Building HIPAA-Compliant Healthcare Applications with Next.js
A practical guide for developers entering the healthcare tech space
Healthcare technology is experiencing unprecedented growth, with digital health funding reaching record highs and hospitals rapidly adopting modern web applications. As a developer looking to break into this space, understanding how to build secure, compliant, and performant healthcare applications is essential.
In this post, I'll explore why Next.js has emerged as a compelling choice for healthcare applications and walk through key considerations when building for this highly regulated industry.
Why Next.js for Healthcare Applications?
Healthcare applications have unique requirements that make framework choice critical:
Performance is patient safety. When clinicians access patient records, medication lists, or lab results, delays aren't just inconvenient—they can impact care decisions. Next.js's server-side rendering (SSR) and static site generation (SSG) capabilities ensure fast initial page loads, critical in high-pressure clinical environments.
Security isn't optional. Healthcare applications handle Protected Health Information (PHI) and must comply with HIPAA regulations. Next.js provides server-side capabilities that keep sensitive data processing away from the client, reducing attack surface area.
Scalability matters. Healthcare systems need to handle varying loads, from routine administrative tasks to emergency department surges. Next.js's architecture scales elegantly with edge computing and API routes that can be deployed serverlessly.
Key Architectural Decisions
1. Authentication and Authorization
Healthcare applications require robust authentication with role-based access control (RBAC). Here's a typical architecture:
// middleware.ts
import { NextResponse } from 'next/server'
import type { NextRequest } from 'next/server'
export function middleware(request: NextRequest) {
const token = request.cookies.get('session')?.value
// Verify session server-side only
if (!token && !request.nextUrl.pathname.startsWith('/login')) {
return NextResponse.redirect(new URL('/login', request.url))
}
return NextResponse.next()
}
export const config = {
matcher: ['/dashboard/:path*', '/patients/:path*', '/admin/:path*']
}
Critical considerations:
Never store PHI in client-side cookies or localStorage
Implement session timeouts (typically 15-30 minutes for HIPAA compliance)
Use secure, httpOnly cookies for session management
Audit all access to PHI with server-side logging
2. Data Handling with Server Components
Next.js 14's Server Components are particularly valuable for healthcare applications because they allow you to fetch and process sensitive data entirely on the server:
// app/patients/[id]/page.tsx
import { getPatientData } from '@/lib/db'
import { PatientDashboard } from '@/components/PatientDashboard'
// This is a Server Component - data never touches the client
export default async function PatientPage({
params
}: {
params: { id: string }
}) {
// Fetch sensitive data on the server
const patient = await getPatientData(params.id)
// Only pass necessary, sanitized data to client components
return <PatientDashboard
patientName={patient.name}
lastVisit={patient.lastVisit}
// Never pass SSN, full medical history, etc.
/>
}
Best practices:
Default to Server Components for pages handling PHI
Use Client Components only when interactivity requires it
Implement the principle of least privilege—send minimal data to the client
Sanitize data before passing to client components
3. API Routes and Data Validation
Healthcare data must be validated rigorously. Here's an example using Zod for schema validation:
// app/api/appointments/route.ts
import { z } from 'zod'
import { NextRequest, NextResponse } from 'next/server'
const appointmentSchema = z.object({
patientId: z.string().uuid(),
providerId: z.string().uuid(),
appointmentDate: z.string().datetime(),
appointmentType: z.enum(['FOLLOW_UP', 'NEW_PATIENT', 'URGENT']),
notes: z.string().max(1000).optional()
})
export async function POST(request: NextRequest) {
try {
const body = await request.json()
// Validate input
const validatedData = appointmentSchema.parse(body)
// Verify authorization
const session = await getSession(request)
if (!canScheduleAppointment(session.userId, validatedData.patientId)) {
return NextResponse.json(
{ error: 'Unauthorized' },
{ status: 403 }
)
}
// Process appointment
const appointment = await createAppointment(validatedData)
// Audit log for HIPAA compliance
await logAccess({
userId: session.userId,
action: 'CREATE_APPOINTMENT',
patientId: validatedData.patientId,
timestamp: new Date()
})
return NextResponse.json({ appointment })
} catch (error) {
if (error instanceof z.ZodError) {
return NextResponse.json(
{ error: 'Invalid input', details: error.errors },
{ status: 400 }
)
}
// Log error but don't expose internal details
console.error('Appointment creation failed:', error)
return NextResponse.json(
{ error: 'Internal server error' },
{ status: 500 }
)
}
}
4. Real-Time Features with Caution
Many healthcare applications need real-time updates (lab results, vital signs monitoring, messaging). However, real-time connections introduce security considerations:
Considerations:
Authenticate WebSocket connections
Encrypt all real-time data transmission (WSS, not WS)
Implement message size limits
Consider using Server-Sent Events (SSE) for one-way updates
HIPAA Compliance Checklist
When building healthcare applications with Next.js:
Technical safeguards:
✅ Enable HTTPS everywhere (use Vercel's automatic SSL or configure custom certificates)
✅ Implement encryption at rest for databases containing PHI
✅ Use secure session management with automatic timeouts
✅ Enable audit logging for all PHI access
✅ Implement IP allowlisting for administrative functions
✅ Use environment variables for sensitive configuration (never commit secrets)
Development practices:
✅ Sign Business Associate Agreements (BAA) with all vendors handling PHI
✅ Conduct regular security audits and penetration testing
✅ Implement role-based access control (RBAC)
✅ Create data breach response procedures
✅ Train team members on HIPAA requirements
Next.js specific:
✅ Disable client-side logging of sensitive data in production
✅ Configure
next.config.jssecurity headers:
// next.config.js
module.exports = {
async headers() {
return [
{
source: '/:path*',
headers: [
{
key: 'X-Frame-Options',
value: 'DENY'
},
{
key: 'X-Content-Type-Options',
value: 'nosniff'
},
{
key: 'Strict-Transport-Security',
value: 'max-age=31536000; includeSubDomains'
},
{
key: 'Content-Security-Policy',
value: "default-src 'self'; script-src 'self'; style-src 'self' 'unsafe-inline';"
}
]
}
]
}
}
Integration Patterns
Healthcare applications rarely exist in isolation. They need to integrate with:
Electronic Health Records (EHR):
HL7 FHIR APIs are becoming the standard
Use Next.js API routes as an abstraction layer
Implement retry logic and error handling for external API calls
Laboratory Information Systems:
Often use HL7 v2 messaging (older but still common)
Consider a separate service for HL7 parsing, expose REST API to Next.js
Payment processors:
Separate billing data from clinical data where possible
Use PCI-compliant payment gateways
Performance Optimization for Clinical Workflows
Clinical users have different performance needs than typical web users:
// app/patients/page.tsx
import Link from 'next/link'
export default function PatientList({ patients }) {
return (
<div>
{patients.map(patient => (
<Link
key={patient.id}
href={`/patients/${patient.id}`}
prefetch={true} // Prefetch patient pages
>
{patient.name}
</Link>
))}
</div>
)
}
'use client'
async function updateVitalSigns(patientId, vitals) {
// Update UI immediately
setVitals(vitals)
try {
await fetch(`/api/patients/${patientId}/vitals`, {
method: 'POST',
body: JSON.stringify(vitals)
})
} catch (error) {
// Revert on failure
setVitals(previousVitals)
showError('Failed to save vital signs')
}
}
Use ISR for reference data:
// app/medications/page.tsx
export const revalidate = 3600 // Revalidate every hour
export default async function MedicationDatabase() {
const medications = await getMedicationList()
return <MedicationTable data={medications} />
}
Testing Healthcare Applications
Healthcare applications require rigorous testing:
Unit tests for validation logic:
// __tests__/validation.test.ts
import { validatePatientData } from '@/lib/validation'
describe('Patient data validation', () => {
it('should reject invalid MRN format', () => {
expect(() => {
validatePatientData({ mrn: 'INVALID' })
}).toThrow('Invalid MRN format')
})
it('should sanitize input to prevent XSS', () => {
const result = validatePatientData({
notes: '<script>alert("xss")</script>'
})
expect(result.notes).not.toContain('<script>')
})
})
Integration tests for API routes:
// __tests__/api/appointments.test.ts
import { POST } from '@/app/api/appointments/route'
describe('Appointment API', () => {
it('should require authentication', async () => {
const request = new Request('http://localhost/api/appointments', {
method: 'POST',
body: JSON.stringify({ /* data */ })
})
const response = await POST(request)
expect(response.status).toBe(401)
})
})
End-to-end tests for critical workflows: Use Playwright or Cypress to test complete user journeys like appointment scheduling, medication ordering, and result viewing.
Deployment Considerations
Environment separation:
Development: Local with test data
Staging: Production-like environment with synthetic PHI
Production: Fully HIPAA-compliant infrastructure
Monitoring and alerting:
Track API latency (critical for clinical decision support)
Monitor error rates
Alert on authentication failures (potential security incidents)
Log audit trails to immutable storage
Recommended platforms:
Vercel Enterprise (offers BAA for HIPAA compliance)
AWS with proper configuration (EC2, RDS with encryption, CloudWatch)
Azure Health Data Services (built for healthcare)
Common Pitfalls to Avoid
❌ Storing PHI in client-side storage localStorage, sessionStorage, and IndexedDB are not HIPAA-compliant storage locations.
❌ Over-fetching data Only query and return the minimum data needed for the current user and context.
❌ Insufficient logging HIPAA requires audit logs of all PHI access. Implement comprehensive logging from day one.
❌ Weak password policies Healthcare applications need strong authentication—implement MFA and password complexity requirements.
❌ Ignoring mobile Many clinicians use tablets and phones. Ensure your Next.js app is responsive and performant on mobile devices.
Conclusion
Building healthcare applications with Next.js combines the framework's excellent developer experience with the rigorous security and compliance requirements of the healthcare industry. The framework's flexibility—from server components for secure data handling to API routes for integrations—makes it well-suited for healthcare use cases.
Key takeaways:
Default to server-side rendering for PHI handling
Implement defense-in-depth security practices
Prioritize performance for clinical workflows
Maintain comprehensive audit logs
Partner with HIPAA-compliant vendors
As healthcare continues its digital transformation, developers with both technical expertise and healthcare domain knowledge will be increasingly valuable. Whether you're building patient portals, clinical decision support tools, or telemedicine platforms, Next.js provides a solid foundation for modern healthcare applications.
Have you built healthcare applications with Next.js? What challenges did you encounter? Let's discuss in the comments below.
