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AWS in Regulated Environments

AWS for regulated cloud — HIPAA, FedRAMP, PCI built in

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Compliance Context

What Regulated Teams Get Wrong with AWS

AWS operates under a shared responsibility model that is frequently misunderstood in regulated engagements: AWS secures the infrastructure; the customer secures everything running on it. In HIPAA-governed deployments, a Business Associate Agreement (BAA) with AWS covers only specific services — S3, RDS, EC2, ECS, Lambda, and others — but not all AWS services. Using an AWS service outside the BAA scope for PHI processing is a HIPAA violation regardless of how secure the service is. FedRAMP deployments must use AWS GovCloud (US) regions, which are physically and logically separate from commercial AWS regions — an architectural constraint that affects every service selection, deployment pipeline, and network topology decision. GDPR data residency requirements under Article 44 prohibit transferring personal data to regions outside the EU/EEA without specific legal mechanisms — S3 bucket replication policies, CloudFront distribution configurations, and RDS read replica placement all have GDPR implications that teams frequently miss. FIPS-140-2 validated endpoints are required for FedRAMP and some HIPAA deployments — AWS provides FIPS endpoints for most services, but they must be explicitly configured; the standard endpoints do not use FIPS-validated cryptographic modules. In PCI DSS environments, VPC network segmentation must isolate the cardholder data environment (CDE) from all other systems, with Security Group rules documented and justified at the individual rule level.

Common Mistakes
Using AWS services outside the HIPAA BAA scope for PHI — Cognito, SES, and SNS have had historical BAA exclusions
Provisioning resources in commercial regions instead of GovCloud for FedRAMP — a fundamental architecture violation
S3 bucket replication to non-EU regions for GDPR-scoped data — GDPR Article 44 requires adequacy decisions for transfers
Using standard AWS API endpoints instead of FIPS endpoints in FedRAMP or FISMA deployments
Security Groups with overly broad ingress rules justified as "temporary" — temporary becomes permanent in production
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How We Use It

AWS in Our Regulated Engagements

We configure AWS environments for regulated workloads from a compliance-first architecture baseline. HIPAA deployments start with HIPAA-eligible service selection, BAA confirmation, and a tagging strategy that marks every resource handling PHI for audit and access control purposes. We implement VPC configurations with private subnets for all data-tier resources, VPC Flow Logs enabled and shipped to a compliance-dedicated log account, CloudTrail enabled in all regions with log file validation, and AWS Config rules enforcing the compliance baseline continuously. For FedRAMP deployments, we architect exclusively within GovCloud with FIPS endpoint configuration across all services. S3 bucket policies enforce encryption at rest, disable public access at the account level, and implement Object Lock for immutable audit logs. IAM policies follow least-privilege with Conditions that restrict access to specific VPCs, IP ranges, and time windows where the regulatory framework permits.

Cloud Infrastructure & MigrationCompliance Infrastructure
Governance

Compliance Enforcement at the Code Level

AWS governance in our engagements is enforced through infrastructure-as-code, AWS Config rules, and SentienGuard continuous monitoring. Every AWS resource is provisioned through Terraform with compliance-validated module configurations — no manual console operations in regulated accounts. AWS Config rules monitor for drift from the compliance baseline: public S3 buckets, Security Groups with 0.0.0.0/0 ingress, unencrypted EBS volumes, CloudTrail disabled, and RDS instances without Multi-AZ are all detected within minutes of creation. SentienGuard integrates with AWS Config and CloudTrail to correlate infrastructure events with audit requirements, generating compliance evidence automatically. IAM Access Analyzer monitors for external access grants continuously. Guard Duty is enabled in all regions for threat detection.

A
ALICE — Autonomous Compliance Engine

ALICE validates every commit against the applicable regulatory framework before it merges. Compliance violations are caught at the commit level — not in production, not in an audit finding.

Production Scenario

In Production

A regional hospital system engaged us to migrate their on-premises EHR infrastructure to AWS under HIPAA BAA. The engagement covered 14 production systems, 3 data warehouses, and a real-time HL7 integration layer. We delivered the migration in 16 weeks with full HIPAA technical safeguard configuration: end-to-end encryption, VPC isolation, audit logging, and BAA-eligible service selection throughout. The hospital's compliance team used the AWS Config compliance report and CloudTrail audit export for their next HIPAA risk assessment. No audit findings were issued against the AWS infrastructure layer.

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HIPAA on AWS — Technical Safeguards Checklist

HIPAA BAA service selection, FedRAMP GovCloud architecture, and GDPR data residency configuration for AWS-hosted regulated workloads.

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