Email Security Solutions for Patients and Healthcare Providers

1. Shouting from the Rooftops: Improving Email Security Dr. Maury Pinsk FRCPC University of Alberta Division of Pediatric Nephrology

2. Dr. V • Uses email to correspond with patients • Answers questions • Gives test results • Changes medications • All emails are signed with disclaimer for confidentiality • Patient A asks how secure her medical information is

3. How secure is email? • Depends : • Where it is being sent • What you choose to use it for • How it is being sent

4. Email - the basics • Your email program is a “mail user agent” • Produces a text file • Sends the file through the internet using a set of instructions that allow commuters to communicate – a “Protocol” • E.g.: SMTP or simple message transfer protocol

5. Email - the basics • SMTP guides the email to final recipients server • Can route through several servers if necessary • Once it reaches its final destination server, it is stored to disk • The recipient accesses the email using a Post office protocol (POP)

6. So what are the security issues Sending an email is like sending a postcard Any server through which it passes is an opportunity for eyes to read For the keen individual, it represents an opportunity to alter the contents of the email as well.

7. So what factors alter the security of the email?

8. Where is it being sent? • Data that stays on a server is less likely to fall into the wrong hands • More so for dedicated service providers (e.g.: intrauniversity, intrahospital) • Less so for data that leaves a server (e.g.: interhospital or interuniversity)

9. How is it being sent? Data that is sent unprocessed is vulnerable to breach of confidentiality or integrity What do I mean by processed? Encryption Digital signatures

10. Encryption • Key a large number used by encryption algorithm to generate cipher code • Public key owner can send you encrypted email securely, but cannot decrypt it • Private key owner can decrypt the email. • The two keys are related, but through very complex algorithms that are difficult to crack

12. Encryption • Keys are stored, encrypted, on your computer, and used by your email software • Keys can be distributed by owner on disk, by email or via access to repository (key server)

13. PGP encryption: an extra layer of security for encryption

14. PGP – decryption – the same in reverse

15. Encryption, but for whom? • Encryption: keeps on-looking eyes away from sensitive data, but doesn’t verify the source • Authentication and integrity is verified by a digital signature

16. Digital Signature

17. Digital signatures

18. But how do you know the key is from the right person? • Key “forgery” is possible, hence the need for security certificates • Security certificate = digital signature + authentication from another user + public encryption key + user identification

19. What is being sent? • The best means of preserving data integrity and confidentiality is to decide if it is absolutely necessary to send it the data by email.

20. Return to Dr. V • Patients informed: • Patient information continues to be transferred over the internet, but patients sign a consent allowing this to happen • Information kept confidential: • Public keys are issued to patients via key server • Patients encouraged to obtain own personal key and distribute public key to Dr. V

21. Integrity of information confirmed: • Security certificates issued with public key • All correspondence with digital signature.

22. Further resources • Encryption and digital signature freeware • Pretty Good Privacy (PGP) • http://www.pgpi.org • Guidelines for Patient Privacy • HIPAA Privacy regulations • http://www.hhs.gov/ocr/hipaa