Cerner Presentation to S&I esMD Workgroup – Industry Scan
Senior Director and Solution Strategist – Compliance
John Travis
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Outline
User Identification and AuthenticationRecording User Identity for Electronic Health Record EntryProxyUse of Advanced AuthenticationUse of Cryptographic Means of Author/Record LinkingSupport for PKI and Digital CertificatesVerification of External Author of Record (AoR) CredentialsSupport for Various Levels of AoR Determination
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User Definition Within The System
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Password Definition
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Password Policies Supported
Minimum LengthMixed Character SetsMinimum Numbers of Alpha, Numeric and Special CharactersExpiration PoliciesPassword History
Configured to retain “n” prior versions
Encrypted StoreNever Passed as Plain Text
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Recording User Identity for Electronic Record Entry
General abilitiesSystem 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)
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Refresher – DEA IRF Authentication Credential
Authentication must be two factor with two of the three factors being from among
A biometricA knowledge factor such as a passwordA hard token
For hard tokensMust be FIPS 140-2 Security Level 1 compliantMust be stored on a device separate from the computer used to access the applicationCould leverage an existing hard token, but would need to still be issued credentials specific to eRX of controlled substancesMay use hardware devices such as a PDA, a cell phone, a smart card, a USB fob or other devices
© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 8
Refresher – DEA IFR Authentication Credential
For biometricsMay 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
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Refresher – DEA IFR Authentication Credential
For biometricsBiometric subsystem must
• Operate at a false match rate of 0.0001 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 800-76-1• Be independently tested by NIST or a DEA approved testing
laboratory
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Controlled Substance Prescribing Example
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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 eventsProxies typically are set for a time period to designated individualsProxies can be revoked or granted at a user’s election on a specific basis while activeGranted proxies can be limited in access to those which have been assigned to a user to takeProxy can be granted in an emergency case even if not generally enabled
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Granting Proxies for Signature – Set Up
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Setting Up Proxy Rights – Grant or Revoke
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Setting Up Proxy Rights – Individual User
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Notification of Proxies to a Recipient User
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Use of Advanced Authentication
For user authentication for a session and for medication management workflow, Cerner Millennium supports integration with Imprivata for strong authenticationImprivata 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 technologyUSB tokensOne-Time-Password (OTP) tokensWindows smart cards and national ID smart cardsActive and passive proximity cards
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Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
deployment Deployment
MillenniumCerner Hub
SureScripts
Imprivata
Basic Flow
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Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
deployment Millennium View
PowerOrders
Imprivata
Certificate Management Serv ice
FSI Outbound
System will interface with Imprivata for strong authentication and the Certificate Management service for digitally signing controlled substance eRX
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Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
Basic workflow for EPCS
sd Workflow
PowerOrders Imprivata CertificateManagement
FSI Outbound Cerner Hub
Prescription Ready()
Strong Authentication Challenge()
Sign Prescription()
Transmit Prescription()
Validate Signature()
Transmit Prescription()
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Support for Advanced Authentication/Cryptographic Means/Use of PKI – EPCS Example
Certificate Management ServiceCryptographic module used to digitally sign the EPCS is at least FIPS 140-2 Level 1 validated and can be higher for deploymentDigital signature service and hash function complies with FIPS 186-3 and FIPS 180-3Private key will be stored encrypted on a FIPS 140-2 Level 1 or higher cryptographic module using a FIPS approved encryption algorithm
© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 21
Support for Validation of External AoR Credentials
This is not an ability we currently enable
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Supporting Various Levels of AofR
General System BehaviorsUpon signature, authorship is included within the documentSigning actions are viewable in a action list viewSpecific contributions are tracked and able to be viewed in the document view with a tracked changes featureSigner authentication currently uses password based method if enabled
• From a use standpoint, most clients rely on authenticated session identity
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Support for Varying Levels of AofR – Single Author
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Support for Varying Levels of AofR – Multiple Author
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Support for Varying Levels of AofR – Tracking of Multiple Authors
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Example of a Signed Document as Output and Online for a Clinic Note
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Example of Signed H&P – Shows Co-Sign and Authenticator Role
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Example of Section of Signed Radiology Report
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Example of Signed Section of ED Report – Multiple Contributors for given sections