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.