A Technical Survey of Fine-Grained Temporal Access Control Models in SQL Databases for HIPAA-Compliant Healthcare Information Systems

Abstract

As healthcare information systems continue to evolve under stringent privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA), the need for precise and time-aware access control mechanisms in SQL-based environments has grown significantly. This review provides a comprehensive survey of fine-grained temporal access control (FGTAC) models designed to support secure, auditable, and policy-driven data access within relational databases used in healthcare. It investigates core architectural components, such as time-interval constraints, role-based access overlays, attribute-based access controls (ABAC), and query rewriting techniques that enforce temporal policies. The paper further categorizes FGTAC schemes based on their adaptability to dynamic access conditions, retroactive auditing, and forward looking permissions. Key challenges addressed include temporal granularity alignment with clinical workflows, performance optimization under concurrent access, and cryptographic enhancements for secure time-bound access. Case studies from HIPAA-compliant deployments illustrate the practical application of these models in real-world health IT systems, emphasizing compliance, traceability, and patient privacy preservation. This survey aims to guide researchers and system architects in designing next-generation secure database systems that effectively balance healthcare usability and privacy obligations.