Identity and Access Management for HIPAA: Technology Model

1. Identity and Access Management for HIPAA: Technology Model William A. Weems Assistant Vice President Academic Technology The University of Texas Health Science Center at Houston

2. Middleware Makes the Global Sharing of Resources Invisible to Users.

3. Increasingly, people must easily and securely exchange information in cyberspace among "known" individuals and to securely access restricted resources they “know” can be trusted without having to struggle with numerous and onerous security processes. 3

4. How do you prove you are who you say you are? • How do you know that someone is legitimate in his or her dealings with you, and how do you get redress if things go wrong? • If your identity is stolen and used fraudulently, or personal records are altered without your knowledge or permission, how do you prove that it was not you? • It is difficult enough to verify someone's identity in the tangible world where forgery, impersonation and credit card fraud are everyday problems related to authentication. • Such problems take on a new dimension with the movement from face-to-face interaction, to the faceless interaction of cyberspace. Identity and Authentication by Simon Rogerson 4

5. Ideally,  individuals would each like a single digital credential that can be securely used to authenticate his or her identity anytime authentication of identity is required to secure any transaction. 5

6. Ideally, a digital credential must • positively identify a person, • positively identify the certifying authority - i.e. the identity provider (IdP), • be presentable only by the person it authenticates, • be tamper proof, and • be accepted by all systems. 6

7. Texas Medical Centerwww.tmc.edu • Forty One Institutions on 740 Acres • Approximately 65,000 Employees • Seven Large Hospitals • 6,176 Licensed Beds & 334 Bassinets • Baylor College of Medicine • Rice University • Texas A&M Institution of Biotechnology • University of Texas Health Science Center at Houston • University of Texas M.D. Anderson Cancer Center 7

8. Scenario I • UT-Houston Residency Programs have some attending physicians that are non-university personnel – e.g. M.D. Anderson & Baylor • Dr. James at M.D. Anderson is to be an attending physician in the UT-Houston Internal Medicine Residency Program. • On-line Graduate Medical Education Information System (GMEIS) contains confidential and sensitive information - including HIPAA data. • Dr. James needs access to GMEIS. • How is Dr. James’ identity verified, authenticated and authorized to have access as an attending physician? • If Dr. James suddenly leaves M.D. Anderson, is his access to UT-Houston Residency Program immediately abolished? 8

9. Scenario I - Problems • Dr. James has no digital credentials. • U.T. Houston policy requires that a responsible party at U. T. Houston assume responsibility for Dr. James and sponsor him as a “guest”. • Dr. James must appear before a Local Registration Administration Agent (LRAA) to have his identity verified and be credentialed. • Does not verify his status with M.D. Anderson. • If Dr. James leaves M.D. Anderson, there is no automatic process in place to revoke his access rights. 9

10. UTHSC-H: An Identity Provider (IdP) It is critical to recognize that the university functions as an identity provider (IdP) in that UTHSC-H provides individuals with digital credentials that consist of an identifier and an authenticator. As an IdP, the university assumes specific responsibilities and liabilities. 10

11. Issuing a Digital Credential • Individual appears before an Identity Provider (IdP) which accepts the responsibility to • positively determine and catalog a person's uniquely identifying physical characteristics (e.g. picture, two fingerprints, DNA sample), • assign a unique, everlasting digital identifier to each person identified, • issue each identified person a digital credential that can only be used by that person to authenticate his or her identity, • maintain a defined affiliation with each individual whereby the validity of the digital credential is renewed at specified intervals. 11

12. Assigns Everlasting Identifier Issues Digital Credential IdP Obtains Physical Characteristics Permanently Bound Person Only Activation Identifier Digital Credential Identity Vetting & Credentialing Identity Provider (IdP) uth.tmc.edu Permanent Identity Database Person 12

13. Identity Vetting & Credentialing UTHSC-H Two Factor Authentication Identity Provider (IdP) uth.tmc.edu Permanent Identity Database Assigns Everlasting Identifier Issues Digital Credential IdP Obtains Physical Characteristics ? ? Permanently Bound Person Only Activation Identifier Person Digital Credential 13

14. Identity Vetting & Credentialing UTHSC-H Username/Password Authentication Identity Provider (IdP) uth.tmc.edu Permanent Identity Database Assigns Everlasting Identifier Issues Digital Credential IdP Obtains Physical Characteristics ? ??????? Permanently Bound Person Only Activation Using Network Username Password Identifier Person Digital Credential 14

15. Identity & Authentication Attributes • Identity Vetting • Basic Trust Level • Medium Trust Level • High Trust Level • Credential Strength • Two-factor PKI Biometric Token • Two-factor PKI Password Token • One-factor Network Username/Password 15

16. UTHSC-H Strategic Authentication Goals • Two authentication mechanisms. • Single university ID (UID) and password • Public Key Digital ID on Token (two-factor authentication) • Digital Signatures • Highly Secure Access Control • Potential for inherent global trust 16

17. Public Key Infrastructure:The Broad Enabler of Collaborative Trust

18. Agencies are using the Internet for an increasing spectrum of applications. Doing so requires that agencies confront the issues of user authentication, confidentiality and integrity of data transferred, and the ability to hold transaction parties accountable when necessary. While there are many technologies which meet some of the requirements, only one provides the tools for meeting all of them: public key technology, implemented in the form of Public Key Infrastructure (PKI). Richard A Guida, June 2000 18

19. Using Digital IDs (DIDs) • Digital Signatures • authenticates senders • guarantees that messages are unaltered (message integrity) • provides for non-repudiation • legal signature with the United States • Encryption of e-mail • Provides confidentiality of e-mail when required • Digitally Signing On-line Forms • Strong Authentication for Access Control 19

20. Mailing List jdoe@uth.tmc.edujsmith@bcm.edugmarks@mhhs.org jdoe@uth.tmc.edu Signed&Encrypted Message Automated Mailer jsmith@bcm.edu Request Recipient'sDigital Cert. LDAP Directory Service gmarks@mhhs.org Mass Mailing of Signed & Encrypted E-mail 20

21. Two Categories of Identity • Physical Identity – Body Identity - Authentication • Facial picture, • Fingerprints • DNA sample • Identity Attributes – Authorization Attributes • Common name, • Address, • Institutional affiliations - e.g. faculty, student, staff, contractor. • Specific group memberships • Birth date • City of Birth • Clinical Credentials • Etc. 21

22. Federated ServicesIdentity (IdP) & Resource Providers (RP) Identity Provider (IdP) uth.tmc.edu Identity Provider (IdP) utsystem.edu Identity Provider (IdP) bcm.edu Resource Provider (RP) library.tmc.edu GMEIS (RP) uth.tmc.edu Federation WAYF Service InCommon Identity Provider (IdP) mdanderson.org Blackboard (RP) uth.tmc.edu Identity Provider (IdP) utmb.edu 22

23. Federated ServicesIdentity (IdP) & Resource Providers (RP) Identity Provider (IdP) uth.tmc.edu Identity Provider (IdP) utsystem.edu Identity Provider (IdP) bcm.edu Public Key Resource Provider (RP) library.tmc.edu GMEIS (RP) uth.tmc.edu Federation WAYF Service InCommon Infrastructure Identity Provider (IdP) mdanderson.org Blackboard (RP) uth.tmc.edu Identity Provider (IdP) utmb.edu 23

24. Home Organization Resource Provider ORIGIN Browser TARGET Authentication System (ISO/SSO/Cert) SHIRE Federation WAYF SERVICE (IN COMMON) SHAR Handle Service Resource Manager Attribute Authority Web Site Attributes determined by ARP RBAC Authorization System - LDAP(eduperson) Shib Software = 24

25. What Does an Institution Do When There is NO Identity Provider?

26. Policy and procedures associated with identifying, credentialing and authenticating employees, students and residents are reasonably appropriate at the university. However, another group of individuals such as contractors, research collaborators and others having legitimate, professional affiliations with the university do not have digital credentials issued by identity providers having relying partying agreements with UTHSC-H. 26

27. Currently, the university accepts the legal responsibility of identifying these individuals, designated as guests, and issuing them digital credentials which they can use to authenticate their university certified identity to others. Individuals in this group are designated as “guests”. 27

28. Because of the extremely varied circumstances associated with how “guest” affiliations arise and terminate, it is difficult to determine the current status of “guest” affiliations and associated levels of “trust”. To ensure that appropriate assurance levels can be asserted by UTHSC-H as an identity provider, special policies exist for identity proofing and credentialing of persons sponsored by individual university personnel. 28