2005-IHE-DGS-workshop-june262005

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Document Digital Signature(DSG)Document Digital Signature(DSG)

Gila Pyke / Lori Reed-Fourquet

Smart Systems for Health Agency / Identrus

IHE ITI Technical Comittee


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June 28-29, 2005 Interoperability Strategy Workshop2

WWW . I H E . N E TWWW . I H E . N E T

Providers and Vendors

Working Togetherto Deliver

Interoperable Health Information Systems

In the Enterprise

and Across Care Settings


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IT Infrastructure ProfilesIT Infrastructure Profiles

2004

Patient Identifier Cross-referencing for MPI (PIX)

Retrieve Information for Display (RID)

Consistent Time (CT)

Patient Synchronized Applications (PSA)

Enterprise User Authentication (EUA)2005

Patient Demographic Query (PDQ)

Cross Enterprise Document Sharing (XDS)

Audit Trail and Note Authentication (ATNA)

Personnel White Pages (PWP)

2006

Cross-Enterprise User Authentication (XUA)

Document Digital Signature (DSG)

Notification of Document Availability (NAV)

Patient Administration/Management (PAM)

Document Digital Signature

(DSG)Use of digital signatures to provide

document integrity, non-repudiation and

accountability.


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Document Digital SignatureDocument Digital Signature

Value PropositionValue Proposition

Leverages XDS Document infrastructure

Providing accountability

Providing document integrity

Providing non-repudiation

Providing satisfactory evidence of: Authorship,Approval, Review, and Authentication

Infrastructural pattern to be further profiled bydomain specific groups (e-Prescribing, e-Referral)


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Abstract/scopeAbstract/scope

Digital Signature Document format

Leverages XDS for signature by reference

New document type in XDS Linkage forwardand back.

Profiles single / multiple signatures

Profiles nested signatures

Provide signature integrity across intermediaryprocessing


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Document Digital SignaturesDocument Digital Signatures

GoalsGoals

Digital Signatures help mitigate risk for the

following attacks:

In the storage or transmission of documents,characteristics of clinician orders reflected in the

prescription could be modified.

In the storage or transmission of documents,

characteristics of countersigned clinician ordersreflected in the prescription could be modified.

A forged prescription could be introduced.


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Document Digital SignaturesDocument Digital Signatures

The following scenarios will not be mitigated byusing digital signatures and require additionalsecurity: Corruption or bribery of a user, or counter-signer

Theft of a private key

Compromise of the physicians workstation to allow accessto the signing key

The confirmation process could be corrupted or modified.

The dispensing system could be corrupted or modified,including simple attacks like burglary.

The dispensing feedback could be corrupted, modified, ordestroyed.


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Key Technical PropertiesKey Technical Properties

W3C XML Signature structure

credentials, timestamp, and other signature attributes

such as signature purpose Reference to document stored in XDS

ISO TS17090 compliant digital certificates

Assures message integrity

Verification of signed document validity

Provides for multiple signers


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Signature AttributesSignature Attributes

Expand signature to include additional data

relevant to the healthcare signature

Includes the date and time the signature wascalculated and applied

The identity of the signer

Signature Purpose


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Signature AttributesSignature Attributes

The role of a signer (purpose of the signature) includesactors that may carry the responsibilities of: Signer: the actor that creates the electronic signature. When the signer

digitally signs over data object(s) using the prescribed format, this

represents a commitment on behalf of the signing entity to the dataobject(s) being signed.

Verifier: the entity that verifies the electronic signature. It may be asingle entity or multiple entities

Trusted Service Providers: one or more entities that help to build trustrelationships between the signer and verifier. Trusted ServiceProviders include PKI Certification Authorities, RegistrationAuthorities, Repository Authorities (e.g. a directory), Time-StampingAuthorities, Signature Policy Issuers and Attribute Authorities.

Arbitrator: An entity that arbitrates in disputes between a signer and averifier.


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Transaction DiagramTransaction Diagram


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Transaction DiagramTransaction Diagram


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Use CasesUse Cases

Attesting a document as true copy Each subsequent use of the original signed digital document or

a digital copy of the document can inspected signatures to

assert that the documents are true copies of informationattestable to the signer at the time of the signature ceremony

Attesting content When a clinician submits a clinical document to the XDS

repository, the clinician using a digital certificate digitally

signs the document Attesting to whole submission set

Translation / Transformation


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CrossCross--Enterprise Document SharingEnterprise Document Sharing

(XDS) Use Case (1)(XDS) Use Case (1)

The XDS profile describes how differenthealth care parties can share documents

A document source is responsible toprovide and register document in aregistry/repository for a query andretrieve by a document consumer

Document Digital Signature enables tomanage the responsibility issues


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The document source wants to prove ithas well authored the document and the

associated submission set metadata The registry/repository it has not

corrupted the documents and metadata

The document consumer wants to checkabove items and check the identity ofauthor(s) and authenticator(s)


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The document source includes the document(s)

signature(s) into the submission set

The registry/repository stores the documentsignature(s) as a document and metadata

associated with it/them as a specific signature

object metadata

The document consumer can see the signature

metadata and retrieve each signature for checking

it, including the certificate(s)


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Document Digital SignatureDocument Digital SignatureSignature PurposeSignature Purpose

From ASTM E1762 * Author - Authors signature,

Author.Co - Coauthors signature

Participant - Co-participants signature

Transcriptionist/Recorder

Verification - Verification signature

Validation - Validation signature Consent - Consent signature

Witness - Witness signature

Witness.Event - Event witness signature

Witness.Identity - Identity witness signature such as a Notary

Witness.Consent - Consent witness signature

Interpreter Review - Review signature

Source - Source signature

Addendum - Addendum signature

Administrative

Timestamp


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Document Digital SignatureDocument Digital SignatureAdditions to ASTM1762Additions to ASTM1762

The following items will be added to

ASTM1762

Modification

Authorization

Transformation

Recipient

Modification is being worked on.


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Standards UsedStandards Used

W3C XML Signature

ISO 17090, 21091

ASTM E2212, E1985, E1762, E1084

IETF x509

DICOM supplement 41, 86

NCPDP

HL7 CDA


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EE--prescribing threatsprescribing threats

Doctor

$

V I S I O C O R P O R A T I O N

Doctors Key

Doctor's System

$

$ $

CounterSigner

$

V I S I O C O R P O R A T I O N

Countersigner's Key

CounterSigner's System

Pharmacy

Confirm

Dispensing

Key ManagementInfrastructure

SignedPrescription

CounterSignedPrescription

ForgedPrescription

DispensingFeedback


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More information.More information.

IHE Web sites: www.ihe.net

Technical Frameworks, Supplements

Fill in relevant supplements and frameworks

Non-Technical Brochures : Calls for Participation

IHE Fact Sheet and FAQ

IHE Integration Profiles: Guidelines for Buyers

IHE Connect-a-thon Results

Vendor Products Integration Statements

Date post:	08-Apr-2018
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