1. 1 The Future of Secure, Reliable Message (SRM) Transport for Exchanging Health Information Gautam Kesarinath – PHINMS Project Sponsor Asst. Director of Technology, DISS/NCPHI Tom Brinks, PMP - PHINMS Project Manager SAIC Consultant to CDC 2008 PHIN Conference, Session H-7 August 28, 2008 8:30 am – 10:00 am

2. 2 Agenda  Current SRM Impact  Current SRM Limitations  Long Term SRM Vision  Possible New Technologies to Achieve Vision  Next Steps  Questions and Answers / User Feedback

3. 3 Current SRM - PHINMS  Secure, reliable transport of any message(s)  Common platform for sending PH data  CDC Applications using PHINMS include: BioSense, Cancer Registry, ELR, Foodnet, LRN, NEDSS, NEPHTN, NHSN, PHLIP/APHL, PHLIS  Some states using PHINMS internally: NYS, NYC, MN, OK, CA, SC, WI, FL, IN, AL  5-year old product deemed “mission critical” by CDC  Over 700 PHINMS nodes used in U.S.

4. 4 PHINMS CDC Usage (data coming to CDC)

5. 5 PHINMS – Message Flow CDC Public Key (Encrypt) StateCDC Proxy Server PHINMS Receiver Internet DB Q DB Q PHINMS Sender Firewall CDC Private Key (Decrypt) HL7 DMZ LDAP

6. 6 Current SRM Impact - PHINMS  5 years product use and Application Integration Consulting to PH organizations for SRM via Internet  New applications built faster, cheaper due to reuse  Automated delivery of critical data replacing manual methods allows new ways of analyzing (Cancer Registry)  PHINMS users (over 700 nodes) include: –25 CDC programs –40 state health departments –32 health systems –11 city and county health departments –16 laboratories –19 universities – VA and FDA reviewing PHINMS for internal use

7. 7 Agenda  Current SRM Impact  Current SRM Limitations  Long Term SRM Vision  Possible New Technologies to Achieve Vision  Next Steps  Questions and Answers / User Feedback

8. 8 Current SRM Limitations - PHINMS  Client certificate authentication does not scale ($$)  Route-not-Read hub can only scale to ~ 150 nodes  Difficulties interfacing with non-ebXML networks  Not easily extended through gateways  Focused on pt-pt connections  Not focused on distributed many-many, “plug and play”, & self-discovery of new nodes

9. 9 Agenda  Current SRM Impact  Current SRM Limitations  Long Term SRM Vision  Possible New Technologies to Achieve Vision  Next Steps  Questions and Answers / User Feedback

10. 10 Long Term Vision - Secure, Reliable Messaging (SRM)  Government sponsored, collaborative, public domain “COTS-like” product enabling healthcare organizations in the nation and world to electronically transport critical, sensitive information to/from one another

11. 11 Business Needs  Use Cases –Self-discovery for fast response during emergencies Ad-hoc querying and secure retrieval for local processing “Plug-n-Play” and replay capabilities –National, state, regional reporting mandates HIEs, NHIN, agencies to agencies –Open Community for collaboration and growth –Scalable point-point secure, reliable data exchanges (current)  Architectural Goals –Scalable, secure (trust) relationships –Reduced costs of maintenance (e.g. certificates) –Interoperable among different health networks –Fast creation of new tools –Grid enabled, open source, SOA, web services –Standards based

12. 12 Agenda  Current SRM Impact  Current SRM Limitations  Long Term SRM Vision  Possible New Technologies to Achieve Vision  Next Steps  Questions and Answers / User Feedback

13. 13 Grid Security Infrastructure – ??? Different security requirements for different VOs define different types of grids

14. 14 1. Public Health GRID Challenges (Trust) X X X PHIN States Hospitals No Cross Domain Trust Trust Mismatch PHINStates Hospitals

15. 15 1. Public Health GRID Solutions (Trust) PHIN States Hospitals GRID VO Federated Proxy Certificates OSA, etc. VO – Virtual Organization Easy to add a new domain

16. 16 2. Public Health GRID Challenges (Reliability) Client node Grid User Grid Data GRID services Fed Strong Auth Secure & Reliable Data Firewall End-to-end payload encryption How to guarantee once and only once delivery in a “many-to-many” health information exchange across different types of networks? End Point End Point

17. 17 2. Public Health GRID Solutions (Reliability)  Grid communities (Open Grid Forum/Global Grid Forum) have proposed the following solutions: –WS-Security Grid implementation guarantees end-to-end payload encryption in OASIS and GRID standard –WS-Reliable Messaging Grid implements the full sets of Grid reliability as described in the previous slide –Build Grid toolkit extensions that is interoperable with other WS-Security and WS-Reliable Messaging implementations such as WSIT (Web Services Interoperability Technology) –Reliable GridFTP has security and reliability features

18. 18 3. Public Health GRID (Scalability) Challenges Possible Solutions Client certificate maintenanceFederated Identify Provider Differing authentication schemesUniversal Open Strong Authentication (OSA) Large data transfer sizes (Gb-Tb)Message Transmission Optimization Mechanism (MTOM)

19. 19 4. Public Health GRID (Cost) Challenges Possible Solutions Client Certificate costProxy Cert + OSA Certificate maintenance costProxy Cert + OSA Software or toolkits maintenance cost Plug-and-play user centric extension to current toolkits

20. 20 5. Public Health GRID (Interoperability)  Challenge: Public Health Grid needs to interoperable with: –States, local governments and hospitals –Other grids –Global grids (EU, Asia grids etc.)  Solutions: –Build cross-network capabilities using toolkits (e.g. Globus) –NHIN-Connect gateway toolkit –WS-I+Grid: web services interoperability plus Grid extensions

21. 21 5. Public Health GRID (Interoperability) Web GRID http WSDL WS-* WSDL2 WSDM GT1 GT2 OGSI RFT WSRF WS- I + Current time frame 1991 www 1993 Mosaic 1995 Netscape Java 1996 Globus Consor- tium 1997 Globus Toolkit 1998 The Grid Book 1999 Grid Forum 2001 Global Grid Forum 2002 OGSA & DAI 2003 Merging closer to WS-* 20052007?? US PH- GRID ?? Global PH- GRID Open Grid Service Architecture

22. 22 Benefits of Leveraging Globus Tools  Building SRM solution on extensions to existing toolkits: –Reduced cost to develop and maintain –Open source and SOA allows for multi-partner functional growth –Scalable, use of SAML for authentication –Faster to deliver new functionality vs. extending PHINMS  SRM Globus extensions could support: –NHIN Connect Gateway –Daily transactional pt-pt exchange of sensitive health data –Self discovery in a grid mode for querying –Health system to health system message transport services

23. 23 Agenda  Current SRM Impact  Current SRM Limitations  Long Term SRM Vision  Possible New Technologies to Achieve Vision  Next Steps  Questions and Answers / User Feedback

24. 24 NCPHI Proof of Concepts  R&D testing in CDC/NCPHI lab to determine: –Best of bread extensions to Globus for SRM –Interoperability approaches w/non-PHIN networks using Globus –How to scale authentication in a SRM many-many network –Ways to transition existing PHINMS sites to new “common platform”  Develop an “Architectural Blueprint” in 2009 –Receive partner feedback and incorporate –Develop transition plans for PHINMS 2.x customers –Develop project charter for building “production grade” open source approach for the next generation for Secure, Reliable Messaging product(s) for public and clinical health

25. 25 Potential SRM Roadmap PHINMS DevelopmentPHINMS Maintenance New SRM Toolkit Services Co-existence and/or Transition Services

26. 26 SRM Roadmap - Summary  Public and clinical health need a common platform to exchange health information in a securely, reliably, scalable, low cost manner  PHINMS has worked well for over 5 years with over 700+ nodes for pt-pt secure, reliable message transport  New approaches are needed to achieve transports that are scalable, interoperable, “plug-play”, and low cost  SRM Globus extensions offer a potential way to achieve the next generation of transport technologies faster and cheaper  Existing PHINMS “global community of practice” expertise in SRM can be leveraged to create a new “common platform” extending open source, web services, SOA, toolkit frameworks for health information exchanges