Deploying HIPAA-Compliant Proxmox VE on Bare Metal

For organizations in healthcare and, increasingly, the AdTech space, the need for control, performance, and provable data security is an unnegotiable prerequisite. While public cloud platforms excel at general-purpose hosting, achieving compliance in those environments can be difficult—often requiring costly, bespoke HIPAA configurations.

However, numerous customers prefer custom Infrastructure-as-a-Service (IaaS) solution over cloud hosting. An environment built on HIPAA-compliant Proxmox VE and dedicated bare metal is an option for those with the skills and experience of managing private virtualized environments.

Is Proxmox HIPAA-Compliant?

Proxmox is a powerful, open-source server management virtual environment platform that bundles KVM hypervisors and LXC containers into a single, web-based interface. When you deploy Proxmox on dedicated bare metal servers, you get the “best of both worlds”: the raw performance of dedicated hardware and the flexibility of a cloud-native environment, all without the prohibitive licensing fees of proprietary alternatives.

However, installing Proxmox is relatively easy. Making it compliant is still extremely challenging. This guide will introduce Proxmox for HIPAA-Compliant environments, and discuss the key areas that must be configured so that you can build a secure, auditable, and high-performance IaaS environment to protect both Electronic Protected Health Information (ePHI) and sensitive Personally Identifiable Information (PII).

Atlantic.Net is a HIPAA-Compliant hosting provider with 30 years of experience in the IT industry. If you are considering Proxmox Bare Metal for your next deployment, get in touch.

Why Bare Metal and Proxmox for Compliance?

A Proxmox stack offers foundational advantages that not all public clouds can match. When combined with the flexibility of bare metal hosting, it becomes a very compelling offering.
Here are 4 key reasons we hear from our customers:

#1: Single-Tenant Security & Control:

The most significant compliance advantage of a bare metal deployment is ownership. There are no shared resources, so co-tenancy risks—only your environment, under your control, from the physical layer upward. This provides a strong foundation for HIPAA and GDPR compliance audits.

#2: Unrivaled Performance:

Healthcare and AdTech applications are typically very data-heavy—think multi-gigabyte PACS images or real-time bidding engines. Bare metal infrastructure allows virtual machines to access CPU cores, RAM, and NVMe storage without contention.
Proxmox’s KVM hypervisor, integrated into the Linux kernel, delivers near-native performance—crucial for latency-sensitive or compute-intensive workloads.

#3: Cost-Effective Scalability:

Proxmox is open-source. Your costs are tied to predictable hardware resources, not fluctuating vCPU charges or proprietary software licensing fees. This makes building a high-availability cluster far more economical than using products like VMware vSphere or Microsoft Hyper-V.

#4: Workload Flexibility (VMs vs. Containers):

Proxmox can be configured to provide full-stack KVM virtual machines and lightweight LXC containers in one platform. This allows you to use the right tool for the job:

• Virtual Machines: Perfect for strong security isolation and running legacy applications or different operating systems (like a Windows server for a specific medical device).
• Linux Containers: Ideal for speed and efficiency, allowing you to spin up microservices for AdTech bidding engines or modern healthcare app components in milliseconds.

Building a HIPAA-Compliant Proxmox Environment

Remember that HIPAA compliance is not a product—it’s a continuous process guided by Administrative, Physical, and Technical safeguards. A compliant IaaS must address all three. When building a HIPAA-ready Proxmox platform, these core principles need to be at the forefront of the design process.

Physical & Administrative Safeguards

Even a perfectly configured Proxmox host cannot be compliant if the underlying data center is insecure. Choose a hosting provider that has compliance built into its data center environments. You need guaranteed security and business processes to ensure data integrity.
The core safeguards include:

The Business Associate Agreement (BAA)

The BAA is non-negotiable. If a provider will not sign a BAA, you cannot use them for ePHI. A BAA is a legal contract that holds the provider accountable for the physical security of your data. As a 30-year veteran in IT, Atlantic.Net has been providing BAA-backed, HIPAA-compliant hosting from our audited data centers for decades.

Physical Security:

Your BAA ensures the provider’s data center meets HIPAA requirements: as a minimum, you require 24x7x365 security, biometric access controls, video surveillance, and secure cabinets.

Technical Safeguards

The flexibility of open-source means the responsibility for these technical safeguards remains in-house. This requires your own technical expertise to configure, manage, and monitor the environment correctly. This is your responsibility. Here’s how you configure Proxmox VE to meet HIPAA’s technical requirements.

Access Controls

Use 2FA/TFA: Enforce Two-Factor Authentication (like TOTP) for all user accounts on the Proxmox web UI, especially the root user.

Implement Role-Based Access Control (RBAC): Don’t let everyone use root. Proxmox has a granular permissions system. Create specific groups like VM-Admins, Auditors (with read-only access), and Backup-Operators. Assign users to these roles to enforce least-privilege access.
Centralize Users: Integrate Proxmox with an Active Directory, LDAP, or SAML server for centralized user management and password policies.

Audit Controls

HIPAA mandates the ability to “record and examine system activity. Forward all relevant logs—/var/log/syslog, /var/log/auth.log, and Proxmox task logs—to a centralized, write-once SIEM platform. This provides an immutable audit trail for incident analysis.

Encryption

Data at Rest: Use ZFS with native encryption during installation to protect VM and container disks automatically.
Data in Transit:

• Replace the default self-signed SSL certificate with a valid one.
• Encrypt live migration traffic (Datacenter → Options → Migration).
• Isolate cluster communication on a dedicated VLAN.
• Ensure internal VM traffic carrying ePHI or PII is encrypted using SSL/TLS, SSH, or VPN tunnels.

Secure Deployment Strategy: Segmentation is Everything

A successful HIPAA-compliant Proxmox deployment hinges on a core concept: segmentation. This is where the true flexibility of an open-source platform shines, allowing you to configure the network to your exact needs in a way that is often impossible with closed-source products.
You must build digital “locked doors” between your services. Proxmox’s built-in firewall and support for Linux bridges/VLANs are your primary tools here.

Segmented Network

Assume your Atlantic.Net bare metal server has two network interfaces:

• eno1 (Management/Cluster): This is for your Proxmox UI, SSH, and cluster traffic. It should be on a private management VLAN accessible only via a secure jump box or VPN. It should never be exposed to the public internet.
• eno2 (VM Traffic): This is for your virtual machines. This is where you create your VLAN-aware bridges.

Your network should look something like this:

By enabling the Proxmox firewall at the Datacenter level and at each VM level, you create a zero-trust environment. For Example, in this setup, a compromised web server in VLAN 30 cannot access the database in VLAN 50, because the hypervisor itself blocks the traffic before it even leaves the host.

Secure Backups & Disaster Recovery

HIPAA’s Contingency Plan requirements mandate proven backup and recovery procedures. Proxmox Backup Server (PBS) is a powerful, open-source option for this purpose:

• Deploy PBS on a separate, dedicated server with encrypted disks.
• Add it as a storage target to your Proxmox cluster.
• Schedule frequent, automated backups.
• Enable encryption at the job level to protect ePHI within backup data.
• Regularly test restore operations—an untested backup is not compliant.

If you prefer, you may be able to use a managed service from your hosting provider.

Use Cases: Healthcare and AdTech

Healthcare

• EHR/EMR Hosting: Deploy EHR systems (e.g., OpenEMR) within isolated VMs using a three-tier architecture—web, application, and database layers—each on its own VLAN.
• PACS and Imaging: Implement ZFS storage pools backed by NVMe drives for fast retrieval of large imaging files.

AdTech

• Secure Data Enclaves: Store health-related user data in encrypted VMs within a locked-down VLAN.
• High-Performance Analytics: Run short-lived, high-CPU VMs for analytics against secure data without exposing raw information.
• Low-Latency Bidding: Deploy RTB microservices in LXC containers for near-bare-metal speed while maintaining strict separation from PII databases.

Shared Responsibility and Compliance Summary

Compliance is a partnership. Even with a secure infrastructure provider, you retain responsibility for maintaining application-level security and documentation.

Your Partner in Compliance

Building a custom HIPAA-compliant Proxmox IaaS on bare metal gives you unparalleled control, performance, and security. It’s the smart, modern alternative to the public cloud, freeing you from vendor lock-in and prohibitive licensing costs. But this flexibility comes with the responsibility of technical management. However, you don’t have to do it alone.

For 30 years, Atlantic.Net has been that foundation. Our USA data centers are all SSAE 18 SOC 2/3 and HIPAA audited, and we’ve been a trusted partner for healthcare and finance industries for decades. We provide the secure bare metal, the BAA, and the 24×7 expert support—including managed services to handle the patching, security, and operations—giving you the confidence needed.

Contact our experts today to discuss your dedicated hosting or HIPAA-compliant infrastructure needs.