Document Digital Signature (DSG)

1. Document Digital Signature (DSG) Gila Pyke / Lori Reed-Fourquet Smart Systems for Health Agency / Identrus IHE ITI Technical Comittee

2. W W W . I H E . N E T Providers and Vendors Working Together to Deliver Interoperable Health Information Systems In the Enterprise and Across Care Settings Interoperability Strategy Workshop

3. IT Infrastructure Profiles 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) • Document Digital Signature (DSG) • Use of digital signatures to provide document integrity, non-repudiation and accountability. Interoperability Strategy Workshop

4. Document Digital SignatureValue Proposition • Leverages XDS Document infrastructure • Providing accountability • Providing document integrity • Providing non-repudiation • Providing satisfactory evidence of: Authorship, Approval, Review, and Authentication • Infrastructural pattern to be further profiled by domain specific groups (e-Prescribing, e-Referral) Interoperability Strategy Workshop

5. Document Digital SignatureAbstract/scope • Provide signature mechanism • Provide verification/validation mechanism • Provide signature attributes • Integration with XDS • Digital signing of documents in XDS • Access to documents in XDS independent of signatures Interoperability Strategy Workshop

6. Document Digital SignatureOut of scope • Certificate management and PKI concepts • Standards and implementations are available and will be discussed later • Focus begins with signing, not encryption • Partial Document Signature Interoperability Strategy Workshop

7. Document Digital SignatureGoals • New Digital Signature Document format in XDS • Leverages XDS for signature by reference • Profile use of single / multiple signatures • Profile use of nested signatures • Provide signature integrity across intermediary processing • E-prescribing • Interface Engine Interoperability Strategy Workshop

8. Document Digital SignatureUse Cases • Attesting a document as true copy • Each subsequent use of the original signed digital document or a digital copy of the document can inspected signatures to assert that the documents are true copies of information attestable to the signer at the time of the signature ceremony • Attesting content • When a clinician submits a clinical document to the XDS repository, the clinician using a digital certificate digitally signs the document • Attesting to whole submission set • Translation / Transformation Interoperability Strategy Workshop

9. Document Digital SignatureUse Cases: True Copy Use Case 1: Attesting a document as true copy • Verify that the document in use by all parties is the same as the original document and has not been modified. • Verify “document integrity”. Interoperability Strategy Workshop

10. Document Digital SignatureUse Cases: True Copy • Non-XDS example: • A physician needs to forward results obtained from a third party to another clinician. There is a need to ensure that all parties are working from the same “true copy” • XDS example: • Medical records staff who submit documents to XDS need to verify and attest their submission. Interoperability Strategy Workshop

11. Document Digital SignatureUse Cases: Attesting to Content Use Case 2: Attesting clinical information content • Attest that a report is complete and correct • Ability to verify that physician has verified and attested to report Interoperability Strategy Workshop

12. Document Digital SignatureUse Cases: Attesting to Content • Non-XDS example: • A clinician needs to rely on the contents of a report created by another clinician; diagnosis, prescription content, etc • Also, this signature can not be repudiated. • XDS example: • When a clinician submits content to XDS he/she signs it to take clinical responsibility for the content Interoperability Strategy Workshop

13. Document Digital SignatureUse Cases: Submission set Use Case 3: Attesting to a whole submission set A digitally signed manifest can indicate both: • That a set of documents is authorized for release by signing clinician • That the set is indeed the complete set of documents and their associated signatures • Manifest signature does NOT verify content or correctness. Interoperability Strategy Workshop

14. Document Digital SignatureUse Cases: Submission Set The recipient organizations can use this digital signature to: • identify the person who selected and authorized the release, • obtain the complete list of documents released, • verify that the released documents have not changed, and • identify the associated XDS submission set. Interoperability Strategy Workshop

15. Document Digital SignatureUse Cases: Submission Set • Non-XDS example: • Attesting to the completeness of a monthly submission of all TB patient records for statistical analysis • Attesting to the completeness of health records in a patient transfer • XDS example: • Use XDS to send a collection of documents relating to a patient referral. Attest that submission includes complete set of relevent documents. Interoperability Strategy Workshop

16. Document Digital SignatureUse Cases: Translation Use Case 4: Translation Introduction of an additional signature to validate : • The original document • The original signature • The translated document • Used to verify that the translator had the original/true document, that the original document was signed, and that the translation has attested to the validity of the translation. Interoperability Strategy Workshop

17. Document Digital SignatureUse Cases: Translation • Non-XDS example: • e-prescribing : Value added networks that translate the format of a prescription before forwarding it to a pharmacy • XDS example: • Reference original document and original signature by using association-type to link them in XDS with translated version Interoperability Strategy Workshop

18. Document Digital SignatureKey Technical Properties • W3C XML Signature structure • credentials, timestamp, and other signature attributes such as signature purpose • Reference to document stored in XDS • ISO TS17090 compliant digital certificates • Provide for multiple signers Interoperability Strategy Workshop

19. Document Digital SignatureSignature Attributes • Expand signature to include additional data relevant to the healthcare signature • Includes the date and time the signature was calculated and applied • The identity of the signer • Signature Purpose Interoperability Strategy Workshop

20. Document Digital SignatureSignature Purpose From ASTM E1762 * • “Author” - Author’s signature, • “Author.Co” - Coauthor’s signature • “Participant” - Co-participant’s signature • “Transcriptionist/Recorder” • “Verification” - Verification signature • “Validation” - Validation signature • “Consent” - Consent signature • “Witness” - Witness signature • “Witness.Event” - Event witness signature • “Witness.Identity” - Identity witness signature such as a Notary • “Witness.Consent” - Consent witness signature • “Interpreter” • “Review” - Review signature • “Source” - Source signature • “Addendum” - Addendum signature • Administrative • Timestamp Interoperability Strategy Workshop

21. Document Digital SignatureAdditions to ASTM1762 The following items will be added to ASTM1762 • Modification • Authorization • Transformation • Recipient Modification is being worked on. Interoperability Strategy Workshop

22. Document Digital SignatureStandards Used W3C XML Signature ISO 17090, 21091 ASTM E2212, E1985, E1762, E1084 IETF x509 DICOM supplement 41, 86 NCPDP HL7 CDA Interoperability Strategy Workshop

23. More information…. • IHE Web sites: www.ihe.net • Technical Frameworks, Supplements • Fill in relevant supplements and frameworks • 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 Interoperability Strategy Workshop