What is ePHI ? Challenges, Best practices, and Strategies

Federal records show that healthcare breaches exposed 385 million patient records from 2010 to 2022. This statistic underscores the pressing need for safeguarding Electronic Protected Health Information (ePHI) in this digitized healthcare landscape. ePHI protection not only upholds HIPAA compliance but also maintains patient trust and the integrity of the entire healthcare system. 

What is ePHI?

Electronic Protected Health Information or ePHI refers to all the protected health information (PHI) created, stored, transmitted, or received electronically. This includes: 

• Patient identifiers: This category comprises any information identifying a patient, such as a patient's name, address, phone number, Social Security number, email address, and more.
• Medical records: A complete record of a patient's medical history, including diagnoses, treatments, prescriptions, lab results, x-rays, and other test findings.
• Billing details: Information about a patient's insurance, billing, and payment history.
• Clinical notes: Notes by doctors, nurses, therapists, and other healthcare practitioners that describe interactions, observations, and patient care.

Protecting ePHI is essential to ensuring patient privacy and security. It often involves adhering to stringent regulations and implementing robust security measures. 

Components of ePHI

Here is the list of all the components of ePHI as defined by the U.S. Department of Health & Human Services (HHS) under the HIPAA Privacy Rule:

• Names: Full name, last name, first name, middle name, or initials
• Geographic data: Street address, city, county, state, zip code, and other geographic information
• Dates: Includes all calendar dates related to an individual like birth date, admission date, discharge date, date of death, and more
• Phone numbers: Any phone number that can be used to call an individual
• Fax numbers: Any fax numbers associated with the individual
• Email addresses: Any email addresses that can be used to contact the individual
• Social Security number: The unique number assigned to individuals for identification purposes
• Medical record numbers: Unique numbers assigned to patients' medical records by healthcare providers
• Health insurance beneficiary numbers: The unique number assigned by health insurers to individuals
• Account numbers: The unique number assigned to the patient's account
• Certificate/license numbers: Unique Numbers associated with any certificates or licenses held by the individual
• Vehicle identifiers and serial numbers: Includes license plate numbers
• Device identifiers and serial numbers: Identifiers for medical devices or other equipment used on or by patients
• Web universal resource locators (URLs): Web addresses or other locations associated with the individual
• Internet protocol (IP) addresses: Addresses assigned to devices used by or for the individual
• Biometric identifiers: Fingerprints, retina, and iris patterns, voiceprints, and any other unique identifying characteristic.
• Full face photos and comparable images: Any images of the individual's face
• Any other unique identifying number, characteristic, or code: Any other data that can be traced back to a specific individual.

How Does ePHI Differ From Other Types of Data?

ePHI is distinct from other types of electronic data in several ways:

• Sensitivity: ePHI contains confidential data regarding a person's medical history and condition. Unauthorized access or disclosure can have serious personal, financial, and reputational consequences.
• Regulation: In the United States, ePHI is regulated by laws and regulations, most notably the Health Insurance Portability and Accountability Act (HIPAA). These regulations specify how ePHI must be stored, transmitted, and accessed.
• Value: ePHI can command greater rates on the black market than other forms of data, making it a desirable target for hackers.
• Complexity: With multiple stakeholders, including doctors, hospitals, insurance companies, and third-party suppliers, controlling access can get tricky.

HIPAA's Role in Safeguarding ePHI: A Closer Look

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the U.S. Department of Health and Human Services (HHS) Secretary to create regulations ensuring the privacy and security of specific health information. To fulfill this mandate, HHS introduced what is commonly known as the HIPAA Privacy Rule and the HIPAA Security Rule. 

The Privacy Rule, officially titled the Standards for Privacy of Individually Identifiable Health Information, establishes nationwide standards to protect certain health data. 

On the other hand, the Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) outline a comprehensive set of national security standards for safeguarding certain health information when it is stored or transmitted electronically.

The Security Rule translates the principles outlined in the Privacy Rule into practical technical and non-technical measures that organizations, known as "covered entities," must implement to secure individuals' ePHI. 

The Office for Civil Rights (OCR) within HHS enforces the Privacy and Security Rules through voluntary compliance efforts and civil monetary penalties.

HIPAA Compliance Checklist for ePHI Protection 

To comply with HIPAA, healthcare entities must adhere to a comprehensive set of requirements, including:

• Risk assessment: Healthcare organizations must regularly conduct assessments to identify system vulnerabilities and potential threats to ePHI.
• Access control: Covered entities are responsible for establishing and implementing role-based access controls, ensuring that only authorized personnel can access ePHI.
• Audit control: Organizations are required to monitor and record ePHI-related activities, allowing for the detection of any unauthorized access or breaches.
• Integrity control: Maintaining ePHI integrity necessitates measures like encryption and data validation to prevent unauthorized alterations.
• Transmission security: During electronic data transmission, ePHI protection is mandatory, with encryption serving as a key safeguard.
• Policies and procedures: Written policies and procedures that delineate ePHI handling are essential for employee guidance and regulatory compliance.
• Training and awareness: Regular education and awareness programs are crucial for reducing the risk of security breaches resulting from human error.
• Contingency plan: Covered entities must have a contingency plan for emergencies, encompassing disaster recovery and data backup strategies.

Challenges in ePHI protection

With the rapid digitization of healthcare data and the increasing sophistication of cyber threats, healthcare organizations face numerous challenges in safeguarding ePHI.

1. Vulnerabilities in storing ePHI

Storing ePHI presents its own challenges, especially when leveraging cloud environments:

• Lack of control: When healthcare businesses rely on third-party cloud service providers, they may not have complete control over their data storage and security standards.
• Data access: Unauthorized access can occur if sufficient access controls are not in place, particularly in multi-tenant cloud systems.
• Data loss: There is always the risk of data loss in cloud storage owing to technological breakdowns, so companies should be aware of various types of data loss prevention.
• Compliance: Ensuring cloud storage solutions comply with HIPAA and other requirements can be complex.
• Data breaches: Cloud environments can expose sensitive patient data if not adequately secured, making cloud data loss prevention a must.

The average cost of a healthcare data breach has reached an all-time high of $10.1 million—a 9.4% increase from 2021. 

2. Threat landscape

The threats healthcare organizations face in safeguarding ePHI include:

• Phishing attacks: Cybercriminals frequently use deceptive emails to mislead healthcare staff into disclosing critical information or passwords.
• Ransomware: Malicious malware, known as ransomware, encrypts data and makes it unavailable unless a ransom is paid. The rate of ransomware attacks in healthcare has almost doubled from 34% in 2021 to 60% in 2023.
• Insider threats: Data breaches can occur accidentally or purposely by employees or other reliable parties. Fraud is the most prevalent case type across all insider threat incidents within the Healthcare Sector.
• Advanced persistent threats (APTs): APTs are sophisticated and well-organized cyber attacks that aim to infiltrate a network, remain undetected for an extended period, and continuously steal data or cause harm.
• Unsecured devices: Unsecured devices, like laptops, smartphones, or tablets, are a leading cause of ePHI breaches. In 2019, a New York medical center faced a $3 million penalty after losing an unencrypted flash drive and laptop, potentially exposing sensitive patient data.

Learn more about what constitutes sensitive data from the Strac Catalog of Sensitive Data Elements. 

3. Stale data & improper data disposal

Stale data refers to outdated or inactive information stored in systems. The improper disposal of this data can have the following consequences:

• Increased risk: Storing unnecessary information increases the likelihood of a breach compromising the data.
• Compliance issues: Retaining data for longer than required might result in noncompliance with data retention guidelines.
• Data integrity: Stale data can jeopardize the accuracy and reliability of active data.
• Improper disposal: Simply deleting data does not guarantee its removal. The data is still retrievable without the use of adequate data disposal measures, such as data wiping or physical destruction.

How to Protect ePHI ?

By implementing the below security protocols, healthcare providers can protect ePHI from unauthorized access or breaches. Here are the best practices to protect ePHI data,

• Encryption and security
• Monitoring and management
• Compliance and auditing

1. Encryption and security

• Using strong encryption methods: Use AES (Advanced Encryption Standard) methods with a key length of at least 256 bits.
• Key management: Rotate encryption keys regularly and securely keep them away from encrypted data.
• Device encryption: Encrypt devices such as computers, cellphones, and tablets to safeguard ePHI in case of device theft or loss.
• End-to-end encryption: Encrypt data at rest and in transit to ensure it remains unreadable to unauthorized individuals even if intercepted.

2. Monitoring and management

• Role-based access controls: Use role-based access controls that only allow authorized people to access ePHI.
• Real-time monitoring: Utilize solutions that enable real-time systems monitoring and detect and alert suspicious activity.
• Log management: Review and analyze logs regularly to quickly detect unauthorized access attempts.
• Multi-factor authentication: Enable more than one authentication method to add additional protection.

3. Compliance and auditing

• Regular audits: Conduct periodic audits to analyze and assess all the security mechanisms. 
• HIPAA compliance: Ensure you satisfy all HIPAA security and privacy rules requirements.
• Education and awareness: Regularly educate employees about HIPAA rules and the significance of ePHI protection.
• Incident response plan: Have a strategy for handling breaches to ensure prompt response and mitigation.

Find the detailed DLP Security Checklist here.

Advanced ePHI protection strategies: Beyond HIPAA compliance

While basic compliance with regulations like HIPAA is essential, the following advanced strategies can ensure more robust ePHI protection.

• Implement zero trust architecture: Authenticate, authorize, and encrypt every access request before approval. ‍
• Adopt advanced technologies: Employ AI to identify anomalous network patterns or behaviors that could indicate a breach.‍
• Redact sensitive data: Data masking renders it anonymous and unusable for malicious purposes, while still retaining its value for legitimate uses.

Redact sensitive ePHI in real-time with Strac DLP

Strac is a data loss prevention (DLP) solution, dedicated to safeguarding ePHI from unwarranted breaches and cyberattacks. Its core features include:

• Instant Detection and Redaction: Strac identifies sensitive information and automatically takes predefined actions, such as data redaction or alerting administrators, to protect ePHI.

• No-Code Integrations: Strac offers effortless integration with multiple platforms, including Zendesk, Slack, Gmail, ChatGPT, and more. This simplifies ePHI security across diverse platforms.           ‍

• Regulatory Compliance: With zero downtime and built-in compliance templates, Strac ensures that your organization consistently complies with HIPAA's stringent regulatory standards.