HIPAA Compliance

ASCEND provides comprehensive HIPAA compliance for healthcare organizations managing AI agents that access Protected Health Information (PHI).

HIPAA Coverage

Rule	Status	Implementation
Privacy Rule	Compliant	PHI access controls, audit trails
Security Rule	Compliant	Technical safeguards, encryption
Breach Notification	Compliant	Incident detection, reporting
Enforcement Rule	Compliant	Policy enforcement, penalties

Security Rule Safeguards

Administrative Safeguards (164.308)

164.308(a)(1) - Security Management Process

Requirement: Implement policies and procedures to prevent, detect, contain, and correct security violations.

Ascend Implementation:

Control	Implementation	Evidence
Risk Analysis	Continuous risk assessment	Risk reports
Risk Management	Automated risk mitigation	Mitigation logs
Sanction Policy	Policy violation tracking	Violation records
Activity Review	Comprehensive audit trails	Audit logs

Risk Analysis Integration:

{
  "action_type": "phi_access",
  "risk_assessment": {
    "risk_score": 75,
    "risk_level": "high",
    "hipaa_controls": ["164.308(a)(1)(ii)(A)", "164.312(b)"],
    "recommendation": "Verify minimum necessary access",
    "requires_approval": true
  }
}

164.308(a)(3) - Workforce Security

Requirement: Implement policies and procedures to ensure appropriate access to ePHI.

Ascend Implementation:

Control	Implementation	Evidence
Authorization	Role-based PHI access	Role definitions
Clearance	Access approval workflows	Approval records
Termination	Immediate access revocation	Termination logs

Agent Authorization for PHI:

{
  "agent_id": "medical-assistant-agent",
  "phi_authorization": {
    "enabled": true,
    "access_level": "read_only",
    "allowed_data_types": ["appointment", "demographics"],
    "blocked_data_types": ["diagnosis", "treatment_notes"],
    "requires_mfa": true,
    "audit_level": "detailed"
  }
}

164.308(a)(4) - Information Access Management

Requirement: Implement policies and procedures for authorizing access to ePHI.

Ascend Implementation:

Control	Implementation	Evidence
Access Authorization	Explicit PHI grants	Authorization logs
Access Establishment	Documented access procedures	Procedure records
Access Modification	Change control workflow	Modification logs

Physical Safeguards (164.310)

164.310(d) - Device and Media Controls

Requirement: Implement policies and procedures for handling electronic media.

Ascend Implementation:

Control	Implementation	Evidence
Disposal	Secure data deletion	Disposal certificates
Media Re-use	Cryptographic erasure	Erasure logs
Accountability	Asset tracking	Inventory records
Data Backup	Encrypted backups	Backup logs

Technical Safeguards (164.312)

164.312(a) - Access Control

Requirement: Implement technical policies and procedures for electronic information systems.

Ascend Implementation:

Control	Implementation	Evidence
Unique User ID	Cognito user IDs	Identity logs
Emergency Access	Break-glass procedures	Emergency access logs
Automatic Logoff	Session timeout (15 min)	Session logs
Encryption	AES-256 at rest	Encryption config

PHI Access Control Example:

# Healthcare action types with HIPAA-specific controls
"phi_access": {
    "attack_vector": "NETWORK",
    "attack_complexity": "LOW",
    "privileges_required": "HIGH",
    "scope": "UNCHANGED",
    "confidentiality_impact": "HIGH",
    "integrity_impact": "NONE",
    "availability_impact": "NONE",
    "hipaa_control": "164.312(a)(1)"
}

164.312(b) - Audit Controls

Requirement: Implement mechanisms to record and examine activity in systems containing ePHI.

Ascend Implementation:

Control	Implementation	Evidence
Audit Logging	All PHI access logged	Audit records
Log Review	Automated log analysis	Review reports
Log Protection	Immutable audit logs	Integrity verification
Log Retention	6-year retention	Retention policy

PHI Audit Trail Structure:

{
  "audit_id": "phi_aud_20250115_143052",
  "timestamp": "2025-01-15T14:30:52Z",
  "hipaa_event_type": "phi_access",
  "user_id": 15,
  "agent_id": "medical-assistant-agent",
  "patient_id_hash": "sha256:abc123...",
  "data_accessed": ["demographics", "appointment_history"],
  "access_purpose": "appointment_scheduling",
  "minimum_necessary_verified": true,
  "authorization_method": "role_based_mfa",
  "session_id": "sess_xyz789",
  "ip_address": "10.0.1.50",
  "device_id": "dev_abc123"
}

164.312(c) - Integrity Controls

Requirement: Implement policies to protect ePHI from improper alteration or destruction.

Ascend Implementation:

Control	Implementation	Evidence
Data Validation	Input/output validation	Validation logs
Integrity Checks	Cryptographic hashing	Hash records
Change Detection	Modification alerts	Alert logs
Version Control	PHI change history	Version records

164.312(d) - Person or Entity Authentication

Requirement: Implement procedures to verify identity before granting access.

Ascend Implementation:

Control	Implementation	Evidence
User Authentication	Cognito MFA	Auth logs
Agent Authentication	API key + certificate	Auth records
Session Validation	JWT token verification	Session logs
Re-authentication	Step-up auth for PHI	Re-auth logs

164.312(e) - Transmission Security

Requirement: Implement technical security measures for ePHI transmission.

Ascend Implementation:

Control	Implementation	Evidence
Encryption	TLS 1.3	Certificate logs
Integrity Controls	HMAC signatures	Integrity logs
Network Security	VPC isolation	Network config

Healthcare Action Types

Ascend includes specialized healthcare action types with HIPAA-specific risk scoring:

PHI Access Actions

Action Type	Risk Level	HIPAA Control	CVSS Score
phi_access	High	164.312(a)(1)	6.5
phi_modify	Critical	164.312(c)(1)	8.1
phi_export	Critical	164.312(e)(1)	8.5
phi_delete	Critical	164.312(c)(1)	9.1

Clinical Actions

Action Type	Risk Level	HIPAA Control	CVSS Score
prescription_write	Critical	164.312(c)(1)	8.5
diagnosis_modify	Critical	164.312(c)(1)	8.5
lab_result_access	High	164.312(a)(1)	6.5
imaging_access	High	164.312(a)(1)	6.5

Administrative Actions

Action Type	Risk Level	HIPAA Control	CVSS Score
patient_register	Medium	164.312(a)(1)	4.5
appointment_create	Low	164.312(a)(1)	2.5
billing_access	Medium	164.312(a)(1)	5.0
insurance_verify	Medium	164.312(e)(1)	4.5

Minimum Necessary Standard

ASCEND enforces the HIPAA minimum necessary standard:

Configuration

{
  "agent_id": "medical-assistant-agent",
  "minimum_necessary": {
    "enabled": true,
    "data_scope": "task_specific",
    "field_restrictions": {
      "patient_name": "allowed",
      "date_of_birth": "allowed",
      "ssn": "blocked",
      "full_medical_history": "blocked"
    },
    "purpose_validation": true,
    "access_justification_required": true
  }
}

Enforcement

{
  "action_type": "phi_access",
  "minimum_necessary_check": {
    "passed": true,
    "requested_fields": ["patient_name", "appointment_date"],
    "allowed_fields": ["patient_name", "appointment_date"],
    "blocked_fields": [],
    "purpose": "appointment_scheduling",
    "purpose_valid": true
  }
}

Business Associate Agreement

Ascend operates as a Business Associate under HIPAA:

BAA Coverage

Aspect	Coverage
PHI Processing	Covered
PHI Storage	Covered
PHI Transmission	Covered
Subcontractor Management	Covered
Breach Notification	24-hour notification
Security Obligations	Full compliance

BAA Request

Contact compliance@owkai.app for BAA execution.

Breach Detection and Notification

Automated Breach Detection

{
  "breach_detection": {
    "enabled": true,
    "detection_types": [
      "unauthorized_phi_access",
      "bulk_phi_export",
      "phi_access_after_hours",
      "phi_access_unusual_volume",
      "phi_access_unauthorized_location"
    ],
    "alert_threshold": "immediate",
    "notification_contacts": ["hipaa-officer@company.com"]
  }
}

Breach Response Workflow

┌─────────────────────────────────────────────────────────────────┐
│                    BREACH RESPONSE WORKFLOW                      │
├─────────────────────────────────────────────────────────────────┤
│                                                                  │
│  Detection → Assessment → Containment → Notification → Remediation
│      │           │            │             │              │     │
│      │           │            │             │              │     │
│   Automated   Risk Score   Agent       60-day HHS      Root     │
│   Alerting   Calculation   Suspend     Deadline        Cause    │
│                                                                  │
└─────────────────────────────────────────────────────────────────┘

Compliance Reporting

HIPAA Audit Report

# Generate HIPAA compliance report
curl -X POST "https://pilot.owkai.app/api/compliance/export/hipaa" \
  -H "X-API-Key: your_api_key" \
  -H "Content-Type: application/json" \
  -d '{
    "period_start": "2025-01-01",
    "period_end": "2025-01-31",
    "report_type": "full_audit",
    "include_phi_access_logs": true
  }'

Report Contents

Section	Description
PHI Access Summary	All PHI access events
User Activity	User-level access patterns
Agent Activity	Agent-level PHI interactions
Risk Events	High-risk PHI access events
Policy Violations	HIPAA policy violations
Remediation Status	Violation remediation tracking

Healthcare Agent Configuration

Recommended Settings

{
  "agent_id": "healthcare-agent",
  "agent_type": "supervised",
  "hipaa_configuration": {
    "phi_access_enabled": true,
    "minimum_necessary_enforced": true,
    "access_justification_required": true,
    "mfa_required": true,
    "session_timeout_minutes": 15,
    "audit_level": "detailed",
    "allowed_phi_types": ["demographics", "appointments"],
    "blocked_phi_types": ["ssn", "full_medical_history", "mental_health"],
    "operating_hours": {
      "enabled": true,
      "start": "06:00",
      "end": "22:00",
      "timezone": "America/New_York"
    },
    "rate_limits": {
      "phi_access_per_hour": 100,
      "phi_export_per_day": 10
    }
  }
}

HIPAA Training Resources

ASCEND provides HIPAA training materials for AI governance:

Resource	Description	Access
Agent Configuration Guide	PHI access setup	Documentation
Audit Log Review	Understanding PHI audit trails	Documentation
Breach Response Playbook	Incident response procedures	On request
BAA Template	Business Associate Agreement	On request

For HIPAA compliance questions, contact compliance@owkai.app

HIPAA Coverage​

Security Rule Safeguards​

Administrative Safeguards (164.308)​

164.308(a)(1) - Security Management Process​

164.308(a)(3) - Workforce Security​

164.308(a)(4) - Information Access Management​

Physical Safeguards (164.310)​

164.310(d) - Device and Media Controls​

Technical Safeguards (164.312)​

164.312(a) - Access Control​

164.312(b) - Audit Controls​

164.312(c) - Integrity Controls​

164.312(d) - Person or Entity Authentication​

164.312(e) - Transmission Security​

Healthcare Action Types​

PHI Access Actions​

Clinical Actions​

Administrative Actions​

Minimum Necessary Standard​

Configuration​

Enforcement​

Business Associate Agreement​

BAA Coverage​

BAA Request​

Breach Detection and Notification​

Automated Breach Detection​

Breach Response Workflow​

Compliance Reporting​

HIPAA Audit Report​

Report Contents​

Healthcare Agent Configuration​

Recommended Settings​

HIPAA Training Resources​

HIPAA Coverage

Security Rule Safeguards

Administrative Safeguards (164.308)

164.308(a)(1) - Security Management Process

164.308(a)(3) - Workforce Security

164.308(a)(4) - Information Access Management

Physical Safeguards (164.310)

164.310(d) - Device and Media Controls

Technical Safeguards (164.312)

164.312(a) - Access Control

164.312(b) - Audit Controls

164.312(c) - Integrity Controls

164.312(d) - Person or Entity Authentication

164.312(e) - Transmission Security

Healthcare Action Types

PHI Access Actions

Clinical Actions

Administrative Actions

Minimum Necessary Standard

Configuration

Enforcement

Business Associate Agreement

BAA Coverage

BAA Request

Breach Detection and Notification

Automated Breach Detection

Breach Response Workflow

Compliance Reporting

HIPAA Audit Report

Report Contents

Healthcare Agent Configuration

Recommended Settings

HIPAA Training Resources