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Radiology Option for Audit Trail and Node Authentication Robert Horn Agfa Healthcare June 28 Radiology Option for Audit Trail and Node Authentication Robert Horn Agfa Healthcare June 28 -29, 2005 Interoperability Strategy Workshop

Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings WWW. IHE. NET June 28 -29, 2005 2 Interoperability Strategy Workshop

IT Infrastructure Profiles Audit Trail and Node Authentication (ATNA) – Centralized privacy audit trail IT Infrastructure Profiles Audit Trail and Node Authentication (ATNA) – Centralized privacy audit trail and node to node authentication to create a secured domain Consistent Time (CT) – Coordinate time across network systems 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) June 28 -29, 2005 3 Interoperability Strategy Workshop

Audit Trail and Node Authentication (ATNA) + Radiology Option Abstract / Scope • Defines Audit Trail and Node Authentication (ATNA) + Radiology Option Abstract / Scope • Defines basic security features for an individual system for use as part of the security and privacy environment for a healthcare enterprise. – Provides host level authentication, which is used in conjunction with the user authentication from EUA and XUA. – Provides audit trail mechanism for monitoring activities related to security and patient privacy June 28 -29, 2005 4 Interoperability Strategy Workshop

Audit Trail and Node Authentication (ATNA) + Radiology Option Compatibility with Basic Security • Audit Trail and Node Authentication (ATNA) + Radiology Option Compatibility with Basic Security • “But, what if I already have systems that support Basic Security? ” – ATNA + Radiology Option is backward compatible with Basic Security – Integration Statements should change support claim from “Basic Security” to “Radiology Option for ATNA” June 28 -29, 2005 5 Interoperability Strategy Workshop

ATNA Value Proposition • Protect Patient Privacy and System Security: – Meet ethical and ATNA Value Proposition • Protect Patient Privacy and System Security: – Meet ethical and regulatory requirements • Enterprise Administrative Convenience: – Unified and uniform auditing system – Common approach from multiple vendors simplifies definition of enterprise policies and protocols. – Common approach simplifies administration • Development and support cost reduction through Code Re-use: – Allows vendors to leverage single development effort to support multiple actors – Allows a single development effort to support the needs of different security policies and regulatory environments. June 28 -29, 2005 6 Interoperability Strategy Workshop

ATNA vs Basic Security Value Proposition • Why Change? • Use an Audit Repository ATNA vs Basic Security Value Proposition • Why Change? • Use an Audit Repository that supports more than just imaging domains like Radiology. • Use a reliable, error correcting, secure transport for audit messages • Is Change necessary? • For Secure Nodes (audit sources): NO, transition when it is convenient. • For Audit Repositories: YES, add the ability to accept audit messages from more than just radiology. June 28 -29, 2005 7 Interoperability Strategy Workshop

ATNA vs Basic Security • What else is different? • ATNA added the requirement ATNA vs Basic Security • What else is different? • ATNA added the requirement to have configurable control over the use of TLS when on a physically secured network or when using a VPN. • Any configurable Secure Node for Radiology Basic Security is also a Secure Node for ATNA with no further modifications. • Basic Security Profile being deprecated by Radiology Option for ATNA • Implementers need to refer to ITI Technical Framework for ATNA definition and Radiology Framework for Radiology Option definition June 28 -29, 2005 8 Interoperability Strategy Workshop

ATNA Security Requirements • Reasons: Clinical Use and Privacy – authorized persons must have ATNA Security Requirements • Reasons: Clinical Use and Privacy – authorized persons must have access to medical data of patients, and the information must not be disclosed otherwise. – Unauthorized persons should not be able to interfere with operations or modify data • By means of procedures and security mechanisms, guarantee: – – Confidentiality Integrity Availability Authenticity June 28 -29, 2005 9 Interoperability Strategy Workshop

ATNA Security Measures • Authentication: Establish the user and/or system identity, answers question: “Who ATNA Security Measures • Authentication: Establish the user and/or system identity, answers question: “Who are you? ” • ATNA defines: How to authenticate network connections. • ATNA Supports: Authentication mechanisms, e. g. Enterprise User Authentication (EUA) or Cross Enterprise User Authentication (XUA). . • Authorization and Access control: Establish user’s ability to perform an action, e. g. access to data, answers question: “Now that I know who you are, what can you do? ” • ATNA defines: How to authorize network connections. • ATNA requires: System internal mechanisms for both local and network access. June 28 -29, 2005 10 Interoperability Strategy Workshop

ATNA Security Measures • Accountability and Audit trail: Establish historical record of user’s or ATNA Security Measures • Accountability and Audit trail: Establish historical record of user’s or system actions over period of time, answers question: “What have you done? ” • ATNA Defines: Audit message format and transport protocol June 28 -29, 2005 11 Interoperability Strategy Workshop

ATNA Integrating Trusted Nodes • Local access control (authentication of user) • Strong authentication ATNA Integrating Trusted Nodes • Local access control (authentication of user) • Strong authentication of remote node (digital certificates) • network traffic encryption is not required, it is optional • Audit trail with: • Real-time access • Time synchronization Secured System Secure network System B System A Central Audit Trail Repository June 28 -29, 2005 13 Interoperability Strategy Workshop

ATNA Suitable Network Environments • Physically secured networks • Explicit physical security preventing access ATNA Suitable Network Environments • Physically secured networks • Explicit physical security preventing access by other nodes, or • VPN and VLAN technologies that provide equivalent network isolation. • Protected networks • Physical security that prevents modification or installation of unauthorized equipment • The network is shared with other authorized nodes within the enterprise that should not have unrestricted access to patient information. • Unprotected networks • Not generally supported, although nodes with sufficient node level security and using encryption may be safe. June 28 -29, 2005 14 Interoperability Strategy Workshop

ATNA Node Security • ATNA specifies some of the capabilities that are needed, e. ATNA Node Security • ATNA specifies some of the capabilities that are needed, e. g. access control. • ATNA does not specify policies • ATNA does not specify mechanisms, although other IHE protocols like EUA are obvious candidates. • This permits vendors and enterprises to select technologies and policies that are appropriate to their own purposes without conflicting with the ATNA profile. June 28 -29, 2005 15 Interoperability Strategy Workshop

ATNA Node Authentication • X. 509 certificates for node identity and keys • TCP/IP ATNA Node Authentication • X. 509 certificates for node identity and keys • TCP/IP Transport Layer Security Protocol (TLS) for node authentication, and optional encryption • Secure handshake protocol of both parties during Association establishment: – Identify encryption protocol – Exchange session keys • Actor must be able to configure certificate list of authorized nodes. • ATNA presently specifies mechanisms for HTTP, DICOM, and HL 7 June 28 -29, 2005 16 Interoperability Strategy Workshop

ATNA Auditing System • Designed for surveillance rather than forensic use. • Two audit ATNA Auditing System • Designed for surveillance rather than forensic use. • Two audit message formats – IHE Radiology interim format, for backward compatibility with radiology – IETF/DICOM/HL 7/ASTM format, for future growth • • DICOM Supplement 95 IETF Draft for Common Audit Message ASTM E. 214 HL 7 Audit Informative documents • Both formats are XML encoded messages, permitting extensions using XML standard extension mechanisms. June 28 -29, 2005 18 Interoperability Strategy Workshop

ATNA Record Audit Event • Reliable Syslog (RFC 3195) is the preferred transport for ATNA Record Audit Event • Reliable Syslog (RFC 3195) is the preferred transport for Audit Records, although BSD Syslog protocol (RFC 3164) is permitted for backward compatibility with Radiology Basic Security. • Audit trail events and content based on IETF, DICOM, HL 7, and ASTM standards. Also, Radiology Basic Security audit event format is allowed for backward compatibility. June 28 -29, 2005 22 Interoperability Strategy Workshop

ATNA – Radiology Option Record Audit Event • Radiology Option for ATNA defines radiology ATNA – Radiology Option Record Audit Event • Radiology Option for ATNA defines radiology specific trigger events (in two main categories) • Security Events: – For example: “The access permissions for Dr. Kildare were changed on the PACS” or “Node authentication between the CT scanner and the PACS failed” • Patient Privacy Events: – For example: “Dr. Welby looked at Mrs. Smith’s MR images and report on 6/29/05” or “Bob Jones’ Renal US study was exported to a CD on 6/30/05”. June 28 -29, 2005 23 Interoperability Strategy Workshop

What it takes to be a secure node • The entire host must be What it takes to be a secure node • The entire host must be secured, not just individual actors. • The entire host must have appropriate user access controls for identification, authentication, and authorization. • All communications that convey protected information must be authenticated and protected from interception. This means every protocol, not just the IHE transactions. • All health information activities should generate audit trails, not just the IHE actors. June 28 -29, 2005 24 Interoperability Strategy Workshop

What it takes to be a secure node • The Secure node is more What it takes to be a secure node • The Secure node is more than add-on auditing capability. The complete work effort includes: • Deciding what events should be auditable • Instrumenting all applications to detect auditable events and generate audit messages. • Ensuring that all communications connections are protected. • Establishing a local security mechanism to protect all local resources. • Establishing configuration mechanisms for: – Time synchronization using Consistent Time (CT) profile – Certificate management – Network configuration June 28 -29, 2005 25 Interoperability Strategy Workshop

More information…. • IHE Web sites: www. ihe. net • Technical Frameworks, Supplements • More information…. • IHE Web sites: www. ihe. net • Technical Frameworks, Supplements • ITI V 1. 0, RAD V 6. 0, LAB V 1. 0 • 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 June 28 -29, 2005 28 Interoperability Strategy Workshop