#Data Protection #HIPAA #Cloud Security #AWS #Healthcare

Cloud Security & Protection · Data Protection

Closing PHI encryption gaps for a healthtech startup — HIPAA-ready in 3 weeks

0 unencrypted data stores · HIPAA-ready on deadline

A healthtech startup had S3 buckets unencrypted, RDS encryption disabled, and no visibility into where PHI lived in their infrastructure — with 4 weeks to a HIPAA audit and no dedicated security team. Adimen ran four parallel tracks and passed the audit with zero findings on data protection.

Challenge

Built fast, audited slow. S3 buckets containing PHI were unencrypted. RDS encryption was disabled. There was no mechanism to discover where PHI existed in the infrastructure, no key management policy, and 4 weeks to a HIPAA compliance audit — with no dedicated security team to run the remediation.

Approach

Four parallel tracks over three weeks: a full encryption audit across all data stores, encryption at rest and in transit enforced for every service, AWS KMS configured with automated key rotation, and Amazon Macie + GuardDuty deployed for ongoing PHI discovery and anomaly detection. Terraform-managed throughout for reproducible compliance evidence.

Outcome

Zero unencrypted data stores. All PHI-bearing services encrypted at rest with KMS-managed keys on automated rotation. Amazon Macie providing continuous PHI discovery. HIPAA audit completed with zero findings on data protection. The entire compliance posture is now codified in Terraform and auditable from a single evidence package.

0
Unencrypted data stores — every S3 bucket, RDS instance, EBS volume, and DynamoDB table encrypted
100%
KMS key coverage — all data encrypted with customer-managed keys on automated annual rotation
48 hrs
From Macie deployment to first PHI discovery report — complete visibility into where PHI lives
3 weeks
From engagement start to HIPAA audit — all four tracks completed and evidence packaged in time

Built fast. Audited slow. Four weeks to fix it.

The startup had built their platform at speed — the product had shipped, customers were onboarding, and PHI was flowing through the system. What hadn't kept pace was the security posture. The infrastructure had been provisioned by engineers focused on shipping features, not compliance. Encryption was assumed to be "on by default" in several places where it wasn't. There was no formal inventory of which services handled PHI and no tooling to discover PHI automatically. The encryption state of data stores was unknown rather than audited.

The trigger was a HIPAA Business Associate Agreement requirement from a hospital system customer — the largest deal the startup had pursued to date. The hospital's security team required HIPAA attestation before the BAA could be signed. The startup had four weeks. They had no dedicated security team and no security engineer on staff. The CEO engaged Adimen to run the remediation and produce the audit evidence in time for the review.

Four tracks. Three weeks. One audit passed.

Full encryption audit

A systematic scan of every AWS service in the account — S3 buckets, RDS instances, EBS volumes, DynamoDB tables, Redshift clusters, and ElasticSearch domains — for encryption state. The audit found 7 S3 buckets unencrypted (2 containing confirmed PHI), RDS encryption disabled on the primary database, and 3 EBS volumes attached to application servers without encryption. This produced the remediation list for tracks 2 and 3.

Encryption at rest & in transit enforced

All 7 S3 buckets enabled with SSE-KMS, bucket policies updated to deny unencrypted PutObject requests. RDS encryption enabled (required a snapshot restore to a new encrypted instance — coordinated during a maintenance window with zero data loss). EBS volumes re-created as encrypted. TLS enforced for all inter-service communication. S3 bucket policies and RDS parameter groups managed as Terraform to prevent configuration drift.

AWS KMS with automated rotation

Customer-managed KMS keys created for each data store category (S3, RDS, EBS) with least-privilege key policies tied to specific IAM roles. Automated annual key rotation enabled on all CMKs. Key usage logging to CloudTrail enabled and verified. A key policy review process added to the quarterly security checklist. The KMS configuration — keys, policies, aliases, grants — is fully managed in Terraform and version-controlled.

PHI discovery & DLP

Amazon Macie enabled across all S3 buckets with a custom job configuration that ran the initial discovery scan within 48 hours of deployment. Macie findings confirmed the 2 PHI-bearing buckets and surfaced 1 additional bucket with potential PII that had been missed in the manual audit. GuardDuty enabled for ongoing anomaly detection — unusual data access patterns, API calls from unexpected locations. All Macie and GuardDuty findings routed to CloudWatch for alerting and to CloudTrail for audit evidence.

From exposed PHI to a fully encrypted, monitored data layer.

AWS KMS · Amazon Macie · AWS GuardDuty · CloudTrail · AWS Config · Terraform Data Stores S3 RDS EBS DynamoDB · Redshift Key Management AWS KMS Customer-managed keys Auto rotation · least-privilege PHI Alerts Macie findings → CloudWatch Threat Alerts GuardDuty → CloudWatch PHI Discovery Amazon Macie Continuous scanning · PII detection Anomaly Detection GuardDuty Unusual access · API anomalies HIPAA Audit Evidence Encryption status KMS key logs Macie findings GuardDuty report Config compliance snapshots

HIPAA audit passed. Zero findings on data protection.

0
Unencrypted data stores. Every S3 bucket, RDS instance, EBS volume, and DynamoDB table is now encrypted at rest with customer-managed KMS keys.
100%
KMS coverage. All data encrypted with CMKs on automated annual rotation — key usage logged to CloudTrail and auditable.
48 hrs
From Macie deployment to full PHI discovery report — including 1 PHI-bearing resource missed in the manual audit.
∞→0
Audit findings on data protection. The HIPAA review completed with zero findings — the BAA was signed and the hospital customer went live.

Tech stack

AWS KMS Amazon Macie AWS GuardDuty AWS S3 AWS RDS AWS EBS AWS CloudTrail AWS Config Terraform

PHI in your infrastructure and an audit coming up?
Let's get you ready — before the deadline does.

Get in touch →
← Back to Case studies