HIPAA Compliance: Technical Database Encryption Controls

For digital health startups, protecting electronic Protected Health Information (ePHI) is a strict legal mandate under the HIPAA Security Rule.

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Core Encryption Safeguards

1. Encryption-in-Transit (TLS 1.3)

All communications carrying health data must route over HTTPS. Disable legacy SSL, TLS 1.0, and TLS 1.1 protocols. Enforce TLS 1.2 minimum, preferring TLS 1.3.

2. Encryption-at-Rest (AES-256)

Database volumes, storage blocks, and diagnostic PDFs must be encrypted. Use cloud-native KMS key services with customer-managed keys (CMKs) to restrict access.

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Node.js Row-Level Field Encryption

If storing patient details in NoSQL or SQL databases, encrypt high-risk PII fields individually before saving:

const crypto = require('crypto');

function encryptField(text, key) {
  const iv = crypto.randomBytes(16);
  const cipher = crypto.createCipheriv('aes-256-gcm', key, iv);
  let encrypted = cipher.update(text, 'utf8', 'hex');
  encrypted += cipher.final('hex');
  return { encrypted, iv: iv.toString('hex') };
}