HIE Security Checklist

HIE Security Checklist

1. Mitigations & Hardening

1.1 Reverse Proxy

  • [ ] Enable HTTPS/TLS: Use strong ciphers, TLS 1.2+ (preferably 1.3). Obtain certificates from a reputable CA.

  • [ ] Hide Internal Services: Only expose necessary routes/ports; keep other service ports internal.

  • [ ] Rate Limiting / DDoS Protections: Configure throttling or use cloud-based DDoS protection.

  • [ ] HTTP to HTTPS Redirection: Force all traffic over secure channels to eliminate plain HTTP usage. (Optional additional item)

1.2 Docker Security Best Practices

  • [ ] Run Containers as Non-Root: Drop privileges in the container where possible.

  • [ ] Use Official or Trusted Base Images: Keep images patched and regularly updated.

  • [ ] Minimize Attack Surface: Use multi-stage builds and minimal base images (e.g., Alpine, Distroless).

  • [ ] Leverage Docker Swarm Secrets: Store database credentials, API keys, etc. in Docker Secrets rather than environment variables.

  • [ ] Enable Resource Limits: Limit CPU, memory, and disk I/O per container to prevent resource hogging.

  • [ ] Vulnerability Scanning: Use container scanning tools (e.g., Trivy, Clair) to detect known vulnerabilities. (Optional additional item)

1.3 Docker Swarm & Cluster Hardening

  • [ ] Lock the Swarm: (docker swarm ca --rotate + passphrase) Encrypts/locks the Swarm’s root CA key.

  • [ ] Use a Private Network for Swarm Traffic: Ensure manager/worker communications occur over a secure VLAN/VPC or VPN.

  • [ ] Control Swarm Membership: Use mutual TLS authentication; only add trusted nodes.

  • [ ] Rotate Secrets & Certificates: Regularly rotate Docker Swarm certificates to reduce exposure.

  • [ ] Enable Swarm Overlay Network Encryption: If possible, enable IPSEC encryption for container-to-container traffic. (Optional additional item)

1.4 Host & OS Hardening

  • [ ] Patch & Update: Keep Linux distributions updated with the latest security patches.

  • [ ] Limit SSH Access: Enforce key-based authentication; disable root login; consider an SSH bastion or VPN.

  • [ ] Use a Host Firewall (iptables/nftables): Whitelist only necessary inbound/outbound connections.

  • [ ] Logging & Auditing: Maintain logs at both host (syslog) and container level. Consider a centralized log aggregator (Elastic Stack, Splunk, Graylog, etc.).

  • [ ] Implement SELinux / AppArmor: Strengthen process-level isolation. (Optional additional item)

1.5 Application Security

  • [ ] Authentication & Authorization: Use strong auth (OAuth, JWT, mutual TLS) to protect HIE APIs.

  • [ ] Input Validation: Mitigate injection attacks with server-side checks, parameterized queries, strict validation.

  • [ ] Encrypt PHI at Rest: Use strong encryption (e.g., AES-256) for databases storing PHI.

  • [ ] Data Access Logging: Track who accesses PHI for audit and compliance.

  • [ ] Implement Secure Session Management: Enforce session expiration and secure cookies if relevant. (Optional additional item)


2. Infrastructure-Level Controls

2.1 Secure Networking

  • [ ] Overlay Network Encryption: Configure IPSEC encryption if using Docker Swarm overlay networks.

  • [ ] Segregate Services: Keep sensitive services (DBs, sensitive APIs) on internal networks not exposed externally.

  • [ ] Micro-Segmentation: Use firewall rules or network policies at the container level to restrict service-to-service traffic.

2.2 WAF (Web Application Firewall)

  • [ ] External WAF: If on AWS, consider AWS WAF or a third-party service like Cloudflare, F5, etc.

  • [ ] ModSecurity / Nginx WAF: If self-managed, integrate ModSecurity with Nginx or Apache.

  • [ ] Rule Customization: Tailor WAF rules for HIE traffic, filtering known exploit signatures.

2.3 IDS/IPS & Monitoring

  • [ ] Intrusion Detection: Tools like Snort, Suricata, or OSSEC to monitor for known attack signatures.

  • [ ] Container Security Monitoring: Solutions like Falco or Aqua Security to watch containers for suspicious runtime activity.

  • [ ] Log Correlation: Combine logs (reverse proxy, Docker, application, OS) for a unified intrusion detection approach.

2.4 Cloud-Specific Controls (If on AWS)

  • [ ] AWS Security Groups: Restrict inbound/outbound traffic to only what’s necessary.

  • [ ] Load Balancer: Use AWS ALB/NLB to distribute traffic and integrate with AWS WAF.

  • [ ] EBS / RDS Encryption: Use KMS-managed keys for storing data volumes and databases.

  • [ ] IAM Roles: Grant least privilege to EC2 containers and services.

  • [ ] CloudWatch / GuardDuty: Enable real-time threat detection and log analysis.

  • [ ] S3 Bucket Policies: Restrict access to logs/backups. (Optional additional item)


3. Application-Level Controls

3.1 Role-Based Access Control (RBAC)

  • [ ] Fine-Grained Permissions: Assign minimal privileges to each service/user role (e.g., read-only for certain APIs).

  • [ ] Review and Revoke: Regularly review roles/permissions and remove unnecessary access.

3.2 Auditing & Compliance

  • [ ] Audit Trails: Log every access to patient data in the HIE.

  • [ ] Compliance: Follow appropriate data handling procedures.

  • [ ] Data Retention Policies: Have a clear policy on how long to retain logs and PHI data.

  • [ ] GDPR/Local Regulations: Ensure compliance with local data protection laws.

3.3 Secure Code Practices

  • [ ] Static & Dynamic Scanning: Use SAST/DAST tools (e.g., SonarQube, OWASP ZAP) to detect code vulnerabilities.

  • [ ] Dependency Updates: Keep third-party libraries current; track vulnerabilities with Dependabot, Snyk, Renovate, etc.

  • [ ] API Rate Limiting: Limit requests per time unit per client to prevent abuse or accidental overuse.


4. Advanced Security Capabilities (Next Steps)

4.1 Zero Trust Architecture

  • [ ] Enforce Authentication/Authorization for every connection, including internal microservices.

  • [ ] Short-Lived Certificates or Tokens: Rotate credentials frequently to reduce risk.

  • [ ] Secure Service Discovery: Ensure internal services only discover/connect with authorized peers. (Optional additional item)

4.2 Service Mesh

  • [ ] Mutual TLS: Use a service mesh (Istio, Linkerd, etc.) to provide mTLS for inter-service communication.

  • [ ] Policy Enforcement (RBAC): Enforce fine-grained RBAC policies at the mesh/network layer.

  • [ ] Advanced Observability: Use mesh telemetry for improved monitoring and troubleshooting.

4.3 Secrets & Key Management

  • [ ] Dedicated Secrets Manager: Store secrets in Vault, AWS Secrets Manager, or an HSM.

  • [ ] Regular Key Rotation: Rotate encryption keys, TLS certificates, and credentials on a set schedule (e.g., every 90 days).

  • [ ] Access Controls on Secrets: Strictly limit which services/roles can fetch specific secrets. (Optional additional item)

4.4 Continuous Security Testing

  • [ ] Penetration Testing: Regularly test the environment/applications to uncover vulnerabilities.

  • [ ] Chaos Engineering (Security-Focused): Simulate node failures, container breakouts, or other attacks to test detection and recovery.

  • [ ] Continuous Integration Checks: Automate scanning of images, code, and dependencies in CI/CD pipelines.


Tip: Regularly review and refine this checklist to keep pace with evolving threats, changes in your HIE setup, and any new regulatory requirements.

1. Mitigations & Hardening

1.1 Reverse Proxy

  • [ ] Enable HTTPS/TLS: Use strong ciphers, TLS 1.2+ (preferably 1.3). Obtain certificates from a reputable CA.

  • [ ] Hide Internal Services: Only expose necessary routes/ports; keep other service ports internal.

  • [ ] Rate Limiting / DDoS Protections: Configure throttling or use cloud-based DDoS protection.

  • [ ] HTTP to HTTPS Redirection: Force all traffic over secure channels to eliminate plain HTTP usage. (Optional additional item)

1.2 Docker Security Best Practices

  • [ ] Run Containers as Non-Root: Drop privileges in the container where possible.

  • [ ] Use Official or Trusted Base Images: Keep images patched and regularly updated.

  • [ ] Minimize Attack Surface: Use multi-stage builds and minimal base images (e.g., Alpine, Distroless).

  • [ ] Leverage Docker Swarm Secrets: Store database credentials, API keys, etc. in Docker Secrets rather than environment variables.

  • [ ] Enable Resource Limits: Limit CPU, memory, and disk I/O per container to prevent resource hogging.

  • [ ] Vulnerability Scanning: Use container scanning tools (e.g., Trivy, Clair) to detect known vulnerabilities. (Optional additional item)

1.3 Docker Swarm & Cluster Hardening

  • [ ] Lock the Swarm: (docker swarm ca --rotate + passphrase) Encrypts/locks the Swarm’s root CA key.

  • [ ] Use a Private Network for Swarm Traffic: Ensure manager/worker communications occur over a secure VLAN/VPC or VPN.

  • [ ] Control Swarm Membership: Use mutual TLS authentication; only add trusted nodes.

  • [ ] Rotate Secrets & Certificates: Regularly rotate Docker Swarm certificates to reduce exposure.

  • [ ] Enable Swarm Overlay Network Encryption: If possible, enable IPSEC encryption for container-to-container traffic. (Optional additional item)

1.4 Host & OS Hardening

  • [ ] Patch & Update: Keep Linux distributions updated with the latest security patches.

  • [ ] Limit SSH Access: Enforce key-based authentication; disable root login; consider an SSH bastion or VPN.

  • [ ] Use a Host Firewall (iptables/nftables): Whitelist only necessary inbound/outbound connections.

  • [ ] Logging & Auditing: Maintain logs at both host (syslog) and container level. Consider a centralized log aggregator (Elastic Stack, Splunk, Graylog, etc.).

  • [ ] Implement SELinux / AppArmor: Strengthen process-level isolation. (Optional additional item)

1.5 Application Security

  • [ ] Authentication & Authorization: Use strong auth (OAuth, JWT, mutual TLS) to protect HIE APIs.

  • [ ] Input Validation: Mitigate injection attacks with server-side checks, parameterized queries, strict validation.

  • [ ] Encrypt PHI at Rest: Use strong encryption (e.g., AES-256) for databases storing PHI.

  • [ ] Data Access Logging: Track who accesses PHI for audit and compliance.

  • [ ] Implement Secure Session Management: Enforce session expiration and secure cookies if relevant. (Optional additional item)


2. Infrastructure-Level Controls

2.1 Secure Networking

  • [ ] Overlay Network Encryption: Configure IPSEC encryption if using Docker Swarm overlay networks.

  • [ ] Segregate Services: Keep sensitive services (DBs, sensitive APIs) on internal networks not exposed externally.

  • [ ] Micro-Segmentation: Use firewall rules or network policies at the container level to restrict service-to-service traffic.

2.2 WAF (Web Application Firewall)

  • [ ] External WAF: If on AWS, consider AWS WAF or a third-party service like Cloudflare, F5, etc.

  • [ ] ModSecurity / Nginx WAF: If self-managed, integrate ModSecurity with Nginx or Apache.

  • [ ] Rule Customization: Tailor WAF rules for HIE traffic, filtering known exploit signatures.

2.3 IDS/IPS & Monitoring

  • [ ] Intrusion Detection: Tools like Snort, Suricata, or OSSEC to monitor for known attack signatures.

  • [ ] Container Security Monitoring: Solutions like Falco or Aqua Security to watch containers for suspicious runtime activity.

  • [ ] Log Correlation: Combine logs (reverse proxy, Docker, application, OS) for a unified intrusion detection approach.

2.4 Cloud-Specific Controls (If on AWS)

  • [ ] AWS Security Groups: Restrict inbound/outbound traffic to only what’s necessary.

  • [ ] Load Balancer: Use AWS ALB/NLB to distribute traffic and integrate with AWS WAF.

  • [ ] EBS / RDS Encryption: Use KMS-managed keys for storing data volumes and databases.

  • [ ] IAM Roles: Grant least privilege to EC2 containers and services.

  • [ ] CloudWatch / GuardDuty: Enable real-time threat detection and log analysis.

  • [ ] S3 Bucket Policies: Restrict access to logs/backups. (Optional additional item)


3. Application-Level Controls

3.1 Role-Based Access Control (RBAC)

  • [ ] Fine-Grained Permissions: Assign minimal privileges to each service/user role (e.g., read-only for certain APIs).

  • [ ] Review and Revoke: Regularly review roles/permissions and remove unnecessary access.

3.2 Auditing & Compliance

  • [ ] Audit Trails: Log every access to patient data in the HIE.

  • [ ] Compliance: Follow appropriate data handling procedures.

  • [ ] Data Retention Policies: Have a clear policy on how long to retain logs and PHI data.

  • [ ] GDPR/Local Regulations: Ensure compliance with local data protection laws.

3.3 Secure Code Practices

  • [ ] Static & Dynamic Scanning: Use SAST/DAST tools (e.g., SonarQube, OWASP ZAP) to detect code vulnerabilities.

  • [ ] Dependency Updates: Keep third-party libraries current; track vulnerabilities with Dependabot, Snyk, Renovate, etc.

  • [ ] API Rate Limiting: Limit requests per time unit per client to prevent abuse or accidental overuse.


4. Advanced Security Capabilities (Next Steps)

4.1 Zero Trust Architecture

  • [ ] Enforce Authentication/Authorization for every connection, including internal microservices.

  • [ ] Short-Lived Certificates or Tokens: Rotate credentials frequently to reduce risk.

  • [ ] Secure Service Discovery: Ensure internal services only discover/connect with authorized peers. (Optional additional item)

4.2 Service Mesh

  • [ ] Mutual TLS: Use a service mesh (Istio, Linkerd, etc.) to provide mTLS for inter-service communication.

  • [ ] Policy Enforcement (RBAC): Enforce fine-grained RBAC policies at the mesh/network layer.

  • [ ] Advanced Observability: Use mesh telemetry for improved monitoring and troubleshooting.

4.3 Secrets & Key Management

  • [ ] Dedicated Secrets Manager: Store secrets in Vault, AWS Secrets Manager, or an HSM.

  • [ ] Regular Key Rotation: Rotate encryption keys, TLS certificates, and credentials on a set schedule (e.g., every 90 days).

  • [ ] Access Controls on Secrets: Strictly limit which services/roles can fetch specific secrets. (Optional additional item)

4.4 Continuous Security Testing

  • [ ] Penetration Testing: Regularly test the environment/applications to uncover vulnerabilities.

  • [ ] Chaos Engineering (Security-Focused): Simulate node failures, container breakouts, or other attacks to test detection and recovery.

  • [ ] Continuous Integration Checks: Automate scanning of images, code, and dependencies in CI/CD pipelines.


Tip: Regularly review and refine this checklist to keep pace with evolving threats, changes in your HIE setup, and any new regulatory requirements.