OpenEvidence Security Basics

OpenEvidence Security Basics

Overview

Security best practices for OpenEvidence integrations handling Protected Health Information (PHI) in compliance with HIPAA regulations.

Prerequisites

• OpenEvidence SDK installed
• Understanding of HIPAA requirements
• Signed Business Associate Agreement (BAA)
• Access to organization security policies

OpenEvidence Security Certifications

• SOC 2 Type II certified
• HIPAA compliant
• AES-256 encryption at rest
• TLS 1.2+ encryption in transit
• Google Cloud Platform hosted

Instructions

Step 1: Secure Credential Management

# .env (NEVER commit to git)
OPENEVIDENCE_API_KEY=oe_live_***
OPENEVIDENCE_ORG_ID=org_***
OPENEVIDENCE_WEBHOOK_SECRET=whsec_***

# .gitignore (REQUIRED)
.env
.env.local
.env.*.local
*.pem
*.key
credentials*.json

// src/​config/​secrets.ts
// Use secret manager in production (AWS Secrets Manager, GCP Secret Manager, HashiCorp Vault)
import { SecretManagerServiceClient } from '@google-cloud/​secret-manager';

const client = new SecretManagerServiceClient();

export async function getOpenEvidenceCredentials(): Promise<{
  apiKey: string;
  orgId: string;
}> {
  const [apiKeyVersion] = await client.accessSecretVersion({
    name: 'projects/​my-project/​secrets/​openevidence-api-key/​versions/​latest',
  });
  const [orgIdVersion] = await client.accessSecretVersion({
    name: 'projects/​my-project/​secrets/​openevidence-org-id/​versions/​latest',
  });

  return {
    apiKey: apiKeyVersion.payload!.data!.toString(),
    orgId: orgIdVersion.payload!.data!.toString(),
  };
}

Step 2: PHI Handling - Input Sanitization

// src/​openevidence/​phi-handler.ts
// IMPORTANT: OpenEvidence should NOT receive direct PHI in queries

interface SanitizedQuery {
  question: string;
  context: {
    ageRange?: string; // "65-74" not exact age
    sex?: string;
    conditionCategories?: string[]; // "cardiovascular" not specific diagnosis
  };
}

export function sanitizeQueryForOpenEvidence(
  question: string,
  patientContext?: PatientContext
): SanitizedQuery {
  // Remove any PHI that might have leaked into the question
  let sanitized = question;

  // Remove potential names
  sanitized = sanitized.replace(/\b(Mr\.|Mrs\.|Ms\.|Dr\.)\s+[A-Z][a-z]+\b/​g, '[PATIENT]');

  // Remove dates of birth
  sanitized = sanitized.replace(/\b\d{1,2}[\/\-]\d{1,2}[\/\-]\d{2,4}\b/​g, '[DATE]');

  // Remove MRNs
  sanitized = sanitized.replace(/\bMRN[:\s]*\d+\b/​gi, '[MRN]');

  // Remove SSNs
  sanitized = sanitized.replace(/\b\d{3}-\d{2}-\d{4}\b/​g, '[SSN]');

  return {
    question: sanitized,
    context: patientContext ? {
      ageRange: getAgeRange(patientContext.age),
      sex: patientContext.sex,
      conditionCategories: categorizeConditions(patientContext.conditions),
    } : undefined,
  };
}

function getAgeRange(age?: number): string | undefined {
  if (!age) return undefined;
  if (age < 18) return 'pediatric';
  if (age < 40) return '18-39';
  if (age < 65) return '40-64';
  if (age < 75) return '65-74';
  return '75+';
}

function categorizeConditions(conditions?: string[]): string[] | undefined {
  // Map specific conditions to categories
  const categoryMap: Record<string, string> = {
    'hypertension': 'cardiovascular',
    'diabetes': 'endocrine',
    'asthma': 'pulmonary',
    // ... more mappings
  };

  return conditions?.map(c => categoryMap[c.toLowerCase()] || 'other');
}

Step 3: Audit Logging (HIPAA Required)

// src/​openevidence/​audit-log.ts
interface AuditEntry {
  timestamp: Date;
  eventType: 'query' | 'deepconsult' | 'access' | 'export';
  userId: string;
  userRole: string;
  action: string;
  resourceType: 'clinical_answer' | 'research_report';
  resourceId?: string;
  ipAddress: string;
  userAgent: string;
  success: boolean;
  errorCode?: string;
  // Never log the actual query content or response - may contain PHI
}

export class HIPAAAuditLogger {
  private logStore: AuditLogStore;

  constructor(store: AuditLogStore) {
    this.logStore = store;
  }

  async logClinicalQuery(
    userId: string,
    userRole: string,
    queryId: string,
    success: boolean,
    request: Request
  ): Promise<void> {
    await this.logStore.insert({
      timestamp: new Date(),
      eventType: 'query',
      userId,
      userRole,
      action: 'clinical_query',
      resourceType: 'clinical_answer',
      resourceId: queryId,
      ipAddress: this.getClientIP(request),
      userAgent: request.headers.get('user-agent') || 'unknown',
      success,
    });
  }

  async logDeepConsult(
    userId: string,
    userRole: string,
    consultId: string,
    success: boolean,
    request: Request
  ): Promise<void> {
    await this.logStore.insert({
      timestamp: new Date(),
      eventType: 'deepconsult',
      userId,
      userRole,
      action: 'research_synthesis',
      resourceType: 'research_report',
      resourceId: consultId,
      ipAddress: this.getClientIP(request),
      userAgent: request.headers.get('user-agent') || 'unknown',
      success,
    });
  }

  private getClientIP(request: Request): string {
    // Handle proxies
    const forwarded = request.headers.get('x-forwarded-for');
    if (forwarded) return forwarded.split(',')[0].trim();
    return 'unknown';
  }
}

Step 4: Webhook Signature Verification

// src/​openevidence/​webhook-security.ts
import crypto from 'crypto';

export function verifyWebhookSignature(
  payload: string | Buffer,
  signature: string,
  secret: string,
  tolerance: number = 300 // 5 minute tolerance
): boolean {
  // Parse signature header: t=timestamp,v1=signature
  const parts = signature.split(',').reduce((acc, part) => {
    const [key, value] = part.split('=');
    acc[key] = value;
    return acc;
  }, {} as Record<string, string>);

  const timestamp = parseInt(parts['t']);
  const providedSignature = parts['v1'];

  // Check timestamp to prevent replay attacks
  const now = Math.floor(Date.now() / 1000);
  if (Math.abs(now - timestamp) > tolerance) {
    console.error('Webhook timestamp too old or in future');
    return false;
  }

  // Compute expected signature
  const signedPayload = `${timestamp}.${payload}`;
  const expectedSignature = crypto
    .createHmac('sha256', secret)
    .update(signedPayload)
    .digest('hex');

  // Timing-safe comparison
  try {
    return crypto.timingSafeEqual(
      Buffer.from(providedSignature),
      Buffer.from(expectedSignature)
    );
  } catch {
    return false;
  }
}

Step 5: Data Retention Compliance

// src/​openevidence/​data-retention.ts
// HIPAA requires minimum 6-year retention of access logs

interface RetentionPolicy {
  auditLogs: number;      // days
  queryResults: number;   // days
  deepConsultReports: number; // days
}

const HIPAA_RETENTION: RetentionPolicy = {
  auditLogs: 2190,        // 6 years
  queryResults: 0,        // Do not store (re-query as needed)
  deepConsultReports: 365, // 1 year (user can re-run)
};

export class DataRetentionManager {
  constructor(private policy: RetentionPolicy = HIPAA_RETENTION) {}

  async cleanupExpiredData(): Promise<CleanupReport> {
    const cutoffs = {
      auditLogs: new Date(Date.now() - this.policy.auditLogs * 24 * 60 * 60 * 1000),
      deepConsultReports: new Date(Date.now() - this.policy.deepConsultReports * 24 * 60 * 60 * 1000),
    };

    // Note: Audit logs should be archived, not deleted
    const archivedLogs = await db.auditLogs.archive({
      where: { timestamp: { lt: cutoffs.auditLogs } },
    });

    const deletedReports = await db.deepConsultReports.deleteMany({
      where: { createdAt: { lt: cutoffs.deepConsultReports } },
    });

    return {
      auditLogsArchived: archivedLogs.count,
      reportsDeleted: deletedReports.count,
      executedAt: new Date(),
    };
  }
}

Security Checklist

• API keys stored in secret manager (not env vars in production)
• BAA signed with OpenEvidence
• PHI sanitization before sending queries
• Audit logging enabled for all access
• Webhook signatures verified
• TLS 1.2+ enforced
• IP allowlist configured (if available)
• Different keys for dev/​staging/​prod
• Key rotation schedule established
• Data retention policy implemented

Output

• Secure credential management
• PHI sanitization layer
• HIPAA-compliant audit logging
• Webhook signature verification
• Data retention compliance

Error Handling

Examples

Secure Query Service

const auditLogger = new HIPAAAuditLogger(auditStore);

export async function secureClinicaQuery(
  question: string,
  patientContext: PatientContext | undefined,
  user: AuthenticatedUser,
  request: Request
): Promise<ClinicalResponse> {
  // 1. Sanitize input
  const sanitized = sanitizeQueryForOpenEvidence(question, patientContext);

  // 2. Make query
  const response = await client.query({
    question: sanitized.question,
    context: {
      specialty: 'internal-medicine',
      urgency: 'routine',
      ...sanitized.context,
    },
  });

  // 3. Audit log
  await auditLogger.logClinicalQuery(
    user.id,
    user.role,
    response.id,
    true,
    request
  );

  return response;
}

Resources

• OpenEvidence Security
• HIPAA Security Rule
• NIST Cybersecurity Framework

Next Steps

For production deployment, see openevidence-prod-checklist.