Perhaps you may want to test if Windows 2003 can give you the information you wish to view before getting a 3rd party product. Windows 2003 object access auditing has been enhanced from Windows 2000. It will show not only when a file was accessed/closed but now also records if a user actually performs a given operation while the file is open. As this informaiton is logged in the security log, it can be saved/exported for auditing purposes (quite easy to filter as well).
Yeah, I understand. Reporting can be a nightmare. I created a scripting solution myself which checks and imports log entries into an access database. I created reports in it which allowed me to filter out events in a presentable format. As all the information is in a database, my reports can generate all the information I require as I want. Took me a month to get it the way I liked. Not sure how HIPAA-savvy it is though.
For a commercial product to do all this for you, perhaps something like
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