hipaa-test-patterns

hipaa-test-patterns

Reference catalog of test patterns by HIPAA Security Rule section (45 CFR §164). Pair with audit-trail-test-author for §164.312(b) audit-log requirements. Anchors: hhs.gov/hipaa and NIST SP 800-66.

When to use

• Product is a Business Associate handling PHI for a Covered Entity (or is itself a Covered Entity).
• BAA (Business Associate Agreement) signed; need test evidence.
• HIPAA risk assessment requires test coverage evidence.
• New feature touches PHI (medical records, billing, scheduling, clinical decision support).

What is PHI?

Per HHS, PHI = individually identifiable health information + created/received/maintained/transmitted by a covered entity. The 18 HIPAA identifiers per §164.514(b)(2) (Safe Harbor):

1. Name
2. Geographic subdivisions smaller than state (ZIP codes need restrictions)
3. All elements of dates (except year) for dates directly related to an individual
4. Telephone numbers
5. Vehicle identifiers + license plates
6. Fax numbers
7. Device identifiers + serial numbers
8. Email addresses
9. Web URLs
10. SSN
11. IP addresses
12. Medical record numbers
13. Biometric identifiers (fingerprints, voiceprints)
14. Health plan beneficiary numbers
15. Full-face photos + comparable images
16. Account numbers
17. Any other unique identifying number / characteristic / code
18. Certificate / license numbers

Test fixtures for HIPAA-scope systems MUST avoid these 18 identifiers (or use the synthetic-pii-generator to generate safe substitutes).

Test patterns by Security Rule section

§164.308(a)(3) - Workforce access management

def test_user_role_grants_only_minimum_necessary_phi():
    """§164.502(b) minimum necessary standard."""
    user = User.objects.create(role='billing-clerk')
    # Billing clerks access financial PHI but NOT clinical notes
    assert user.can_access(PhiType.BILLING)
    assert not user.can_access(PhiType.CLINICAL_NOTES)
    assert not user.can_access(PhiType.GENETIC_TEST_RESULTS)

§164.308(a)(5) - Workforce training

Test that training-completion is enforced before access grant:

def test_user_cannot_access_phi_without_training_completion():
    user = User.objects.create(role='nurse', hipaa_training_completed=False)
    response = client.get('/patient/123/records', headers={'Authorization': f'Bearer {user.token}'})
    assert response.status_code == 403
    assert 'training_required' in response.json()['error']

§164.310(d)(2) - Device + media disposal

def test_phi_overwritten_when_device_decommissioned():
    device = Device.objects.create(serial='ABC123', has_phi=True)
    decommission(device)
    # Device record marked as wiped + audit log entry
    device.refresh_from_db()
    assert device.status == 'wiped'
    assert device.wipe_method in ['NIST 800-88 Clear', 'NIST 800-88 Purge']
    assert AuditLog.objects.filter(action='device_wipe', subject=device.serial).exists()

§164.312(a)(1) - Access control

def test_phi_access_requires_unique_user_id():
    """§164.312(a)(2)(i) Unique User Identification — no shared accounts."""
    # System must reject login attempts on generic / shared accounts:
    response = client.post('/login', json={'username': 'admin', 'password': 'secret'})
    assert response.status_code == 403  # generic 'admin' account forbidden

§164.312(b) - Audit controls

Cross-ref audit-trail-test-author:

def test_phi_access_creates_audit_record():
    """§164.312(b): record + examine activity in info systems containing PHI."""
    user = User.objects.create(role='nurse')
    client.get(f'/patient/{patient.id}/records', headers={'Authorization': f'Bearer {user.token}'})

    audit = AuditLog.objects.filter(
        actor=user.id,
        action='phi_access',
        subject=f'patient:{patient.id}',
    ).first()
    assert audit is not None
    assert audit.timestamp is not None
    assert audit.tamper_evident_hash is not None   # required for integrity

§164.312(c)(1) - Integrity

def test_phi_modification_requires_authentication_and_audit():
    """§164.312(c)(1): protect ePHI from improper alteration / destruction."""
    user_unauth = User.objects.create(role='intake-staff')
    response = client.put(
        f'/patient/{patient.id}/records',
        json={'diagnosis': 'modified'},
        headers={'Authorization': f'Bearer {user_unauth.token}'},
    )
    assert response.status_code == 403  # intake staff cannot modify clinical
    # Even authorized modification is logged:
    user_doc = User.objects.create(role='physician')
    response = client.put(
        f'/patient/{patient.id}/records',
        json={'diagnosis': 'updated'},
        headers={'Authorization': f'Bearer {user_doc.token}'},
    )
    audit = AuditLog.objects.filter(
        action='phi_modify',
        subject=f'patient:{patient.id}',
        actor=user_doc.id,
    ).first()
    assert audit.before_value == 'original'
    assert audit.after_value == 'updated'

§164.312(e)(1) - Transmission security

def test_phi_transmitted_only_via_encrypted_channels():
    """§164.312(e)(2)(ii): encryption in transit for PHI."""
    # Plaintext HTTP must redirect or refuse:
    response = http_client.get('http://api.example.com/patient/123')
    assert response.status_code in [301, 308, 403]
    # HTTPS must use TLS 1.2+ + secure ciphers:
    tls_info = inspect_tls('https://api.example.com')
    assert tls_info.protocol >= 'TLSv1.2'
    assert tls_info.cipher in ALLOWED_CIPHERS

§164.502(b) - Minimum necessary standard

def test_query_returns_only_minimum_necessary_fields():
    response = client.get(
        '/patient/123/billing-summary',
        headers={'Authorization': f'Bearer {billing_clerk_token}'},
    )
    body = response.json()
    # Billing summary should NOT include clinical notes or sensitive fields:
    assert 'amount_due' in body
    assert 'insurance_provider' in body
    assert 'clinical_notes' not in body
    assert 'medications' not in body
    assert 'genetic_test_results' not in body

§164.504(e) - Business Associate Agreement scope

def test_phi_only_processed_for_baa_purposes():
    # Test fixture: BAA scope = appointment-scheduling only
    baa = BusinessAssociateAgreement.objects.get(partner='SchedulingVendor')
    assert baa.allowed_purposes == ['appointment_scheduling']

    # Vendor SHOULD NOT be able to access PHI for non-scheduling purposes:
    vendor_user = User.objects.create(employer='SchedulingVendor')
    response = client.get(
        '/patient/123/billing',
        headers={'Authorization': f'Bearer {vendor_user.token}'},
    )
    assert response.status_code == 403

Anti-patterns

Anti-pattern	Why it fails	Fix
Real PHI in test fixtures	HIPAA violation in tests	synthetic-pii-generator + de-identified data
Audit log without tamper-evidence	Logs can be modified post-incident	Hash-chain or signed-batch log integrity (§164.312(b))
Role-based access without minimum-necessary check	Over-broad access; minimum-necessary violation	Per-PHI-type test (Step §164.502(b))
Skip BAA scope tests	Vendor accesses PHI outside agreement	Step §164.504(e) scope test
Allow plaintext HTTP for PHI even in dev	Production drift; eventual leak	Always enforce HTTPS (Step §164.312(e))

Limitations

• This skill targets HIPAA Security Rule. HIPAA Privacy Rule (45 CFR §164 Subpart E) has additional requirements (use/disclosure rules, accounting of disclosures); test patterns there are use-case specific.
• HITECH Act (2009) added breach-notification + enforcement; tests intersect with §164.404 - §164.414.
• State laws (e.g., California CMIA) may add additional requirements beyond HIPAA.
• This skill doesn't replace a HIPAA risk analysis or compliance consultant.

References

• hipaa-hhs - HHS HIPAA reference
• ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164 - HIPAA regulations text (45 CFR §164)
• nist.gov/publications/sp-800-66-revision-1-introductory-resource-guide-implementing-hipaa-security - NIST SP 800-66 implementation guidance
• nist.gov/publications/sp-800-88-revision-1-guidelines-media-sanitization - NIST SP 800-88 device sanitization
• gdpr-test-patterns, ccpa-test-patterns - sister privacy-pattern catalogs
• audit-trail-test-author - §164.312(b) audit log requirements
• synthetic-pii-generator - cross-plugin: safe PHI fixture generation
• compliance-readiness-reviewer - agent