Shouting from the Rooftops: Improving Security Dr. Maury Pinsk FRCPC University of Alberta Division of Pediatric Nephrology

Dr. V Uses to correspond with patients Answers questions Gives test results Changes medications All s are signed with disclaimer for confidentiality Patient A asks how secure her medical information is

How secure is ? Depends : Where it is being sent What you choose to use it for How it is being sent

- the basics Your program is a “mail user agent” Produces a text file Sends the file through the internet using a set of instructions that allow commuters to communicate – a “Protocol” E.g.: SMTP or simple message transfer protocol

- the basics SMTP guides the to final recipients server Can route through several servers if necessary Once it reaches its final destination server, it is stored to disk The recipient accesses the using a Post office protocol (POP)

So what are the security issues Sending an is like sending a postcard Any server through which it passes is an opportunity for eyes to read For the keen individual, it represents an opportunity to alter the contents of the as well.

So what factors alter the security of the ?

Where is it being sent? Data that stays on a server is less likely to fall into the wrong hands More so for dedicated service providers (e.g.: intrauniversity, intrahospital) Less so for data that leaves a server (e.g.: interhospital or interuniversity)

How is it being sent? Data that is sent unprocessed is vulnerable to breach of confidentiality or integrity What do I mean by processed? Encryption Digital signatures

Encryption Key a large number used by encryption algorithm to generate cipher code Public key owner can send you encrypted securely, but cannot decrypt it Private keyowner can decrypt the . The two keys are related, but through very complex algorithms that are difficult to crack

Encryption Keys are stored, encrypted, on your computer, and used by your software Keys can be distributed by owner on disk, by or via access to repository (key server)

PGP encryption: an extra layer of security for encryption

PGP – decryption – the same in reverse

Encryption, but for whom? Encryption: keeps on-looking eyes away from sensitive data, but doesn’t verify the source Authentication and integrity is verified by a digital signature

Digital Signature

Digital signatures

But how do you know the key is from the right person? Key “forgery” is possible, hence the need for security certificates Security certificate = digital signature + authentication from another user + public encryption key + user identification

What is being sent? The best means of preserving data integrity and confidentiality is to decide if it is absolutely necessary to send it the data by .

Return to Dr. V Patients informed: Patient information continues to be transferred over the internet, but patients sign a consent allowing this to happen Information kept confidential: Public keys are issued to patients via key server Patients encouraged to obtain own personal key and distribute public key to Dr. V

Integrity of information confirmed: Security certificates issued with public key All correspondence with digital signature.

Further resources Encryption and digital signature freeware Pretty Good Privacy (PGP) Guidelines for Patient Privacy HIPAA Privacy regulations