NHIN-Direct SMTP/ Notes 6/10/2010
Why we chose Concepts match the charter exactly Implementations match the charter exactly* Well understood by end users Well understood by existing ISP industry Well understood by existing vendors Almost no new code - security agent only (same code that is a subset of other implementations) ISPs can participate with their existing infrastructure and skill set
Implementation Overview Really, it’s just . Security agent plugged in at any point in the pipeline between Client (Source) and Server (Source HISP) Channels can be TLS- encrypted to protect routing information Client EHR, PHR Server Server Client EHR, PHR SMTP, MAPI POP3, IMAP, MAPI SMTP POP3, IMAP, MAPI SMTP, MAPI SSHDHD
Key Technologies Content Packaging: RFC MIME Addressing: Security & Trust: S/MIME HISP-HISP Transport: SMTP(S) Client-HISP Transport: SMTP, POP3, IMAP, MAPI, etc… Certificate distribution: DNS CERT
Structure, metadata and innovation Scalable structure – Body Text (always available, Individual Involvement) – Unstructured attachments (PDF) – Structured attachments (CCx, SCRIPT, etc.) – Explicit metadata MIME part (XDM) Transport has proven itself over 20+ years Innovate in the payload
Security Agent S/MIME Sign and Encrypt of messages fully supports requirements of Security & Trust Workgroup Certificate distribution by DNS CERT records Scalable approach to PKI Management – starts easy as TLS, adds ability to scale down to individual – HISP manages certificates – Organization manages certificates – Individual manages certificates Ability to use across implementations demonstrates the value of taking a transport-independent approach
Sample Message “On the wire” thread-index: AcsGjnbwhdd7B5CFQSuA2mgm0a8D9Q== Received: from umeshma4 ([ ]) by nhind.hsgincubator.com with Microsoft SMTPSVC( ); Mon, 7 Jun :12: Message-ID: From: "Dr Biff Hooper" To:"Dr. Alsip", Subject: Fw: Patient Referral Date: Mon, 7 Jun :11: Organization: Biff's Clinic Content-Transfer-Encoding:base64 MIME-Version: 1.0 Content-Type:application/pkcs7-mime; smime-type=enveloped-data; name="smime.p7m" X-Priority: 3 X-MSMail-Priority: Normal Importance: Normal X-Mailer: Microsoft Windows Live Mail X-MimeOLE: Produced By Microsoft MimeOLE V Content-Class: urn:content-classes:message Priority: normal Return-Path: X-OriginalArrivalTime: 07 Jun :12: (UTC) FILETIME=[76B95050:01CB068E] MIMDtx4GCSqGSIb3DQEHA6CDA7cOMIMDtwkCAQAxggJvMIG6AgEAMCMwFTETMBEGA1UEAxMKVU0t QU1BTEdBMQIKFmbg8QAAAAAAGDANBgkqhkiG9w0BAQEFAASBgMrVicD/tjx0ZZ0daK0nN2GMLqJg FalBuKGxe+ZZATxHxJPCD4rg80pI5vLt/s8A3sRrCrrOSniwpl1kzg6Nunlq6wz/PpK7QTVofwpt H0ZGYMRin/CxQD4tlf9YFmLuXNdvrvG7AkgRdMS7MZZzBliEdCdUZncb6qnyEf9Y1JlsMIIBrgIB ADCBlTCBhzELMAkGA1UEBhMCVVMxETAPBgNVBAgTCE1pc3NvdXJpMQ8wDQYDVQQKEwZDZXJuZXIx... fEL7VbSd34tez2pUHCL9FbtRBWReSW1hcLEvlsJjeCBaVAKFrW6VZqzTt+M=
Reliable Messaging Store and forward model is critical in a massively distributed network – because it is likely that destinations will be unavailable – Daily issues, upgrades, disaster, remote Ability to route across intermediate hops will be important in a heterogeneous network – Corporate intranet gateways
Why Existing Services Matter Operations – Administration and provisioning – Backups – System health monitoring – Patch and upgrade process Security history, minimal new attack surface Multi-tenant issues worked out Training and industry skill set – admin, NOC, customer service Account support: quota management, billing, fraud detection, etc.
Demo: Step 1 Source: Outlook + Windows SMTP Destination: Thunderbird + Postfix Notes – Attached CCD document – Read receipt
Demo: Step 2 Source: Millennium + IronPort Destination: Thunderbird + Postfix Notes – EHR integration – Flexible attachment types
Demo: Step 3 Source: Thunderbird + Postfix Destination: Windows Live Mail + Windows SMTP Notes – Simple text message – Out of Office
Demo: Step 4 Source: Windows Live Mail + Windows SMTP Destination: HealthVault & Thunderbird Notes – Multiple recipients – Structured PHR integration
Demo Technologies Clients – Cerner Millennium – Thunderbird – Outlook – Windows Live Mail – HealthVault DNS – Bind Servers – Windows SMTP – Postfix Operating Systems – Amazon EC2 – Windows Server – Linux
Demo Topology
Since Tuesday Secure Exchange Solutions has successfully sent and received NHIN-D messages using the SMTP implementation A “desktop gateway” is available that enables any currently- live mail service (Gmail, Hotmail) to be used for NHIN-D messaging – We believe that with the SMTP solution, the bar for the largest webmail providers to offer NHIN-D service is low enough that we can expect to see offerings emerge.