1. Sanzi-1 CSE5 810 CSE5810: Intro to Biomedical Informatics Dynamically Generated Adaptive Credentials for Health Information Exchange Eugene Sanzi

2. Sanzi-2 CSE5 810Problem  Many stakeholders want easy access to new systems  Physicians need to access patient data, no matter where it may be  Researchers want access to de-identified data repositories  Data may be needed quickly  Emergency medical situations leave little time to gain proper authorization  Systems today still use outdated username/password techniques  Incorrect assumption that physicians have time and ability to register with these systems

3. Sanzi-3 CSE5 810Requirements  Need a way for physicians identify themselves to any system  Users possess an electronic ID that they can present for authentication  Provide a method for verifying that presented credentials are legitimate  Allow systems to automatically allow or deny different levels of access based on the presented credentials

4. Sanzi-4 CSE5 810 SolutionOverview Solution Overview  A physician gains access to different systems over the course of a career  Ex. - Access to their local hospital's data  Access may happen under different roles  Use the physician's system access history as a set of credentials  Each system grants a certificate if access is allowed  Physicians can collect these certificates into a digital wallet and present them as credentials  Systems can see which other systems have granted access

5. Sanzi-5 CSE5 810Certificates  Identity certificates are used to establish a user's identity  Public key cryptography is used to ensure that you are communicating with the certificate's owner  Certificates are issued by Certificate Authorities (CAs)  Certificate authorities establish user's identity by other means before issuing a certificate  Ex. Driver's license, SSN  You trust any valid certificate issued by a certificate authority that you trust  Certificate authorities sign the certificates they issue  The user inspects the signature, a valid signature proves it was issued by the certificate authority

6. Sanzi-6 CSE5 810Certificates

7. Sanzi-7 CSE5 810 AttributeCertificates Attribute Certificates  A specialized certificate that stores attributes in a key- value pair format  Attribute certificates are signed by an attribute authority rather than a certificate authority  Attribute certificates are connected to an identity certificate  An identity certificate may be tied to multiple attribute certificates  We will use this ability to store information related to user access  Save information on user role assigned by the system

8. Sanzi-8 CSE5 810 DIRECTProject DIRECT Project  Has the concept of a HISP (Health Information Service Provider)  Concept encapsulates systems needed for health exchange  HISPs must maintain their domain and a list of Trusted Anchors  Trusted Anchors are like root certificates  If one certificate in a certificate chain during the certificate validation process is found to be a trusted anchor, the leaf certificate is valid

9. Sanzi-9 CSE5 810 DIRECT Project

10. Sanzi-10 CSE5 810OIDs  HL7 OIDs are prefixed with the code 2.16.840.1.113883  There are 3 root branches  The 2 indicates that the root of this branch is managed by JOINT-ISO-ITU-T  Each number represents another branch in a hierarchy  HL7 controls all the children of this code  New OIDs can be generated by registering them with a node's registration authority  HL7 provides a form where new OIDs can be submitted and become part of the HL7 OID standard  A record of the user who submitted the OID is kept on record

11. Sanzi-11 CSE5 810 MedicalRoleOIDs Medical Role OIDs Source: https://www.hl7.org/oid /index.cfm

12. Sanzi-12 CSE5 810 Gaining Access  When John Smith wants to obtain access to a new system, he will:  Create a secure connection to the system  Decide which credentials he will send to gain access  Send the relevant identity and attribute certificates along with the request  If access is granted, John Smith will generate a new public/private key pair and receive a new identity and attribute certificate issued by the system's certificate and attribute authority  The system may choose to use a session-scoped Rule Certificate to define John's security policy

13. Sanzi-13 CSE5 810 DefiningAnAccessPolicy Defining An Access Policy  Each system defines a security policy that specifies constraints based on:  The user role  The type of data being accessed  Valid certificates presented  Provide a mapping from HL7 defined roles to the data that the system guards  Mappings for remote, automatically authenticated users may be different from the mappings given to local users

14. Sanzi-14 CSE5 810Example  John Smith wants to access research data on diabetes management from Day Kimball Hospital  He does not have any kind of affiliation with Day Kimball Hospital  He does have his digital wallet of certificates proving his active involvement in the field of medical research

15. Sanzi-15 CSE5 810 John Smith's Wallet

16. Sanzi-16 CSE5 810 Choose Relevant Credentials

17. Sanzi-17 CSE5 810 Send Request With Credentials

18. Sanzi-18 CSE5 810 Check Security Policy

19. Sanzi-19 CSE5 810 Generate Certificates

20. Sanzi-20 CSE5 810 John Smith's New Wallet

21. Sanzi-21 CSE5 810 JohnSmith'sNewWallet John Smith's New Wallet  John Smith adds the identity and attribute certificates issued to him to his digital wallet  He can now use the certificate issued to him by Day Kimball hospital to gain access to other new systems  Day Kimball Hospital can now identify him with his new identity certificate  John Smith could also make requests for Physician role access using his attribute certificates that name him a physician and the certificates given to him by Day Kimball Hospital

22. Sanzi-22 CSE5 810 FutureWork Future Work  Increase the granularity of security policies  Providers may want to allow/deny access based on location as in Access Control based on Attribute Certificates for Medical Intranet Applications  If a physician is requesting information for a specific patient they have already treated it may help the decision process  May require extension to attribute certificates  Security based on Access Time or Count  Someone who only accessed research data once 20 years ago for a school project should not have automatic access to research data now  Differentiate between certificates issued by an employer and certificates issued in an automatic fashion

23. Sanzi-23 CSE5 810 FutureWork Future Work  Increase efficiency  Validating long certificate chains is a time consuming process  Updates to saved attributes would result in needing to have the Attribute Authority resign attribute certificates  How can a physician regain proper credentials if a CA is compromised?  How to handle local practices which may not have a separation between certificate administration and the medical providers using certificates  Need a method for constraining what local CAs can do