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HIPAA-eligible cloud foundations
Multi-account / multi-subscription topology on HIPAA-eligible service catalogs. BAA-covered subprocessors only. ePHI boundaries explicit; audit logs continuous.
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Platform & Cloud × Healthcare & Life Sciences
Platform & Cloud for Healthcare.
HIPAA-eligible AWS / Azure / GCP foundations with explicit ePHI boundaries, IaC-backed evidence collection, and the operating discipline regulators expect — engineered for the substrate AI and clinical workloads will rest on.
- HIPAA / HITECH
- Aligned
- HITRUST CSF
- Mapped
- SOC 2 Type II
- In flight
- FedRAMP (where applicable)
- Supported
The reality
Healthcare cloud fails at ePHI boundaries, audit logging, and BAA chain — not at the infrastructure.
Healthcare cloud failure modes are uniquely unforgiving. ePHI flowing into a non-BAA-covered service is a regulatory event. Audit logs without granularity equate to no audit logs at all. A subprocessor without BAA breaks the chain. Architecture that doesn't map to HITRUST CSF controls produces a nine-month audit. Most healthcare cloud estates work in the happy path and decompose under regulatory examination.
Prosigns engineers healthcare cloud with the regulatory frame as primary scope. NEXUS handles the cloud platform; CITADEL co-pilots HIPAA scope, BAA chain, and HITRUST CSF mapping; FOUNDATION handles the data substrate. Architecture decisions land against the regulatory frame in writing before resources are provisioned. Audit pulls run in days, not weeks.
Where it ships
6 workloads, scoped to healthcare & life sciences.
Concrete applications where platform & cloud unlocks measurable value inside healthcare & life sciences delivery constraints.
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12M
FHIR resources synced
FHIR-aligned data platform
Lakehouse / warehouse on HIPAA-eligible substrate with FHIR-aligned schemas, dbt transformations, and end-to-end lineage. Substrate that AI use cases inherit.
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Clinical observability
Observability stack designed for clinical operations: SLO dashboards calibrated to patient-facing impact, on-call rotation aware of clinical urgency, IR plan rehearsed with clinical leadership in the loop.
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Medical imaging infrastructure
DICOM-native infrastructure for radiology / pathology / cardiology imaging. Edge inference where latency demands it, on-prem where sovereignty requires it.
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Migration off legacy clinical systems
Strangler-fig migration off aging clinical infrastructure with documented rollback, dual-running windows, and explicit data preservation under HIPAA frame.
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HITRUST / SOC 2 / ISO evidence pipelines
Continuous evidence collection mapping to HITRUST CSF controls, SOC 2 Trust Services Criteria, and HIPAA Security Rule. Audit pulls measured in days.
How we engage
4 phases, named in the SOW.
Each phase has a deliverable, an owner, and an acceptance criterion calibrated to healthcare & life sciences delivery.
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Regulatory frame and ePHI mapping
Discovery starts with the regulatory frame: HIPAA scope, HITRUST applicability, state-level requirements (TX HB 300, CA CMIA), and ePHI flow mapping. Architecture lands against the frame in writing.
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HIPAA-engineered architecture
Multi-account / multi-subscription topology with HIPAA-eligible services only. BAA chain documented for every subprocessor. ePHI encryption with customer-managed keys. Audit logging granularity defined before the first commit.
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IaC + policy-as-code
Terraform / Pulumi / CDK with policy-as-code (OPA, Conftest, Checkov) enforcing HIPAA-aligned guardrails in CI. Every resource lives in IaC; no untracked drift.
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Audit-defensible operations
Continuous evidence collection. Quarterly access reviews, monthly audit-log triage, IR plan rehearsed quarterly with clinical leadership. Audits pull what they need in days, not weeks.
Capabilities
What’s in scope.
- AWS / Azure / GCP HIPAA-eligible cloud foundations
- Multi-account topology with explicit ePHI boundary segmentation
- FHIR-aligned data platforms (Snowflake, Databricks, BigQuery on BAA-covered tiers)
- Medical imaging infrastructure: DICOM-native, edge / on-prem options
- Clinical observability with SLO dashboards calibrated to patient impact
- Identity model: SSO, MFA, JIT elevated access, quarterly access reviews
- HITRUST CSF / SOC 2 / HIPAA evidence pipelines (Vanta, Drata, custom)
- Migration off legacy clinical systems with documented rollback
Stack
Tools we use in production.
- Clouds (HIPAA BAA)
- AWS (HIPAA-eligible)Azure (HIPAA BAA)GCP (HIPAA BAA)
- IaC
- TerraformPulumiAWS CDKBicep
- Identity
- AWS IAM Identity CenterMicrosoft Entra IDOkta
- Data platform (BAA)
- Snowflake (BAA)Databricks (BAA)AWS Lake Formation
- Observability
- Datadog (BAA)OpenTelemetrySplunkAWS CloudWatch
- Compliance automation
- VantaDrataCustom evidence pipelinesAWS Audit Manager
Compliance overlay
Frameworks we engineer to.
Every healthcare & life sciences engagement carries the evidence collection that procurement and audit teams expect on day one.
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HIPAA Security & Privacy Rules
Administrative, physical, and technical safeguards mapped to architectural components. BAA-covered subprocessors only. Documented risk analysis, incident response, workforce training, access reviews. Encryption at rest with customer-managed keys.
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HITRUST CSF
Architectural decisions mapped to HITRUST CSF controls. Continuous evidence collection across the control set. CSF self-assessment or third-party-validated assessment supported.
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SOC 2 Type II
Continuous evidence collection — control activity logs, change-management artifacts, access reviews, vendor risk records. Audits pull what they need in days. First-attempt audit pass rate: 100%.
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State-level supervision
TX HB 300, CA CMIA, NY SHIELD Act, and other state-level health-data laws layered on as engagement requires. Privacy threat model includes state frame from discovery.
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FedRAMP (where applicable)
For federal health workloads (VA, DoD health, CMS): FedRAMP Moderate / High alignment with AWS GovCloud or Azure Government. We partner with FedRAMP-authorized cloud providers; we don't hold our own ATO.
Selected work
Quantified outcomes, not adjectives.
Where this fits
Open the parent practice or industry hub.
Common questions
Asked before the first call.
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Can you ship on AWS GovCloud / Azure Government?
Yes — federal health workloads (VA, DoD health, CMS) commonly require AWS GovCloud or Azure Government for FedRAMP Moderate / High. We engineer to FedRAMP standards on those workloads and partner with FedRAMP-authorized providers; we don't hold our own ATO.
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How do you handle the BAA chain?
Documented end-to-end. Every subprocessor that touches ePHI signs a BAA before data flows. We maintain the BAA chain register as part of the audit pack and update it quarterly. Architecture decisions are constrained to BAA-covered services only.
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Can you migrate us off our existing on-prem clinical infrastructure?
Yes — strangler-fig migration with documented rollback per workload. Most clinical-infrastructure migrations land in 9–18 months with no benefits-payment or clinical-operations downtime. Wave plans with explicit data preservation under HIPAA frame.
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What about HITRUST CSF specifically?
Architectural decisions mapped to HITRUST CSF controls during discovery. Continuous evidence collection across the control set; CSF self-assessment or third-party-validated assessment supported. We've taken multiple healthcare clients through HITRUST validation on first attempt.
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Can you operate the platform after we ship it?
Yes — through Managed Services. Named SLOs calibrated to clinical urgency, on-call coverage 24×7, monthly FinOps and posture reviews, quarterly architectural reviews. Or hand-off with 90-day shadowing to your team.
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What does a healthcare platform engagement cost?
Architecture and ADR: 4–8 weeks, $80K–$250K. Foundation build (multi-account + first workload): 4–9 months, $400K–$1.5M. Multi-account modernization: 9–14 months, $1M–$4M. Managed Services: $40K–$200K monthly retainer.
Talk to us
Bring a platform & cloud for healthcare problem. We’ll bring a senior engineer.
A senior engineer plus the FOUNDATION + SKYWAY department lead joins the first call — both with prior healthcare & life sciences delivery experience.