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Electronic Submission of Medical Documentation (esMD) Digital Signature and Author of Record Pre-Discovery. Wednesday May 16, 2012. Agenda. Schedule and objectives Scope of workgroup effort Review of standards Review options as explored in other initiatives. Schedule -- Original. - PowerPoint PPT Presentation
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Electronic Submission of Medical Documentation (esMD)
Digital Signature and Author of Record Pre-Discovery
Wednesday May 16, 2012
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Agenda
1. Schedule and objectives
2. Scope of workgroup effort
3. Review of standards
4. Review options as explored in other initiatives
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Schedule -- Original
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Date Objective(s)
Wednesday, May 2nd, 2012, 10 AM (Week 1)
Identify the needs of other S&I initiatives, the community at large, and esMD
Wednesday, May 9th, 2012, 10 AM(Week 2)
Conduct a survey of options applicable to the identified needs from Week 1
Wednesday, May 16th, 2012, 10 AM(Week 3)
Identify implications and obstacles associated with the adoption of various approaches to digital authentication technologies
Schedule – Amended and Proposed
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Date Objective(s)
Wednesday, May 2nd, 2012, 10 AM (Week 1)
Identify the needs of other S&I initiatives, the community at large, and esMD
Wednesday, May 9th, 2012, 10 AM(Week 2)
Conduct a survey of details, options and approaches to meeting the specific needs from Week 1
Wednesday, May 16th, 2012, 10 AM(Week 3)
Continue with effort from Week 2 and start to identify operational, technical and cost issues associated with various solutions
Wednesday, May 23rd, 2012, 10 AM(Week 4) – new, stakeholder decision
Finish Week 3 effort and discuss priorities
Scope of workgroup effort
1. Identity proofing
2. Digital identity management
3. Encryption
4. Digital signatures
5. Delegation of Rights
6. Author of Record
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Initiative Requirement Summary
Initiative Identify Proofing Digital Identity Management
Signing(Exchange Artifact) Encryption Delegation
of RightsAuthor
of Record
DS4P Org/Individual Yes Yes Yes Yes YesDirect Project Address/Server Yes Yes Yes
esMD Org/Individual Yes Yes Yes Yes Yes
Healthcare Directories Org/Individual Yes Yes Yes Yes Audit?
LCC Org/Individual Yes Yes Yes Yes YesQuery Health Org/Individual Yes Yes YesTransitions of
Care Org/Individual Yes Yes Yes Yes
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Mandatory
Optional with consequences
Optional
Future Uses
Review of Standards and Solutions
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1. Applicable Standards (overview)
2. Option and approaches for – Identify proofing– Digital identity management– Encryption– Digital signatures– Delegation of rights– Author of Record
Approach: Examples and then group input
Relevant Standards• NIST SP 800-63, Electronic Authentication Guideline Version 1.0.1, September 2004• NIST SP 800-103, DRAFT An Ontology of Identity Credentials, Part I: Background and Formulation, Oct
6, 2066• ASTM E2595-07, Standard Guide for Privilege Management Infrastructure, 2007• ISO/IEC 27001:2005, Information technology-Security techniques-Information security management
systems-Requirements, 2005• ISO/IEC 27002 Information technology -- Security techniques -- Code of practice for information
security• ISO/TS 21091:2005, Health Informatics-Directory services for security, communications and
identification• ISO 21089 "Health Informatics - Trusted End-to-End Information Flows"• NIST FIPS PUB 201-1, Personal Identity Verification (PIV) of Federal Employees and Contractors, Mar
2006• OASIS, Security Assertion Markup Language (SAML) v2.0, March 2005• 17090-3:2008 Health informatics -- Public key infrastructure -- Part 3: Policy management of
certification authority
Additional IHE and HITSP Standards
Identity Management
IHE PWP IETF: RFC‐2181, ‐2219, ‐2782 (DNS services)
IHE PWP IETF: RFC‐2251, ‐2252, ‐2253 (LDAP)
Non-repudiation
IHE XDM IETF Cryptographic Message Syntax, RFC‐2630, ‐3852
IHE DSG ISO/TS‐17090, Health Informatics, Public Key Infrastructure
HITSP C26 ETSI Technical Specification TS 101 903: XML Advanced Electronic Signatures (XadES)
HITSP C26 ASTM Standard Guide for Electronic Authentication of Health Care Information: # E1762‐95(2003)
Secure Transmission
IHE ATNA FIPS 197, Advanced Encryption Standard
IHE ATNA FIPS PUB 180‐2 with change notice to include SHA‐224.
IHE ATNA IETF Transport Layer Security (TLS) Protocol: RFC 2246, RFC 3546
IHE BPPC IHE ITI‐TF Cross Enterprise Document Reliable Interchange (XDR)
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Summary Documents
Federal Identity, Credential, and Access Management (FICAM) Roadmap and
Implementation Guidance (ID: CSD5885)
3/5/2012
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Requirements Area
Level 1 Level 2 Level 3 Level 4
Level MajorCharacteristics
Little or no confidence in the asserted identity’s validity
Some confidence in the asserted identity’s validity
High confidence in the asserted identity’s validity
Provides highest practical remote network authentication assurance
Authentication Token
None Single-factor Multi-factor Multi-factor; requires hard cryptographic token
Components for identity proofing
Confirmation of address, telephone number, or email address of applicant
Confirmation of address or telephone number in records with voice recording
In-person presentation of two identifying documents with confirmation; fingerprint or photo taken
Background: NIST E-Authentication Guidelines SP 800-63
Note: Other security frameworks have been developed and have been used in the private sector
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National Health Information Network Exchange
Authentication performed at the Gateway (machine) level, using certificates issued at the Exchange level
Gateways generally correspond to Participants (signatories to the DURSA) which may be Federal providers or agencies, IDNs, State or Regional HIOs, etc.
Behind the Gateway, Participants implement authentication and express the result of authentication in SAML assertions
Requirements for authentication defined at a high level in the DURSA, not otherwise standardized
See background section for relevant excerpts from the DURSA
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DEA Level 3 – Factors from 800-63 Draft
Knowledge Tokens– Memorized Secret Token (password)– Pre-registered Knowledge Token (favorite ice cream flavor)– Look-up Secret Token (card with number in cells)– Out of Band Token (text message to cell phone)
Hard Tokens– Single Factor (SF) One Time Password (OTP) Device (SecureID fob)– Multi Factor (MF) OTP Device (OTP w/biometric unlock mechanism)– SF Cryptographic Device (FIPS verified crypto software)– MF Software Cryptographic Token (crypto software activated by password or biometric)– MF Cryptographic Device (crypto device activated by password or biometric)
Stringent identity proofing requirements– e.g., requires use of federally approved credential service providers (CSPs) or
certification authorities (CAs)The computer being used is not by itself a factor
A biometric adds to the factor count when activating a device but not when used directly
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Identity Proofing and Authentication: The Process
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Identity Proofing (Stakeholder)
1. Identity proofing compatible with requirements of the federal bridge (i.e. certification authorities cross-certified with the federal bridge)
2. Numerous certificate issuers have a variety of processes for ID proofing which needs to be further explored (i.e. notaries, raised seals, stamps, Lexis Nexis)
3. Identity proofing for organizations
1. Establish a responsible party within the organization taking responsibility for the information (person with authority to bind the organization, may include physical visits to verify identify)
2. Mix between individual and organization level authorization with IHEs in various states such as Oregon and Arizona
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Identity Management (Stakeholder)1. Digital certificates (X509, *assertion)
2. Work-level identity management
1. Individual level: single level/one-factor (password)
2. Within the context of an organization, an individual may be certified with a lesser approach than a digital certificate
3. General Applicability of tokens/certificates
1. One or multiple certificates/tokens per organization based on specific Use Case(s)?
2. DS4P: Requirement to be able to identify the organization and departments within an organization; therefore, multiple certificates may be needed for each organization for each department1. Individual level may be needed depending on the Use Case
16* Indicates an item added during the meeting on 5/16
Encryption (Stakeholder)1. Who
– Author– Sending System– Third party– *Authority at source
2. What – Message (i.e.- HL7 2.x transported on MLLP)– *Routing/Header– *Transport– Metadata– Payload (if content neutral message)
3. Why– Protect from inappropriate use– Avoid tampering– *Non-repudiation
4. How– Secure transmission vehicles (VPNs)– Secure transmission protocols– *TLS (AES Encryption)– *Message and Transport Mechanisms
17* Indicates an item added during the meeting on 5/16
Signing (Stakeholder)
1. Who– Author– Sending System– Third party– *Authority at the source
2. What– Message– Metadata– Payload (if content neutral message)– *Assertions (i.e.- SAML holder of key, piece of metadata that goes along with a message)
• Legal/Compliance vs. Technical
3. Why– Authenticity of a message (e.g. encrypt hash)– Authenticity of individual– As proof of identity
4. How– Operationally– Signature Artifact (characteristics)– *IHE Digital Signature Profile– *SMIME and detached signatures
18* Indicates an item added during the meeting on 5/16
Delegation of Rights (Stakeholder)
1. Who is delegating rights
2. What rights are they delegating
3. What is the process for delegation
1. *Proxy accounts for EHRs and HIEs
4. How is the delegation used and proved to a third party– e.g. Signature/Assignment Artifact (characteristics)
5. *Considerations
1. Transcriber/Nurses’ Agent vs. Author
2. Credentials of parent and proxy
3. Patient and healthcare proxy
4. Distinction between electronic and cryptographic signatures
19* Indicates an item added during the meeting on 5/16
Author of Record (Stakeholder)
1. Who is the Author– Contributor– Responsible party– Legal owner
2. What are they “signing”– Specific contribution– Final “document”– Assembled set of “documents”
3. Why– Verify authenticity of the content– Verify credentials of “author”– Legal proof of “author”
4. How– Operationally– Signature Artifact (characteristics)
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Summary (Stakeholder)
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Next Steps
• Do we want an additional call next week 5/23 10am EDT to continue the pre-discovery process
• Focus on issues and challenges• Consideration for technical, cost, regulatory, implementation and operational
issues
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