HIPAA-Compliant Patient Data Encryption Middleware

Design a robust Node.js middleware that automatically encrypts and decrypts sensitive patient health information (PHI) using AES-256-GCM encryption. The middleware must seamlessly integrate with existing Express.js healthcare APIs, handle dynamic encryption key rotation every 30 days, and log all cryptographic operations without exposing raw data. Include comprehensive error handling for decryption failures and implement a secure key management strategy using AWS KMS or HashiCorp Vault.