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NHIN-Direct SMTP/Email Notes

NHIN-Direct SMTP/Email Notes. 6/10/2010. Why we chose Email. Concepts match the charter exactly Implementations match the charter exactly* Well understood by end users Well understood by existing ISP industry Well understood by existing vendors

alika-tyler
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NHIN-Direct SMTP/Email Notes

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  1. NHIN-Direct SMTP/Email Notes 6/10/2010

  2. Why we chose Email • Concepts match the charter exactly • Implementations match the charter exactly* • Well understood by end users • Well understood by existing ISP industry • Well understood by existing vendors • Almost no new code - security agent only(same code that is a subset of other implementations) • ISPs can participate with their existing infrastructure and skill set

  3. Implementation Overview • Really, it’s just email. • Security agent plugged in at any point in the pipeline between Client (Source) and Server (Source HISP) • Channels can be TLS-encrypted to protect routing information SMTP, MAPI POP3, IMAP, MAPI • Email Client • EHR, PHR Email Server Email Server • Email Client • EHR, PHR SMTP S SH DH D POP3, IMAP, MAPI SMTP, MAPI

  4. Key Technologies • Content Packaging: RFC 5322 + MIME • Addressing: endpoint@domain • Security & Trust: S/MIME • HISP-HISP Transport: SMTP(S) • Client-HISP Transport: SMTP, POP3, IMAP, MAPI, etc… • Certificate distribution: DNS CERT

  5. Structure, metadata and innovation • Scalable structure • Body Text (always available, Individual Involvement) • Unstructured attachments (PDF) • Structured attachments (CCx, SCRIPT, etc.) • Explicit metadata MIME part (XDM) • Transport has proven itself over 20+ years • Innovate in the payload

  6. Security Agent • S/MIME Sign and Encrypt of messages fully supports requirements of Security & Trust Workgroup • Certificate distribution by DNS CERT records • Scalable approach to PKI Management – starts easy as TLS, adds ability to scale down to individual • HISP manages certificates • Organization manages certificates • Individual manages certificates • Ability to use across implementations demonstrates the value of taking a transport-independent approach

  7. Sample Message “On the wire” thread-index: AcsGjnbwhdd7B5CFQSuA2mgm0a8D9Q== Received: from umeshma4 ([131.107.0.72]) by nhind.hsgincubator.com with Microsoft SMTPSVC(6.0.3790.4675); Mon, 7 Jun 2010 15:12:05 -0700 Message-ID: <3854EE3793424007ADEA236042807DF0@northamerica.corp.microsoft.com> From: "Dr Biff Hooper" <biff@nhind.hsgincubator.com> To:"Dr. Alsip" <highlandclinic@securehealthemail.com>, daa858cb-a066-4c76-885f-ffa67242d6c3.9c24b165-7429-4ee2-a646-3bd7986b9968@hvnhind.hsgincubator.com Subject: Fw: Patient Referral Date: Mon, 7 Jun 2010 15:11:44 -0700 Organization: Biff's Clinic Content-Transfer-Encoding:base64 MIME-Version: 1.0 Content-Type:application/pkcs7-mime; smime-type=enveloped-data; name="smime.p7m" X-Priority: 3 X-MSMail-Priority: Normal Importance: Normal X-Mailer: Microsoft Windows Live Mail 14.0.8089.726 X-MimeOLE: Produced By Microsoft MimeOLE V6.00.3790.4657 Content-Class: urn:content-classes:message Priority: normal Return-Path: <biff@nhind.hsgincubator.com> X-OriginalArrivalTime: 07 Jun 2010 22:12:05.0717 (UTC) FILETIME=[76B95050:01CB068E] MIMDtx4GCSqGSIb3DQEHA6CDA7cOMIMDtwkCAQAxggJvMIG6AgEAMCMwFTETMBEGA1UEAxMKVU0t QU1BTEdBMQIKFmbg8QAAAAAAGDANBgkqhkiG9w0BAQEFAASBgMrVicD/tjx0ZZ0daK0nN2GMLqJg FalBuKGxe+ZZATxHxJPCD4rg80pI5vLt/s8A3sRrCrrOSniwpl1kzg6Nunlq6wz/PpK7QTVofwpt H0ZGYMRin/CxQD4tlf9YFmLuXNdvrvG7AkgRdMS7MZZzBliEdCdUZncb6qnyEf9Y1JlsMIIBrgIB ADCBlTCBhzELMAkGA1UEBhMCVVMxETAPBgNVBAgTCE1pc3NvdXJpMQ8wDQYDVQQKEwZDZXJuZXIx ... fEL7VbSd34tez2pUHCL9FbtRBWReSW1hcLEvlsJjeCBaVAKFrW6VZqzTt+M=

  8. Reliable Messaging • Store and forward model is critical in a massively distributed network – because it is likely that destinations will be unavailable • Daily issues, upgrades, disaster, remote • Ability to route across intermediate hops will be important in a heterogeneous network • Corporate intranet gateways

  9. Why Existing Services Matter • Operations • Administration and provisioning • Backups • System health monitoring • Patch and upgrade process • Security history, minimal new attack surface • Multi-tenant issues worked out • Training and industry skill set • admin, NOC, customer service • Account support: quota management, billing, fraud detection, etc.

  10. Demo: Step 1 • Source: Outlook + Windows SMTP • Destination: Thunderbird + Postfix • Notes • Attached CCD document • Read receipt

  11. Demo: Step 2 • Source: Millennium + IronPort • Destination: Thunderbird + Postfix • Notes • EHR integration • Flexible attachment types

  12. Demo: Step 3 • Source: Thunderbird + Postfix • Destination: Windows Live Mail + Windows SMTP • Notes • Simple text message • Out of Office

  13. Demo: Step 4 • Source: Windows Live Mail + Windows SMTP • Destination: HealthVault & Thunderbird • Notes • Multiple recipients • Structured PHR integration

  14. Demo Technologies • Clients • Cerner Millennium • Thunderbird • Outlook • Windows Live Mail • HealthVault • DNS • Bind • Servers • Windows SMTP • Postfix • Operating Systems • Amazon EC2 • Windows Server • Linux

  15. Demo Topology

  16. Since Tuesday • Secure Exchange Solutions has successfully sent and received NHIN-D messages using the SMTP implementation • A “desktop gateway” is available that enables any currently-live mail service (Gmail, Hotmail) to be used for NHIN-D messaging • We believe that with the SMTP solution, the bar for the largest webmail providers to offer NHIN-D service is low enough that we can expect to see offerings emerge.

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