HIPAA Compliance for Recovery Coach

This skill helps you maintain HIPAA compliance when developing features that handle Protected Health Information (PHI).

What is PHI in This Application?

Data Type	PHI Status	Handling
Check-in mood/cravings	PHI	Audit all access
Journal entries	PHI	Audit all access
Chat conversations	PHI	Audit all access
User profile (name, email)	PHI	Audit modifications
Sobriety date	PHI	Audit access
Emergency contacts	PHI	Audit access
Usage analytics (aggregated)	NOT PHI	No audit needed
Page views (no content)	NOT PHI	No audit needed

Audit Logging Requirements

When to Log

Always log these operations:

• Viewing any PHI (check-ins, journal, messages)
• Creating/updating/deleting PHI
• Exporting user data
• Admin access to user information
• Failed authentication attempts
• Security events (rate limiting, unauthorized access)

How to Log

Use the audit logging utilities in src/lib/hipaa/audit.ts:

import {
  logPHIAccess,
  logPHIModification,
  logSecurityEvent,
  logAdminAction
} from '@/lib/hipaa/audit';

// Viewing PHI
await logPHIAccess(
  userId,
  'checkin',        // targetType
  checkinId,        // targetId
  AuditAction.PHI_VIEW
);

// Modifying PHI
await logPHIModification(
  userId,
  'journal',
  journalId,
  AuditAction.PHI_UPDATE,
  { field: 'content' }  // Never include actual content!
);

// Security event
await logSecurityEvent(
  userId,
  AuditAction.RATE_LIMIT,
  { path: '/api/chat', attempts: 60 }
);

// Admin action
await logAdminAction(
  adminId,
  AuditAction.ADMIN_USER_VIEW,
  'user',
  targetUserId
);

Data Sanitization

Never Log These Fields

The audit system automatically sanitizes, but be explicit:

// BAD - Contains PHI
await logPHIAccess(userId, 'journal', id, action, {
  content: journalEntry.content  // NEVER DO THIS
});

// GOOD - Only metadata
await logPHIAccess(userId, 'journal', id, action, {
  wordCount: journalEntry.content.length,
  hasAttachments: false
});

Sanitized Fields (Auto-Redacted)

• password, token, secret, key
• authorization, cookie, session
• credential, content, message, notes

Session Security Requirements

From src/lib/auth.ts:

• Session timeout: 15 minutes of inactivity (HIPAA requirement)
• Max session: 8 hours absolute maximum
• Failed login lockout: 5 attempts = 30 minute ban
• Password requirements: 12+ chars, mixed case, numbers, special chars

Code Patterns

API Route with Audit Logging

import { getSession, requireAuth } from '@/lib/auth';
import { logPHIAccess } from '@/lib/hipaa/audit';

export async function GET(request: Request) {
  const session = await getSession();
  if (!session) {
    return Response.json({ error: 'Unauthorized' }, { status: 401 });
  }

  // Fetch the data
  const data = await fetchUserData(session.userId);

  // Log the access
  await logPHIAccess(
    session.userId,
    'userdata',
    session.userId,
    AuditAction.PHI_VIEW
  );

  return Response.json(data);
}

Component with PHI Access

'use client';

import { useEffect } from 'react';

export function JournalViewer({ entryId }: { entryId: string }) {
  useEffect(() => {
    // Log view on mount (server-side preferred, but client backup)
    fetch('/api/audit/log', {
      method: 'POST',
      body: JSON.stringify({
        action: 'PHI_VIEW',
        targetType: 'journal',
        targetId: entryId
      })
    });
  }, [entryId]);

  // ... render
}

Compliance Checklist

Before shipping any feature that touches PHI:

• All PHI access is audit logged
• No PHI content in logs (only IDs and metadata)
• Data access requires authentication
• Admin access has separate audit trail
• Failed access attempts are logged
• Data export includes audit entry
• Sensitive fields are encrypted at rest
• Session timeout is enforced

Audit Log Retention

• Minimum: 6 years (HIPAA requirement)
• Format: Raw logs for 1 year, compressed thereafter
• Location: audit_log table in database
• Export: Encrypted exports for compliance audits

Emergency Access (Break Glass)

For emergency situations, use break-glass access:

import { requestBreakGlassAccess } from '@/lib/hipaa/break-glass';

// This creates enhanced audit trail
const access = await requestBreakGlassAccess(
  adminId,
  targetUserId,
  'Emergency support required - user reported crisis'
);

Break glass access:

• Requires written justification
• Creates permanent audit record
• Triggers alert to compliance officer
• Must be reviewed within 24 hours

Resources

• HIPAA Security Rule: 45 C.F.R. § 164.312
• Audit controls standard: 45 C.F.R. § 164.312(b)
• Incident response plan: docs/INCIDENT-RESPONSE-PLAN.md
• Security documentation: docs/SECURITY-HARDENING.md