Cerner Presentation to S&I esMD Workgroup – Industry Scan

1. Cerner Presentation to S&I esMD Workgroup – Industry Scan Senior Director and Solution Strategist – Compliance John Travis

2. Outline • User Identification and Authentication • Recording User Identity for Electronic Health Record Entry • Proxy • Use of Advanced Authentication • Use of Cryptographic Means of Author/Record Linking • Support for PKI and Digital Certificates • Verification of External Author of Record (AoR) Credentials • Support for Various Levels of AoR Determination

3. User Definition Within The System

4. Password Definition

5. Password Policies Supported • Minimum Length • Mixed Character Sets • Minimum Numbers of Alpha, Numeric and Special Characters • Expiration Policies • Password History • Configured to retain “n” prior versions • Encrypted Store • Never Passed as Plain Text

6. Recording User Identity for Electronic Record Entry • General abilities • System generally relies on authenticated user identity for session • System supports time out policies for suspension and termination configurable to the application server (Citrix) or end user device depending on the context • System supports password based signer authentication for order and document signature • System supports advanced authentication methods for medication management events • Order verification and co-signature • Medication Administration • Medication Dispensing • We are in process of enabling requirements of DEA IFR for Electronic Prescribing of Controlled Substances (EPCS)

7. Refresher – DEA IRF Authentication Credential • Authentication must be two factor with two of the three factors being from among • A biometric • A knowledge factor such as a password • A hard token • For hard tokens • Must be FIPS 140-2 Security Level 1 compliant • Must be stored on a device separate from the computer used to access the application • Could leverage an existing hard token, but would need to still be issued credentials specific to eRX of controlled substances • May use hardware devices such as a PDA, a cell phone, a smart card, a USB fob or other devices

8. Refresher – DEA IFR Authentication Credential • For biometrics • May be stored on a computer, hard token or biometric reader • If on a computer or PDA, device must be in a known controlled location or must be build directly into the computer or PDA • Storage of biometric data must be adequately protected or maintained • Subsystem must store device ID data at enrollment with biometric data • Device ID must be verified at time of user authentication • Raw data and templates must be protected if authentication is not local • For an open network, data must be • Cryptographically source authenticated • Combined with a random challenge, nonce or timestamp • Cryptographically protected • Sent only to authorized systems • TLS may be used

9. Refresher – DEA IFR Authentication Credential • For biometrics • Biometric subsystem must • Operate at a false match rate of 0.0001 or lower • Use matching software with demonstrated performance corresponding to the required false match rate • Conform to Personal Identity Verification (PIV) specifications as per NIST SP 800-76-1 • Be independently tested by NIST or a DEA approved testing laboratory

10. Controlled Substance Prescribing Example

11. Proxies – General Principles • Assuming appropriate security authorizations are in place, one user may grant proxy to another for purpose of notifications of signing events • Proxies are granted to categories of events – not individual events • Proxies typically are set for a time period to designated individuals • Proxies can be revoked or granted at a user’s election on a specific basis while active • Granted proxies can be limited in access to those which have been assigned to a user to take • Proxy can be granted in an emergency case even if not generally enabled

12. Granting Proxies for Signature – Set Up

13. Setting Up Proxy Rights – Grant or Revoke

14. Setting Up Proxy Rights – Individual User

15. Notification of Proxies to a Recipient User

16. Use of Advanced Authentication • For user authentication for a session and for medication management workflow, Cerner Millennium supports integration with Imprivata for strong authentication • Imprivata currently has support for • Fingerprint biometric authentication. Support for biometric technology found in Lenovo, Dell and other laptop PCs, Motion tablets, etc., using UPEK TouchStrip or Authentec technology • USB tokens • One-Time-Password (OTP) tokens • Windows smart cards and national ID smart cards • Active and passive proximity cards

17. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example Basic Flow

18. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example System will interface with Imprivata for strong authentication and the Certificate Management service for digitally signing controlled substance eRX

19. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example • Basic workflow for EPCS

20. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example • Certificate Management Service • Cryptographic module used to digitally sign the EPCS is at least FIPS 140-2 Level 1 validated and can be higher for deployment • Digital signature service and hash function complies with FIPS 186-3 and FIPS 180-3 • Private key will be stored encrypted on a FIPS 140-2 Level 1 or higher cryptographic module using a FIPS approved encryption algorithm

21. Support for Validation of External AoR Credentials • This is not an ability we currently enable

22. Supporting Various Levels of AofR • General System Behaviors • Upon signature, authorship is included within the document • Signing actions are viewable in a action list view • Specific contributions are tracked and able to be viewed in the document view with a tracked changes feature • Signer authentication currently uses password based method if enabled • From a use standpoint, most clients rely on authenticated session identity

23. Support for Varying Levels of AofR – Single Author

24. Support for Varying Levels of AofR – Multiple Author

25. Support for Varying Levels of AofR – Tracking of Multiple Authors

26. Example of a Signed Document as Output and Online for a Clinic Note

27. Example of Signed H&P – Shows Co-Sign and Authenticator Role

28. Example of Section of Signed Radiology Report

29. Example of Signed Section of ED Report – Multiple Contributors for given sections

30. QUESTIONS? jtravis@cerner.com