Best Practices and Tips

In 2015, Anthem Inc. (now Elevance Health) was hacked. On February 4, they announced that criminal hackers had gotten into their system and potentially stole 37.5 million personal records. By the end of the month, that number grew to 78.8 million people. Hackers got names, birthdates, social security numbers, electronic mail addresses, and employment info across multiple Anthem brands, including Blue Cross and Blue Shield.

Hackers had accessed the data over a period of weeks before the breach was discovered. Since no medical info was stolen, Anthem didn’t have to encrypt the data. But they did face several civil class-action lawsuits which were settled in 2017 for $115 million.

They offered free credit monitoring. But the point is clear: security matters. Period.

So here are some best practices for proper PHI and PII to ensure HIPAA compliance and robust security within your organization.

Run regular security checks & penetration tests

One of the best practices in every industry, but healthcare especially, is to regularly conduct professional security testing (including pentests)  and build a strong resilience system.

Such an approach helps to assess your security system under the real-world attack scenario and find weaknesses before they are exploited by attackers. Do not forget to review who has access to your systems and how data is handled to stay HIPAA compliant.

In this case, it is better to find a reliable security service provider and check every part of the security perimeter, as the data is the most valuable asset.

Encryption

Encrypt sensitive data when it’s sent and when it’s stored. Even if someone intercepts the data, encryption will prevent them from reading it without the right keys. Make sure to use HIPAA-compliant encryption on all devices and communication channels.

Backup your PHI and PII data to a secure offsite location. Make sure these backups are encrypted and can be restored quickly in case of an attack or data loss. Having a disaster recovery plan will minimize downtime and data loss if something goes wrong.

Control access with role-based permissions

Only let authorized personnel access PHI and PII. Role-based access control (RBAC) is a great way to make sure employees only see what they need for their jobs. Add an extra layer of security by using multi-factor authentication (MFA) when accessing sensitive data.

It is also necessary to set up logging and monitoring to track who accesses PHI and PII to understand why they research health information and when and how they do it. These logs will help you catch suspicious behavior and provide an audit trail. Automated alerts will also notify you of unusual activity so you can act fast.

Keep your software up to date

This is obvious security advice, but people often neglect it. Make sure your software is always up to date with the latest security patches to protect against known vulnerabilities. Automated tools will make this process easier and more consistent.

Train employees and spread awareness

Train your employees not only on HIPAA rules but also on simple things like how to distinguish suspicious web universal resource locators, for instance. They must be aware of best practices for handling PHI and PII.

Make sure they know how to spot phishing, secure their devices, and follow security protocols. They also should have clear security policies at their disposal, so that they know how to handle sensitive data within the company, on every healthcare service event, etc.

PII vs. PHI: Final Thoughts

Distinguishing PII vs. PHI is essential for maintaining HIPAA compliance, but simply knowing the difference isn't enough. With the increasing frequency of data breaches, the need for a fresh security perspective and better data defense is also growing.

Regular and, what is no less important, professional security audits, penetration testing, and encryption are critical to protecting sensitive data. Investing in comprehensive security services not only ensures compliance but also safeguards your healthcare organization from costly violations and reputational damage.

So, don’t wait for a breach to happen – reach out to us today. Let’s discuss how to secure your systems and protect your valuable data.

FAQ

1. Why is it important to distinguish between PHI and PII?

   PHI involves health-related data protected by HIPAA, while PII includes general personal identifiers. Distinguishing them helps apply the right level of protection and comply with specific regulations.

2. How do PHI and PII impact HIPAA compliance?

   HIPAA primarily governs PHI, requiring strict safeguards for health-related data. PII may also fall under HIPAA if used in a healthcare context, making its protection vital for compliance.

3. What steps can organizations take to protect PHI and PII?

   Organizations should use encryption, access controls, regular security testing, employee training, and perform audits to safeguard both PHI and PII. The best way to build resilience against cyber threats and prevent attacks is to combine automated testing with different types of penetration testing. This way, your data security can be tested and improved both by AI-based tools and by real people under real-world circumstances.

4. What are the consequences of mishandling PHI or PII?

   Mishandling can result in hefty fines, legal penalties, and reputational damage, especially under HIPAA if PHI is compromised. In addition to huge money losses, companies can end up with seriously damaged reputations and loss of customer loyalty.

5. How can I ensure my organization is compliant with HIPAA regulations regarding PHI and PII?

   Implement proper safeguards like encryption, conduct regular security audits, restrict access to sensitive data, and ensure ongoing HIPAA training for all employees.