How to Achieve HIPAA Compliance in PostgreSQL

Galaxy Glossary

How do I make PostgreSQL HIPAA compliant?

Configuring PostgreSQL to meet HIPAA’s privacy and security rules through encryption, auditing, and access controls.

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Description

Example H2

Example H3

What HIPAA rules apply to PostgreSQL?

HIPAA requires confidentiality, integrity, and availability of Protected Health Information (PHI). In PostgreSQL this translates to strong authentication, at-rest and in-transit encryption, fine-grained access, auditing, and backup policies.

How do I encrypt PHI at rest?

Enable full-disk encryption (OS level) or use Transparent Data Encryption (cloud-provider). For column-level protection, install pgcrypto and store ciphertext in sensitive columns.

Column-level encryption with pgcrypto

Use PGENCRYPT/PGP_SYM_ENCRYPT to encrypt and PGP_SYM_DECRYPT to read. Rotate keys regularly and store them in a Hardware Security Module (HSM) or cloud KMS.

How do I secure data in transit?

Force SSL/TLS by setting ssl = on in postgresql.conf. In pg_hba.conf, use hostssl entries only.

Which roles and privileges should I use?

Create least-privilege roles: app_reader, app_writer, and auditor. Revoke default public privileges and grant explicit SELECT/INSERT rights on necessary tables.

How do I implement Row Level Security (RLS)?

Enable RLS on PHI tables so users see only authorized rows. Combine with session variables to filter by customer or organization.

How can I produce an audit trail?

Use pgAudit to log SELECT, INSERT, UPDATE, and DELETE on PHI tables. Send logs to a centralized, immutable store such as AWS CloudWatch or Splunk.

What backup strategy is HIPAA-ready?

Schedule base backups plus WAL archiving to an encrypted object store. Test restores quarterly and keep a documented Disaster Recovery plan.

Best practices checklist

• Force TLS
• Encrypt sensitive columns
• Enable RLS
• Use pgAudit
• Rotate credentials and keys
• Test backups
• Sign a Business Associate Agreement (BAA) with hosting provider

Why How to Achieve HIPAA Compliance in PostgreSQL is important

How to Achieve HIPAA Compliance in PostgreSQL Example Usage


-- Insert an encrypted email and audited order for HIPAA compliance
BEGIN;
SET LOCAL pgaudit.log_level = 'log';
SET LOCAL app.current_customer = '17';

INSERT INTO Customers (id, name, email, created_at)
VALUES (17,
        'Dr. Meredith Grey',
        pgp_sym_encrypt('meredith@example.com', :kms_key_id, 'cipher-algo=aes256'),
        NOW());

INSERT INTO Orders (id, customer_id, order_date, total_amount)
VALUES (501, 17, NOW(), 120.00);
COMMIT;

How to Achieve HIPAA Compliance in PostgreSQL Syntax


-- Column-level encryption
UPDATE Customers
SET email = pgp_sym_encrypt(email, :kms_key_id, 'cipher-algo=aes256')
WHERE id = 42;

-- Decryption at query time
SELECT id,
       pgp_sym_decrypt(email::bytea, :kms_key_id, 'cipher-algo=aes256') AS email_plain
FROM Customers
WHERE id = 42;

-- Create least-privilege role
CREATE ROLE app_reader NOLOGIN;
GRANT CONNECT ON DATABASE ecommerce TO app_reader;
GRANT USAGE ON SCHEMA public TO app_reader;
GRANT SELECT ON Customers, Orders, Products, OrderItems TO app_reader;

-- Enable Row Level Security for Orders
ALTER TABLE Orders ENABLE ROW LEVEL SECURITY;
CREATE POLICY order_org_access ON Orders
USING (customer_id = current_setting('app.current_customer')::int);

-- Audit all writes on PHI tables
ALTER SYSTEM SET pgaudit.log = 'write,role';
SELECT pg_reload_conf();

Common Mistakes

Storing encryption keys in the same database. This defeats encryption. Fix by moving keys to an HSM or cloud KMS and referencing them through secure environment variables.
Granting broad CONNECT/USAGE rights to the public role. This exposes PHI metadata. Revoke all public privileges and grant explicit rights only to required roles.

Frequently Asked Questions (FAQs)

Do I need a BAA for self-hosted Postgres?

A BAA is required only with third-party services that may access PHI. For self-hosting on your own servers, document administrative safeguards instead.