1. Document Encryption Profile Brief Profile Proposal for 2009/10 presented to the IT Infrastructure Planning Committee Martin Rosner, Paul Koster October 18, 2010

2. IT Infrastructure Planning Committee Third party opinion in tele-monitoring 1.DMO transfers encrypted CDA document to hospital in different affinity domain 2.Hospital GP accesses the document 3.GP forwards encrypted document to expert specialist using IHE XDR 4.Expert specialist accesses document for 2 nd opinion Exchanging health records using USB drives 1.Doctor E-mails record summary to patient as encrypted XD* document 2.Patient detaches document and saves it on his USB drive 3.Patient shares encrypted document with healthcare providers Use cases

3. IT Infrastructure Planning Committee The Problem Lack of persistent end-to-end encryption for health documentsLack of persistent end-to-end encryption for health documents –Distributed heterogeneous environments with multiple intermediaries –Encryption currently at transport level (e.g. IHE ATNA) –Certain transports lack standard solutions (e.g. USB drive) Need for enabling technology towards addressing meaningful use, privacy legislation, and patient consent directivesNeed for enabling technology towards addressing meaningful use, privacy legislation, and patient consent directives Continua Health Alliance, national health networks, etc. foreseen as possible adoptersContinua Health Alliance, national health networks, etc. foreseen as possible adopters

4. IT Infrastructure Planning Committee General approach to proposed workitem Define document level encryptionDefine document level encryption –Document type agnostic, e.g. CDA and others –Look to S\MIME, IHE PDI, DICOM, and CCR for guidance and lessons learned Investigate key management and discovery approachesInvestigate key management and discovery approaches Transport Application Transport Application Document-level encryption

5. IT Infrastructure Planning Committee Benefits of proposed approach Ecosystem benefitsEcosystem benefits –Patient: preserving patient privacy –IT Staff: simplifies often complex security architectures –Care providers: improves compliance to regulations –Supports compliance with data protection legislation (also in Canada and Europe) Alignment with national programs and other initiativesAlignment with national programs and other initiatives –NHIND (Stage 1 requirements for Meaningful Use) align with what is done with SMTP and S/MIMEalign with what is done with SMTP and S/MIME similar approach but not specific to mailsimilar approach but not specific to mail –Complementary to existing transport protocols in health networks –Continua Health Alliance – requirements pointing to confidentiality

6. IT Infrastructure Planning Committee Alignment in healthcare Persistent end-to-end security across heterogeneous HIT environmentsPersistent end-to-end security across heterogeneous HIT environments Encryption layer between already used document types and transport layer protocolsEncryption layer between already used document types and transport layer protocols Open standard for confidentiality of health data in transit or storageOpen standard for confidentiality of health data in transit or storage Communication of health information between trusted entities through untrusted or less controlled environmentsCommunication of health information between trusted entities through untrusted or less controlled environments

7. IT Infrastructure Planning Committee Alignment with infrastructure standards Should target robust solution to address all cross enterprise interchange standardsShould target robust solution to address all cross enterprise interchange standards –Fitting well with transport standards (e.g. IHE XD*) and application document types (e.g. CDA) with little cross dependencies –Leaving room to be used in combination with document types that have their own encryption method Alignment with HL7 Structured Documents WGAlignment with HL7 Structured Documents WG –Content agnostic solution minimizes dependency –Initial alignment in Cambridge last week Possible inspiration from IHE PDI (Portable Data for Imaging) developed in IHE Radiology domainPossible inspiration from IHE PDI (Portable Data for Imaging) developed in IHE Radiology domain