HIPAA-Compliant Patient Data Encryption Middleware

Design a robust Laravel middleware that automatically encrypts and decrypts patient Personal Health Information (PHI) at the database and API transmission layers. Implement AES-256 encryption with rotating key management, ensuring each patient's data has a unique encryption key stored in a secure vault. The solution must handle automatic encryption during database writes and decryption during reads, with transparent performance monitoring and mandatory logging of all encryption/decryption events for compliance auditing.