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Here's what LUKE Health actually implements: AES-256 field-level encryption with per-tenant keys not just TLS in transit PostgreSQL Row-Level Security enforcing tenant isolation at the database layer, not application logic SHA-256 hash-chained audit logs tamper-proof by design, not by policy Automated breach detection monitoring bulk PHI access, after-hours activity, failed auth spikes, and unauthorized access patterns Crypto-shredding for instant, verified data destruction when required Multi-state provider licensing support baked into the clinical workflow For peptide therapy clinics operating across state lines with telehealth, multi-state licensing support isn't optional it's the difference between a scalable practice and a compliance nightmare