Pilot WEDI Review
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1 WEDI/AFEHCT Internet Encryption Interoperability Pilot WEDI Board Meeting September 26, Phoenix Hyatt Kepa Zubeldia, M.D. Vice President, Technology ENVOY Corporation
2 Why a Pilot HIPAA NPRM Technology independent Encryption and Digital Signatures HCFA s Internet Policy (Nov 24, 1998) Technology independent Encryption and Authentication/Identification Specifies some minimum technology requirements
3 Uncertainty in both What exactly do I need to do? How can I tell for sure that I am in compliance? How much is this going to cost me? Will my security and encryption software work with the software installed at hospital(s), HMO(s), providers? Medicare Carrier/Intermediary?
4 Pilot Focus Internet only Healthcare only, both Medicare and others. Administrative simplification transactions Business to business Specifically Provider to Payer (or Clearinghouse) Integration into provider and payer systems Interoperability and legacy systems
5 Out of focus Dial-up, leased lines, Frame relay, etc. Other non-healthcare electronic commerce Medical records, other non-transaction data General consumer Internet Merits of XML, CORBA, EDIFACT, etc. Software distribution Programming languages My way of doing it is the best
6 Internet Communications pipeline Web facilities, HTTP, HTML, XML,... EDI transaction support Computer-to-computer, application-toapplication No human intervention
7 Assumptions Firewall in place to protect connection Only trading partners in the USA Scalable to all of health care Multiple pilots Different alternatives» to see which one works better Same method» to prove interoperability
8 Workgroups Batch file transfer Real Time Web Browser Virtual Private Network Certification Authority Final Report
9 Batch EDI Workgroup Batch EDI file transfers in both directions what encryption?» PGP, encryption required what digital signatures?» PGP, signature required what file transfer mechanism?» FTP, with individual accounts (no anonymous FTP)» Specific file name extensions, and/or directories how to identify the trading partner?» PGP digital certificate, login/password not enough
10 Batch EDI results Simple to use, inexpensive, very efficient, easy to automate or script. Creation of FTP account can be automated. Both X.509 certificates or peer certification (for small sites) work well. Very interoperable. Works well with legacy systems as well as PCs.
11 Real Time EDI Workgroup Real time EDI transaction transfers between applications what encryption?» SSL version 3, or TLS version 1, minimum 128 bits what user authentication?» digital certificate required at server end, optional at client end for X12, required for NCPDP.» X12 Transaction has authentication in the EDI data. what transfer mechanism?» persistent sessions» session per transaction
12 Real Time results We built it nobody came. SSL software libraries are complex to use. SSL wrappers are easy to use but have limitations (revocation, access control.) One session per transaction inefficient. Software vendors eager to work with us and improve their products. Great hopes for the future if they come.
13 Web browser Workgroup Web based interface standards Assume SSL version 3, or TLS version 1 Minimum encryption strength?» 128 bits (HCFA specifies DES3) or more» 40, 56 bits must be disabled at server» Server requires digital certificate what user authentication?» login / password, or» client browser certificates» token or smart card optional
14 Web browser results Easiest to deploy and support. Deployment of 128 bit browsers getting easier, still a challenge. Strong preference of login/password over the use of client certificates. Server access control with client certificates is difficult to implement.
15 Workgroup Electronic mail protection. Both encryption and digital signature required. what encryption?» S/MIME, EDIINT-S/MIME, EDIINT-PGP» Minimum 112 bits. Recommended 128 bits. what authentication?» digital signatures required» acknowledgment of receipt/delivery required
16 results Easy to deploy in non-interoperable way. Message tracking, acknowledgement of delivery still not fully interoperable. Prone to operator (mail sender) errors. Difficult to automate in the server. EDIINT seems like the best option. Needs more work.
17 VPN Workgroup Virtual Private Network Multi-vendor interoperability Authentication issues VPN authenticates network end points HCFA requires end user authentication
18 VPN results Interoperability among vendors is a problem. Single vendor solutions work VERY well. Windows 2000 could become the standard.
19 Certification Authority Workgroup User Authentication and Identification Who needs to be identified?» individual ID, entity ID, servers What needs to be verified?» identity, healthcare license Who needs to verify it?» payer, registration authority, or third party CA How to verify the identity?» Strong verification: physical presence before registration authority is required. The application must be notarized.
20 Certification Authorities Four CAs, one VA in the pilot as of December of 99: ARCANVS, CHIME, Unisys, CitX. Valicert. Agreement on common Certificate policies and identification requirements: Individual, Entity, Licensed Individual, Licensed Entity, Server, Licensed Server. High security of authentication using Notary Public. Interconnected and replicated repositories: Access via LDAP and HTTP. Some also X.500. National shared virtual backbone with certificates and core data elements. Individual value added directories with additional information.
21 Certification Authority results Healthcare Certificate Policies, Certificate Profiles, Directory Profile. Adequate authentication requirements. Certificate mobility essential: tokens or smart cards strongly recommended. LDAP access control very effective, but needs do be integrated with applications. Directory replication technically difficult. Healthcare Root CA recommended.
22 Pending Issues Role of biometrics. Viable alternative to certificates or tokens for authentication and access control. Publicity and Education. Publicity and Education. Publicity and Education. Publicity and Education. Publicity and Education. Publicity and Education.
23 More Information Draft of final report WEDI AFEHCT mailing list:
24 Report Table of Contents (1 of 2) Executive Summary Batch file transfer workgroup Web browser workgroup workgroup Real Time applications workgroup Certification Authority workgroup Virtual Private Network workgroup Reporting workgroup Accomplishments, Next Steps, Recommendations
25 Report Table of Contents (2 of 2) The working proposals Certificate Policies Certificate Profiles Directory Profile HCFA Internet Policy HCFA - Pilot understandings Glossary Reports from participants CA Master Document
26 Pilot Recommendations WEDI to create a PAG in conjunction with an AFEHCT Workgroup for creating policy and technical recommendations on Internet Security. Educational forum in WEDI. WEDI and AFEHCT should work with industry experts to establish, and test against, reference implementations in the public domain.
27 Pilot recommendations (cont.) Pilot to be used as a base for national standards for Internet Security under HIPAA. HCFA and rest of industry should consider implementing the security techniques proven during the pilot. Note: These recommendations have NOT yet been approved by the AFEHCT board.
28 Questions?
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