1. Cerner Presentation to S&I esMD Workgroup – Industry Scan
John Travis
Senior Director and Solution Strategist – Compliance

2. Outline User Identification and Authentication
Recording User Identity for Electronic Health Record Entry
Proxy
Use of Advanced Authentication
Use of Cryptographic Means of Author/Record Linking
Support for PKI and Digital Certificates
Verification of External Author of Record (AoR) Credentials
Support for Various Levels of AoR Determination

3. User Definition Within The System
Completed dialog for adding a new user.

4. Password Definition
Shows querying for the user just created and doing a “reset” on the password for the user – this is a single-use password – as soon as the user logs on with this password the system will require the password to be changed for the user to proceed.

5. Password Policies Supported
Minimum Length
Mixed Character Sets
Minimum Numbers of Alpha, Numeric and Special Characters
Expiration Policies
Password History
Configured to retain “n” prior versions
Encrypted Store
Never Passed as Plain Text

6. Recording User Identity for Electronic Record Entry
General abilities
System generally relies on authenticated user identity for session
System supports time out policies for suspension and termination configurable to the application server (Citrix) or end user device depending on the context
System supports password based signer authentication for order and document signature
System supports advanced authentication methods for medication management events
Order verification and co-signature
Medication Administration
Medication Dispensing
We are in process of enabling requirements of DEA IFR for Electronic Prescribing of Controlled Substances (EPCS)

7. Refresher – DEA IRF Authentication Credential
Authentication must be two factor with two of the three factors being from among
A biometric
A knowledge factor such as a password
A hard token
For hard tokens
Must be FIPS Security Level 1 compliant
Must be stored on a device separate from the computer used to access the application
Could leverage an existing hard token, but would need to still be issued credentials specific to eRX of controlled substances
May use hardware devices such as a PDA, a cell phone, a smart card, a USB fob or other devices

8. Refresher – DEA IFR Authentication Credential
For biometrics
May be stored on a computer, hard token or biometric reader
If on a computer or PDA, device must be in a known controlled location or must be build directly into the computer or PDA
Storage of biometric data must be adequately protected or maintained
Subsystem must store device ID data at enrollment with biometric data
Device ID must be verified at time of user authentication
Raw data and templates must be protected if authentication is not local
For an open network, data must be
Cryptographically source authenticated
Combined with a random challenge, nonce or timestamp
Cryptographically protected
Sent only to authorized systems
TLS may be used

9. Refresher – DEA IFR Authentication Credential
For biometrics
Biometric subsystem must
Operate at a false match rate of or lower
Use matching software with demonstrated performance corresponding to the required false match rate
Conform to Personal Identity Verification (PIV) specifications as per NIST SP
Be independently tested by NIST or a DEA approved testing laboratory

10. Controlled Substance Prescribing Example

11. Proxies – General Principles
Assuming appropriate security authorizations are in place, one user may grant proxy to another for purpose of notifications of signing events
Proxies are granted to categories of events – not individual events
Proxies typically are set for a time period to designated individuals
Proxies can be revoked or granted at a user’s election on a specific basis while active
Granted proxies can be limited in access to those which have been assigned to a user to take
Proxy can be granted in an emergency case even if not generally enabled

12. Granting Proxies for Signature – Set Up

13. Setting Up Proxy Rights – Grant or Revoke

14. Setting Up Proxy Rights – Individual User

15. Notification of Proxies to a Recipient User

16. Use of Advanced Authentication
For user authentication for a session and for medication management workflow, Cerner Millennium supports integration with Imprivata for strong authentication
Imprivata currently has support for
Fingerprint biometric authentication. Support for biometric technology found in Lenovo, Dell and other laptop PCs, Motion tablets, etc., using UPEK TouchStrip or Authentec technology
USB tokens
One-Time-Password (OTP) tokens
Windows smart cards and national ID smart cards
Active and passive proximity cards

17. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
Basic Flow

18. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
System will interface with Imprivata for strong authentication and the
Certificate Management service for digitally signing controlled substance eRX

19. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
Basic workflow for EPCS

20. Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
Certificate Management Service
Cryptographic module used to digitally sign the EPCS is at least FIPS Level 1 validated and can be higher for deployment
Digital signature service and hash function complies with FIPS and FIPS 180-3
Private key will be stored encrypted on a FIPS Level 1 or higher cryptographic module using a FIPS approved encryption algorithm

21. Support for Validation of External AoR Credentials
This is not an ability we currently enable

22. Supporting Various Levels of AofR
General System Behaviors
Upon signature, authorship is included within the document
Signing actions are viewable in a action list view
Specific contributions are tracked and able to be viewed in the document view with a tracked changes feature
Signer authentication currently uses password based method if enabled
From a use standpoint, most clients rely on authenticated session identity

23. Support for Varying Levels of AofR – Single Author

24. Support for Varying Levels of AofR – Multiple Author

25. Support for Varying Levels of AofR – Tracking of Multiple Authors

26. Example of a Signed Document as Output and Online for a Clinic Note

27. Example of Signed H&P – Shows Co-Sign and Authenticator Role

28. Example of Section of Signed Radiology Report

29. Example of Signed Section of ED Report – Multiple Contributors for given sections

30. QUESTIONS?