Electronic Submission of Medical Documentation (esMD) Digital Signature and Author of Record Pre-Discovery

1. Electronic Submission of Medical Documentation (esMD)Digital Signature and Author of Record Pre-Discovery Wednesday May 9, 2012

2. Agenda • Schedule and objectives • Scope of workgroup effort • Review of standards • Review options as explored in other initiatives

3. Schedule

4. Scope of workgroup effort • Identity proofing • Digital identity management • Encryption • Digital signatures • Delegation of Rights • Author of Record

5. Initiative Requirement Summary

6. Review of Standards and Solutions • Applicable Standards (overview) • Option and approaches for • Identify proofing • Digital identity management • Encryption • Digital signatures • Delegation of rights • Author of Record • Approach: Examples and then group input

7. Relevant Standards

8. 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)

9. Summary Documents • Federal Identity, Credential, and Access Management (FICAM) Roadmap and Implementation Guidance (ID: CSD5885) • 3/5/2012

10. Background: NIST E-Authentication Guidelines SP 800-63 Note: Other security frameworks have been developed and have been used in the private sector

11. 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

12. 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

13. Identity Proofing and Authentication: The Process

14. Identity Proofing (Stakeholder) • Identity proofing compatible with requirements of the federal bridge (i.e. certification authorities cross-certified with the federal bridge) • 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) • Identity proofing for organizations • 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) • Mix between individual and organization level authorization with IHEs in various states such as Oregon and Arizona

15. Identity Management (Stakeholder) • Digital certificates (X509) • Work-level identity management • Individual level: single level/one-factor (password) • Within the context of an organization, an individual may be certified with a lesser approach than a digital certificate • General Applicability of tokens/certificates • One or multiple certificates/tokens per organization based on specific Use Case(s)? • 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 department • Individual level may be needed depending on the Use Case

16. Encryption (Stakeholder)

17. Signing (Stakeholder)

18. Delegation of Rights (Stakeholder)

19. Author of Record (Stakeholder)

20. Summary

21. Next Steps • Call next week 5/16 10am EDT • Focus on issues and challenges • Consideration for technical, cost, regulatory, implementation and operational issues