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The concept of Protected Health Information (PHI) often causes confusion among healthcare providers, marketers, and IT professionals. Recent enforcement actions and regulatory updates have highlighted the importance of understanding what constitutes PHI and how the misuse of tracking tools can lead to significant violations. This guide aims to clarify these concepts, explain how data can inadvertently become PHI, and offer strategies to ensure compliance when using digital marketing and analytics platforms.

Without a clear grasp of what PHI entails, organizations risk violating HIPAA regulations, especially when integrating third-party tools like Google Analytics or Facebook Ads. These platforms often collect personal identifiers and health-related data that, if combined, could breach privacy laws. As the healthcare industry continues to adapt to digital transformation, understanding the boundaries of protected information becomes more critical than ever.

What Is PHI?

The U.S. Department of Health and Human Services (HHS) defines PHI within the HIPAA Privacy Rule as “individually identifiable health information” that a covered entity or its business associate holds or transmits, regardless of the media—be it electronic, paper, or oral.

In simpler terms, PHI includes any health-related data that can be linked to an individual. This encompasses details about their physical or mental health, healthcare services received, or payments made for healthcare. For example, knowledge that someone has diabetes or has undergone a specific treatment qualifies as health information. When this data is paired with identifiable details such as a person’s email address, phone number, or IP address, it transforms into PHI, creating potential privacy risks if mishandled.

The 18 Identifiers That Constitute PHI

HIPAA specifies a list of 18 identifiers that can reveal an individual’s identity. These identifiers are often used in tandem with health data, and their presence can elevate information to PHI status. Some are obvious, like names or social security numbers, but others are less apparent. Examples include:

• Geographic details smaller than a state. Full addresses are clear identifiers, but ZIP codes can also be revealing, especially if they cover small populations. ZIP codes with fewer than 20,000 residents, or combined geographic units with such ZIP codes, can identify individuals when linked with health data. If ZIP codes are combined with other identifiers, they contribute to PHI risks.
• IP addresses. Digital tracking tools like the Meta Pixel and analytics platforms such as Google Analytics collect IP addresses directly from visitors’ devices. This data can be used to identify individuals and, when linked with health information, constitutes PHI.
• Dates. Birth dates, admission dates, or discharge dates are considered identifiers because they can help pinpoint a person’s identity when combined with other data.
• Device identifiers and serial numbers. Unique device IDs, often tracked by marketing and health apps, can serve as identifiers if linked with health details.

The key point is that any of these identifiers, combined with health-related information, can turn seemingly innocuous data into protected health information, especially if shared with third-party platforms.

What Counts as Health Information Under HIPAA

The second component required to classify data as PHI is health information itself. HIPAA categorizes health data into three main types:

• Physical or mental health conditions. Diagnoses like diabetes or injuries such as torn ligaments qualify. Digital tools that track page visits or view videos on healthcare websites can also infer health status.
• Provision of healthcare services. Scheduled appointments, prescriptions, or medical procedures are considered health information.
• Payment for healthcare. Invoices, bills, or billing attempts related to healthcare services are also part of health data.

When these types of information are linked with identifiers, they form the basis of PHI. For example, knowing that a person with a specific email address has a certain diagnosis creates a clear case of protected health data.

How Tracking Tools Can Turn Data Into HIPAA Violations

The risk arises when organizations share identifiers combined with health information with platforms that are not HIPAA-compliant. For example, sending an email address linked to a diagnosis to Google Analytics or Facebook Ads without proper safeguards can breach HIPAA rules. Since these tools typically collect both personal identifiers and health data by default, the potential for violations is high.

This is why there have been numerous HIPAA-related fines and lawsuits since 2022, especially related to marketing activities. Sharing PHI with non-HIPAA compliant destinations not only violates privacy laws but also exposes healthcare providers to legal repercussions and reputational damage.

Destinations That Aren’t HIPAA-Compliant

Many popular tracking and advertising platforms, including Google and Meta, do not sign Business Associate Agreements (BAAs), which are essential for HIPAA compliance. As a result, deploying tracking technologies that send PHI to these companies violates privacy regulations. For instance, the recent $1.5 million FTC fine against GoodRx stemmed from sharing sensitive patient data with ad platforms.

Organizations must recognize that using these platforms without proper safeguards can lead to legal liabilities. Ensuring data is transmitted only to compliant destinations is crucial for maintaining privacy and avoiding costly penalties. Explore a privacy-first approach to managing third-party tracking to better understand how to navigate these challenges.

Making Your Ad Platforms HIPAA-Compliant

Despite the challenges, healthcare organizations are investing heavily in digital marketing, with projected spends reaching $19.6 billion by 2025. Completely abandoning these channels is impractical, given their effectiveness. Instead, solutions like Freshpaint provide a way to utilize ad platforms and analytics tools while maintaining HIPAA compliance. These platforms minimize data collection to only what is necessary, reducing the risk of violations and enabling compliant marketing efforts.

Implementing such tools allows healthcare providers to continue leveraging digital advertising without compromising patient privacy. To learn more about secure data practices, check out immersive therapy as a new mental health treatment frontier.

Insights from a Healthcare Privacy Expert

We consulted Dori Cain, a healthcare privacy attorney at Faegre Drinker, to address common questions about PHI and compliance:

• Who is responsible for preventing PHI from reaching non-HIPAA vendors?

Dori emphasizes that the OCR primarily holds the covered entity accountable. Organizations must maintain strict control over their PHI to avoid violations.

• Is an ad click ID considered PHI?

She notes that while an ad click ID is similar to an IP address and can uniquely identify someone, it alone does not contain health information. Therefore, it is not considered PHI unless linked with health data.

• Would combining an email address with a device ID count as PHI?

Only if these identifiers are associated with health information or linked to healthcare services. Without this connection, such data remains outside HIPAA’s protected scope.

For more detailed guidance, review answers from a healthcare lawyer on HIPAA compliance for marketers.

Maintaining compliance in digital healthcare marketing requires a nuanced understanding of what constitutes PHI and how to handle it responsibly. By staying informed and adopting privacy-focused strategies, organizations can protect patient data while effectively leveraging modern marketing tools.