As privacy regulations evolve and healthcare marketers increasingly rely on data-driven strategies to reach patients and providers, navigating how to use sensitive data compliantly is critical. A key privacy mechanism to ensure data usage and transfer is secure is expert determination.
Key takeaways
- Use patient-level data through Expert Determination while adhering to compliance regulations.
- Expert Determination is required for compliant targeting, analytics, and RWE initiatives.
- Keep Expert Determinations fresh to stay protected as data use cases or environments evolve.
- Drive better experiences and outcomes while protecting patients with the right privacy safeguards in place.
What is Expert Determination?
Expert Determination is one of two methods recognized by HIPAA for de-identifying protected health information (PHI). Through this method, a qualified statistical expert evaluates the data and applies scientific principles to ensure the risk of re-identification is minimal. Once this safe threshold is met, the data is no longer considered PHI and can be used for marketing and analytic purposes as outlined in the report.
Expert determination is more flexible. It allows for retention of key data elements (such as dates, geographic data, or longitudinal signals) that are critical for advanced analytics and measurement when the necessary safeguards are in place.
Why Expert Determination matters to marketers
In highly regulated industries like healthcare, data utility is often limited by compliance requirements. But with expert determination, organizations can unlock the full value of their data while maintaining patient privacy.
Expert determination is required any time PHI is used for purposes outside of treatment, payment, or healthcare operations, such as marketing, audience creation, or real-world evidence studies. Leveraging the Expert Determination Method is especially valuable when:
- Using patient-level data for audience segmentation, activation, or measurement.
- Sharing insights with partners or activating data outside of HIPAA-specific environments.
When should Expert Determination be refreshed?
Expert determination is not a “one and done” process. It should be reassessed:
- When new data sources are added that weren’t part of the original assessment.
- When use cases change, particularly if they increase exposure risk (e.g., more granular targeting or different types of data linkage).
- On a regular basis (typically every 12-24 months) to account for changes in data environments, re-identification risks, and evolving best practices.
This ongoing review assists with adhering to HIPAA requirements relating to the de-identification process.
Privacy and marketing performance aren’t mutually exclusive. With the right guardrails in place, organizations can unlock meaningful new insights, drive high-performing marketing outcomes, and deliver better patient experiences and care.
Expert Determination FAQs
What is expert determination under HIPAA?
A HIPAA‐approved method of de-identifying PHI where a qualified statistical expert analyzes the data and confirms the risk of re‐identification is very small.
What is an example of expert determination?
A statistician evaluates a patient’s data set, applies suppression and data‐masking techniques, and certifies it can be shared for research without identifying individuals.
What are the de-identification requirements for HIPAA?
Under HIPAA, patient data is considered de-identified when it no longer identifies an individual and there is no reasonable basis to believe it can be used to identify them.
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